Ward 54

Not too long ago I casually commented that the military seems to have gotten a much better at recognizing and treating PTSD. Apparently I spoke too soon. Good Lord, after the suffering of the Vietnam vets I thought there was no way that mental health treatment would slip through the cracks again. In fact, I was sort of worried that the treatment might be too aggressive. Not the case.

On Feb. 18th Salon ran a story called "Behind the Walls of Ward 54" which read in part:

"Perhaps most troubling, the Army seems bent on denying that the stress of war has caused the soldiers' mental trauma in the first place. (There is an economic reason for doing so: Mental problems from combat stress can require the Army to pay disability for years.) Soto-Ramirez's medical records reveal the economical mindset of an Army doctor who evaluated him. "Adequate care and treatment may prevent a claim against the government for PTSD," wrote a psychologist in Puerto Rico before sending him to Walter Reed."

There it is ... there is the root of the problem. Once again psychiatrists are in a role other than the one that they are meant to play. They are not there to save the Pentagon some cash and they are not there to protect the government from claims. They must be allowed to do what they are meant to do - to treat people who are having psychological problems to the very best of their ability.

In her blog "The Broad View" Ellen Dana Nagler writes:

"For some time now I've been collecting information on post-traumatic stress disorder and suicide in the armed forces, going all the way back to World War II. As my dossier grows, so does the evidence that today the Army is seriously short-changing its Iraq warriors by denying them the dignity of their service-related psychological disorders — which translates to denying them adequate treatment and denying them disability pay."

This travesty cannot be allowed to continue. Right now these people are soldiers - in a year or two they won't have that status anymore - they just be "crazies", perhaps homeless, and possibly end up in a jail cell where their illnesses will get much worse. Mentally ill people are so reviled in our society that they make the homosexual community look warmly accepted. If we are going to help these soldiers it has to happen now, before they are tossed aside.

Lobotomy in Scandinavian Psychiatry

I found this interesting article online:

Lobotomy in Scandinavian psychiatry 1
Joar Tranøy

Institute for Criminology, University of Oslo

This article surveys the development of the use of lobotomy in Scandinavian psychiatry. Scandinavian mental hospitals lobotomized 2.5 times as many people per capita as mental hospitals in the United States. The use of lobotomy in Scandinavia is chiefly illustrated by patient records from the leading institution in the performance of lobotomies in Scandinavia, Gaustad Mental Hospital, Oslo, Norway. Overcrowding and understaffing at mental hospitals cannot explain the extensive use of lobotomy in Scandinavia since the frequency of lobotomy operations did not correlate with overcrowding and understaffing. Neither can an alleged ignorance of damaging effects be used as a justification since these damaging effects were discussed very early in the development of the surgery. Rather lobotomy seems to have been primarily a way of controlling troublesome patients. The patient's external behavior in its bearing on nursing problems was decisive for the use of lobotomy. The patient's own suffering did not seem to be a significant factor.

Introduction

From the early 1930's until the 1950's Scandinavian psychiatry, like psychiatry elsewhere in the western world, evolved from being the most "isolated" of medical specialties to being a respected branch of modern medicine (Pressman, 1986, p. 1). This development was caused by the breakthrough of somatic treatment methods such as insulincoma, cardiazolcoma, electroshock and lobotomy. Troublesome wards in insane asylums became calmer, and lengths of hospitalizations were reduced. Psychiatrists gained more prestige, and their growing public status and increased representation in medical literature led to greater influence within the field of medicine. Lobotomy, a type of surgery used in the treatment of mental illness, was an important factor in this development.

During this period western psychiatry also suffered from a general crisis characterized by hospital overcrowding and the shortage of ward staff (Valenstein, 1986, pp. 174-177). It is informative to view the development of lobotomy in Scandinavian psychiatry in relationship to the growing prestige of psychiatrists and the hospital conditions of the day. This relationship is illustrated in this article chiefly by events occurring at the leading institution in the performance of lobotomies in Scandinavia, Gaustad Mental Hospital, Oslo, Norway.

