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Rally, the Excellence blog, gives voice to issues, ideas and news in mental health recovery

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December 18, 2014 by Bob Nikkel, MSW

Assessing the Cost of Psychiatric Drugs to the Elderly and Disabled Citizens of the United States

BobNikkel_lgProPublica is well known for creating interesting data bases that allow anyone hooked up to a computer to see by name whether a physician is accepting Big Pharma payments–from dinners to speaking engagements to consulting services. What may be lesser known is that occasionally ProPublica will publish other data that when carefully mined can reveal even more about the use of psychiatric drugs, especially when there is a public funding source available.

This past week, we got more than a glimpse into the costs of psychiatric drugs by mining ProPublica’s listing of Medicare Part D prescriptions. Part D is the federal program that Social Security uses to pay pharmacies for all types of medications, psychiatric and non-psychiatric. Their tables list all drugs and their costs for the most recent year available, 2012. If one separates out the data, it looks like this:

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December 18, 2014 by Lauren Spiro

Healing From Intergenerational Trauma: Facing the Unfaceable

Lauren_Spiro

I spent 15 years slowly preparing for a trip into the unfaceable. One of the most important processes that supported me on this journey was observing and being witness to a U.S. human rights advocate and coalition builder (who has German gentile heritage) do gut-wrenching emotional healing work particularly against anti-Semitism and white racism. She inspired me with her intelligence, tenacity and determination to be free from the damaging effects of these forms of oppression. Some members of her family supported the Nazis.

Two years ago, I told her I was ready to join her in going to Poland and the eight day Healing from War workshop.

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December 12, 2014 by Lauren Spiro

An Unplanned Path to Discovering My Truth

Lauren_SpiroWhat began as a story of self-discovery, spiritual awakening, and healing written only for family and friends evolved into a memoir reflecting my path towards liberation that other people might find useful on their journey of awakening to the person they were born to be.

A power greater than myself became a wind under my wings moving the creation of this memoir forward. The story was enhanced by the process of creative expression that deepened the intimate look at my experience of loss and grieving that were intertwined with my liberation journey. Finally, after ten years’ gestation, it gave birth to a memoir, Living for Two: A Daughter’s Journey from Grief and Madness to Forgiveness and Peace.

 

At first I thought the purpose of the book was to let people know that even though my father died when I was 14 years old, his life and his death continue to have a significant impact on me. My father was murdered by a teenager with a handgun in an act of street violence. In some ways, my life ended with his death. I needed to recreate myself, to find meaning in an unsafe and irrational world. This led to my being put in a mental institution at the age of 16 and labeled with chronic schizophrenia.

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December 3, 2014 by Bob Nikkel, MSW

Announcing the Mad in America Continuing Education Project

Bob-NikkelThe Mad in America Continuing Education Project is preparing for takeoff after months of planning by a 5-person Board of Directors led by Bob Whitaker. This project is organized as a fund within the Foundation for Excellence in Mental Health Care, a 501c3 non-profit organization. I have the honor and challenge of serving as the executive director of Mad in America Continuing Education.

Our purpose is to provide online courses presented by internationally-recognized leaders on unbiased research regarding the short- and long-term effects of psychiatric medications, as well as alternative approaches to an over-reliance on pharmaceutical interventions.  These courses will be available online for ease of access and will qualify for Continuing Medical Education credits (CMEs) and Continuing Education Units (CEUs).  The project will provide classes on the full range of psychiatric medications — the ways in which they affect the neurology, physiology and outcomes for people taking them.  The overarching goal is to change the standard of practice so that it becomes consistent with well-designed research.

One key practice (among many others) that we anticipate will be impacted by the courses is the informed consent process that all programs must use when prescribing psychiatric medications.  In a 2000 article in the Journal of Humanistic Psychology, David Cohen and David Jacobs pointed out that there is a notorious lack of truly informed consent in North American programs.  They propose a model consent form four pages long (!) which includes many — but not even all — of the elements that I believe research since then would support.

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December 3, 2014 by Gina Nikkel, PhD

Highlights of EXCELLENCE’s 4th Annual Board Retreat

Gina-NikkelThe Foundation for Excellence in Mental Health Care just completed its fourth annual board retreat in North Carolina–with views of the Blue Ridge Mountains just out the window and views of the Foundation’s future just as intriguing.

Time together as a board is always stimulating and energizing.  This year was exceptional in that way with reports on initiatives that are clearly bearing more and more fruit for changing the standard of care from medical maintenance to vibrant recovery.  Five presentations constituted highlights for me as President and CEO and for every board member present.

The first of these reports was Dr. Chris Gordon’s on the Collaborative Pathway early psychosis project, which is entering its third year in Framingham, Massachusetts.  Chris’s honesty in sharing his views of the process of adapting the Finnish Open Dialogue model to a working-class  New England community was matched by his excitement about the results for young people and their families–young people who are returning to school, getting into the job market and reducing and in some instances eliminating the use of psychiatric medications.  Several board members told me it was one of the best program presentations they had ever heard.

Dr. Doug Ziedonis, Chair of the Department of Psychiatry at the University of Massachusetts Medical School, complemented Chris’s report with

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December 2, 2014 by Sandra Steingard, MD

Tapering Neuroleptics: Three Year Outcomes

Sandra-SteingardThis week we launch Mad In America Continuing Education. It is an enormous privilege to be a part of this project and to proudly announce that the first course offering is a series of lectures by me on neuroleptic drugs. I review the history of the development of these drugs as well as their short and long term effects. I discuss what conclusions I have drawn from the data; I recommend that we need to work harder to keep people off these drugs or – if we use them – to minimize the dose and stop them as soon as possible.

But there remain other pressing concerns for those individuals who are currently taking these drugs. There is almost no guidance on how