Historical Background

The introduction of lobotomy in Scandinavian was hardly easy. The Swedish psychiatrist Gøsta Rylander was one of the men on the Nobel Institute committee who advocated that the Nobel Prize in Medicine should go to Egas Moniz (Valenstein, 1986, p. 225). In 1939 Rylander proposed that lobotomies should be attempted in Sweden:

Once as a young assistant at the Psychiatric University Clinic of Stockholm I gave an account of the just published monograph by Moniz, "Tentatives Operatoires dans le Yraitement de Certain Psychoses", pointing out that anxiety was reduced in these cases. My chief, Professor Wigert, was horrified and forbade every experiment of that type with human beings. Then I approached Olivercrona, the neurosurgeon. He said that psychiatrists damaged the brain by electroshock treatment and that there was no reason to destroy part of it in such a doubtful way as Moniz had done (Laitinen and Livingstone, 1973, p.3).
It was Freeman's 1942 book, Psychosurgery, which was decisive for the beginning of lobotomy in Sweden. Rylander has stated that without Freeman's influence it is doubtful that lobotomy would have been used in Sweden (Laitinen and Livingstone, 1973, p. 1).
The famous Danish psychiatrist, Erik Strømgren, noted that lobotomy encountered initial resistance in Denmark also:

In August 1939 there was an international congress of neurology in Copenhagen. One of the lecturers was Walter Freeman. He reported on a great number of lobotomies. All Scandinavian psychiatrists who listened to Freeman shook their heads, deeply shocked: 'Never in our lives.' But the situation changed rapidly. We heard of good results on schizophrenics. Five years later most of us felt an obligation to offer this operation to the worst of the schizophrenics. In the meantime many good results from this operation had been reliably reported in the United States and England. We could no longer resist this operation. It would have been unethical (Strømgren, 1991).

The example of the United States was decisive for the development of lobotomy in Scandinavia. This can be illustrated by Gaustad Mental Hospital in Oslo, Norway, which was the first institution in Scandinavia to perform lobotomies. The development of lobotomy in Norway was led by this institution and its leader, Ørnulv Ødegård. Ødegård had many contacts in the United States, where he had studied psychiatry before the Second World War. He had been a student of Adolf Meyer, one of the most influential psychiatrists in the United States. Ødegård had learned a pragmatic attitude on methodology from Meyer (Astrup, 1977, p. 7). Ødegård's assistant, Carl W. Sem-Jacobsen, traveled to the United States to complete his study of psychosurgery and later returned to Norway to establish a psychosurgery project at Gaustad Mental hospital in the mid 50's.
Gaustad Mental Hospital was the last Norwegian institution to give up the practice of psychosurgery. It is also interesting to note that Gaustad had been a center for psychosurgery research from the middle of the 1950's with financial support from the Ford foundation and the United States Defense Department.4


There is much, much more ...

Pregnant Women Risk Murder in U.S., Report Finds

Okay, I have some thoughts coming together.

First I have been thinking about the relationship between psychosurgery and pregnancy. I speak to many families of psychosurgery victims and a pregnancy or childbirth often seems to fit into the story.

Second, I have been thinking about the word 'hysterectomy'. An appendectomy is the removal of the appendix. A lumpectomy is the removal of a lump. What is a hysterectomy? The removal of ... hysteria. Somehow the womb is related to hysteria.

Now there is this story which asserts, "Murder is a surprisingly common cause of death among pregnant women in the United States, U.S. government researchers reported on Wednesday.
...
"Homicide is a leading cause of pregnancy-associated injury deaths," Jeani Chang and colleagues wrote in the latest issue of the American Journal of Public Health.
...
Most of the murdered women, 56 percent, were shot to death while the rest were either stabbed or strangled."

Wow. Now the part that doesn't quite fit into place is that far more pregnant black women are murdered than white women, while far more white women were lobotomized than black women.

There is something important here. It's related to the reality of post-partum depression and psychosis, and it's also related to misogyny. I can't quite put my finger on it ...

Fat police lock up Chris

No, not me ... a British fella named Chris Leppard. I understand he was featured in a BBC1 documentary recently. Wish I'd seen it.
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Fat police lock up Chris

SOBBING 31-stone Chris Leppard was dragged off to a mental hospital against his will by meddling social workers and police.

Chris, 23, has been forcibly detained for a month because he cannot stop eating.

The authorities used powers normally used to detain mentally ill people who might harm themselves or others.

They locked him up despite the fact neither he nor his family wanted him to go. Last night Chris’s furious mother Anne said he has no mental problems and was winning his fight against the rare illness that compels him to eat.

Read the Story

Bush Budget Proposes Halt in Housing Aid for Disabled

From the New York Times (reg required to access full article)

With little fanfare, the Bush administration is proposing to stop financing the construction of new housing for the mentally ill and physically handicapped as part of a 50 percent cut in its housing budget for people with disabilities.

The proposal, which has been overshadowed by the administration's plans to shrink its community development programs, affects what is known as the Section 811 program. Since 1998, Section 811 has helped nonprofit developers produce more than 11,000 units of housing for low-income people with disabilities, including more than 700 in New York State.

But the proposal appears to comport with the administration's broader determination to trim domestic programs in the face of record deficits.

This time, the federal government would discontinue financing housing for people with spinal cord injuries or psychiatric illnesses who are not necessarily homeless but may live in nursing homes or psychiatric hospitals.

By relying exclusively on vouchers, the federal government would essentially be lumping these people with able-bodied Section 8 recipients in competing for some of the same apartments.

"What you have for disabled folks is you're getting a double whammy," said Jonathan Harwitz, director of public policy for the Corporation for Supportive Housing, which promotes housing for people with special needs. "You're looking at both the landlord making a decision, 'Do I even want to rely on Section 8?' and secondly, saying, 'Do I want a disabled person in here?' Because that's an additional issue."
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PREDICTION: You think the "homeslessness" problem is bad now? You think the prisons are crowded now? Just wait five years. Don't forget that in October 2003 Human Rights Watch already criticized the United States for putting the mentally ill in prisons:

One in six U.S. prisoners is mentally ill. Many of them suffer from serious illnesses such as schizophrenia, bipolar disorder, and major depression. There are three times as many men and women with mental illness in U.S. prisons as in mental health hospitals.

The rate of mental illness in the prison population is three times higher than in the general population. “Prisons have become the nation’s primary mental health facilities,” said Jamie Fellner, director of Human Rights Watch’s U.S. Program and a co-author of the report. “But for those with serious illnesses, prison can be the worst place to be.”

That dangrous, blurry line between criminality and illness, between punishment and treatment, between a civilized society and one in which every man is for himself, blurs just a bit more.

Frank J. Ayd Jr., M.D.

Below is a clip from an article in the January 2005 Psychiatric Times about a person who was instrumental in turning psychiatry in the biological direction. If anyone knows how I can get hold of this episode of the old show "Medical Horizons", I would be very grateful. I want to know if there are lobomized children in it.
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In the early years of biological psychiatry, Ayd said many pioneers were ridiculed and denigrated by colleagues faithful to psychodynamic concepts on the etiology of psychiatric disorders.

It was a challenge to convince them "that we weren't crazy, and I really mean that" he said. He tells the story of how in the mid-1950s, he was contacted by a producer-director of the television series Medical Horizons, which was telecast on ABC. The series focused on medical dramatizations and stories on specific diseases and treatments for patients. Ayd was asked to help put together a show on psychiatry. He arranged for several health care professionals and some patients to talk about lobotomies, psychotherapies, pharmacological advances and electroshock. The show was live, and the crew had to run wires up two blocks from Ayd's office to the local television station in order to transmit the show.

"We talked about the use of medications, such as the early antipsychotics, Thorazine and perphenazine [Trilafon]. We had a patient who had had a lobotomy and a nice recovery. She was interviewed. There were children interviewed. An elderly woman had had ECT, and she and her family talked about what a help ECT had been," he recalled.

As part of the show, Ayd demonstrated ECT.

"I gave this woman a muscle relaxant medication, and they [the television crew] photographed her as she was given ECT. All that showed was some tremor in her hands," Ayd said. Afterward, many people accused Ayd of faking the ECT treatment, since the woman did not exhibit violent convulsions, common with ECT during that time period.

The show's producer-director arranged to have a reception at a downtown hotel and invited a couple hundred people, including members of the Maryland Psychiatric Society and the Maryland Medical Association, according to Ayd.

"No more than five people showed [for the reception], and they were all analysts," said Ayd, acknowledging that many of the psychiatric leaders in Maryland had boycotted him.

Although psychopharmacology in recent years has come to the foreground, Ayd does not agree with throwing psychoanalysis and psychotherapy out the window. "You are treating a human being, and you have to take into consideration the requirements of that human being."

The New FDA Monitoring Board

Hey hey, some people are complaining about the limited scope of the new FDA monitoring board, but I'm delighted that they have done anything at all. It's not perfect, they can't stop unsafe drugs from reaching the shelves, but they will go after drugs that are already on the market. It's a start, and you've got to start somewhere.
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Safety board to check FDA-approved drugs

After a string of miscues, the FDA announced that a new federal board will follow up with safety checks of prescription drugs after they receive government approval.
By TONY PUGH

WASHINGTON - In a move designed to quiet criticism of its regulation, the Food and Drug Administration said Tuesday that it plans to establish an independent board to monitor the safety of prescription drugs now being sold to consumers.

The FDA also plans to launch a new Drug Watch Web page on which it will post and update data about the safety, risks and possible side effects of drugs that might be dangerous for patients. In addition, the agency wants to provide information sheets that inform healthcare providers and patients of all the drugs listed on the new Web page.

Health and Human Services Secretary Michael Leavitt described the moves as a new FDA effort toward transparency in regulating the prescription-drug industry.

The FDA has been battered recently for a string of miscues that raised questions about the agency's effectiveness in keeping Americans safe from the dangers of modern pharmaceuticals. It delayed issuing strong warning labels on antidepressants even though studies indicated they caused suicidal tendencies in children and teenagers. It also approved popular arthritis pain relievers Vioxx and Celebrex, even though studies linked both to heart attacks and strokes.

Beginning today, the agency will hold three days of hearings on the class of pain relievers known as Cox-2 inhibitors, which includes Celebrex and Bextra, to decide whether to keep them on the market.

Read the whole story

Mental Health Treatment in Bangladesh

Shoeb Faruquee, Drik Picture Library photographer based in Bangladesh, has won second prize in the Contempory issues Singles catagory at the World Press Photo 2004 contest announced February 11, 2005, with this picture of a patient at mental hospital, Bangladesh. The prestigious competition is the world's largest annual press photography contest.

Foods Like Fish May Buoy Your Mental Health

Foods Like Fish May Buoy Your Mental Health

By Ed Edelson
HealthDay Reporter

THURSDAY, Feb. 10 (HealthDay News) -- In research that literally offers food for thought, scientists have found that omega-3 fatty acids and uridine -- a natural substance found in foods -- work as well as antidepressants in preventing signs of depression.

The rat experiments used a well-established animal model of depression, according to the researchers from Harvard-affiliated McLean Hospital in Belmont, Mass.

The rats were placed in a tank of water, where they had no choice but to swim. After a while, the rats realized swimming was futile, so they simply began to float, a sign of surrender to depression. Given an antidepressant drug, however, they started swimming again, the researchers said.

But combined doses of omega-3 fatty acids and uridine were as effective as three different antidepressants in prompting the rats to start swimming again, said study author William Carlezon, director of McLean's Behavioral Genetics Laboratory.

<>Read the Whole Story

Norway Changes her Mind

Insane Must Pay

Norway's Supreme Court has ruled that even those judged as insane when committing a crime must be held financially accountable for their acts, reversing common legal practice.

Up until now insanity has acted as a protection against compensation claims for non-economic damages to victims of violence or their survivors, newspaper VG reports.

On Tuesday the Supreme Court overturned an appeals court decision and ordered a 36-year-old to pay NOK 50,000 (USD 7,600) in compensation despite being assessed as insane at the time of the crime.

"A dramatic change. The Supreme Court is now saying that consideration of the victim is more important than madness," said attorney Christian Lundin, who represented victim Roy Atle Kirkeby.

Read the whole story

Utne Reader links to us

Hey, check it out ...

http://www.utne.com/webwatch/2005_184/news/11543-1.html

Are you ready for your implant?

US OKs Cyberonics depression implant-shares soar
So it begins. Many people don't realize that Americans can be court ordered to submit to ECT treatments and/or to take powerful psychiatric medications. In other words, the government uses force to compel certain people to submit to treatment. This implant that has everyone so excited is one more step on this slippery slope ...

Don't forget that the government plans nationwide mental health screening. Can you see where these two things together could lead? People could be forced to undergo screening and then forced to get an implant of time-release medication.

I have little doubt that Big Pharma is quite pleased ...

I love this story

This guy knows you can be diagnosed as crazy even if you aren't:

Doctor Fakes Insanity to Avoid Military

OSLO, Norway - A Norwegian doctor called in for military service would have made Cpl. Klinger of the American television series "MASH" proud.

The doctor rubbed sour cream in his hair, poured sticky liqueur in his shoes, spilled beer on his clothes and sat in a closet smoking 40 cigarettes at once in a bid to convince the military that he wasn't fit mentally for service.

And just to be sure he looked and felt his worst, he stayed awake for two days before his physical, the Fredrikstad Blad newspaper reported Thursday.

As part of Norway's compulsory military service, veterans — such as the doctor — can be called back for refresher training or longer service.

"I used a made-up life story about how things had gone downhill from being a student in medical school to be being down and out," the doctor told the newspaper on condition his name not be published.

It worked, too. He was so convincing that the military doctor alerted the national health authority about the man they had licensed to work as physician.

read the rest

Family Care

In an earlier post I looked at an article out of India that showed a different perspective on mental illness. In it, the newspaper emphasized family support as a key to recovery. It all sounds very nice until something like this happens:
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Brothers' tragic end
Cops believe older of 2 siblings killed mentally disabled brother, then himself, as both feared other dying first

BY SAMUEL BRUCHEY AND ZACHARY R. DOWDY
STAFF WRITERS

February 2, 2005

In the past few years since their mother died, Roland Nielsen began caring for his mentally disabled younger brother, John, in the Levittown home where the two men had grown up nearly half a century ago.

But the responsibility of providing for the younger brother, who was unable to work, was a growing burden, especially as both men's health began to decline, police and neighbors said last night.

The result, they said, was tragic.

Yesterday afternoon, after more than a week of failing to reach John Nielsen, 54, by telephone, a mental health counselor contacted Nassau police. At 12:30 p.m., uniformed officers forced their way into the white colonial house on Sprucewood Drive and found both brothers dead from gunshot wounds.

"It appears to be a homicide-suicide," Nassau Homicide Det. Sgt. Richard Laurson said, adding that detectives believe the older brother committed the shootings.
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This case is troubling to me because I actually live mere blocks away from where this happened. I wouldn't have known about it if I hadn't seen it in the paper. What does it say when exactly the kind of people I want to help come to this kind of end in such close proximity to me?

I want to excuse myself by pointing out that there are over 50,000 residents of Levittown and I cannot know the stories of them all, but I'm not sure that's quite right. "Am I my brother's keeper?" In my opinion, we all should be, at least when they really need us ...

This terrible story reminds me of Motty whose daughter had had psychosurgery for serious OCD. What struck me most about Motty's story was her deep concern over who would care for her daughter after she had gone. She wondered who else could deal with her daughter's troubles and love her with all their heart? Would an end like the above be best for them too?

The options for these people seem to be so few and the burdens so heavy. My grandfather also wandered around, looking for help, and finding anything but ...

A mental health counselor was the one who called police. At least there was someone on the fringe of their lives who cared. It's still a shame.

They Put Children in Cages in California

If we were having lunch and I told you that the State of California drugs mentally ill children and locks them in cages, you would probably think I was exaggerating. Sadly, not only is it true, but it's probably happening at right this very moment. At least they are committed to change, even if it is going to happen "gradually".
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Deal OK'd for Calif. Youth Prison System

By DON THOMPSON, Associated Press Writer
SACRAMENTO, Calif. - In a drastic change, Gov. Arnold Schwarzenegger administration has committed California to reforming the way it treats youthful offenders, promising to replace more punitive measures with therapy and positive reinforcement.

The agreement was announced Monday to settle a lawsuit. Only last year, the juvenile system was criticized by national experts as draconian. Among the methods they cited was the use of cages and drugs to subdue mentally ill or substance addicted youths.
Under a timetable set for the agreement, reforms will be implemented gradually. The body that oversees the system, the California Youth Authority, set a fall deadline for having a plan to shift the approach to one similar to those being used successfully by other states.
By Nov. 30, the authority will lay out a plan to provide rehabilitation, keep youths as close to their homes as possible, include their families when possible, minimize when youths are locked in their cells for 23 hours a day, and "emphasize positive reinforcement rather than punitive disciplinary measures."

The Bear of Controversy

Here it is, the bear of controversy:



Ah, the hatred of "political correctness". It's all the fashion these days. It's funny though ... while many people bemoan political correctness, few people can define it if you ask them to. Here is the definition:

politically correct
adj. (Abbr. PC)

Of, relating to, or supporting broad social, political, and educational change, especially to redress historical injustices in matters such as race, class, gender, and sexual orientation.

Wow, I can see why people would hate ... um ... being concerned about historical injustices and whatnot. How being concerned about the plight of others became a crime is beyond me. I guess it's an example of how well those who pretend to be compassionate have played the game of semantics.

Yes, the bear is tasteless and if the Vermont Bear Company had any decency they would discontinue it immediately.

What to do with Kings Park

Kings Park and Pilgrim State Psychiatric Hospitals were once gigantic facilities of amazing proportions. At its prime Pilgrim alone held about 19,000 patient-inmates. Both now sit on huge parcels of land on Long Island within reasonable distance of New York City. Many developers have eyes these massive parcels, but no one has been brave enough to actually develop them. This Newsday article discusses the latest attempt to do so:

Kings Park Try No. 3: Will this developer make it work?

Now that a third developer has agreed to try to turn the former Kings Park Psychiatric Center into something more economically beneficial than crumbling old buildings, a word of caution is in order: This developer could very well make the same decision as the previous two - that the economics of the project are way too scary to proceed. If that happens, it will be time for the state and the Town of Smithtown to step back and rethink the whole process.

In order to build anything desirable on this site, a developer would have to invest tens of millions of dollars to clean up the deteriorating buildings above ground and the bones of past buildings below. Then, to recover that investment, the builder would have to persuade Smithtown to allow much greater density than current zoning allows. It would be easier to sip oatmeal through a straw.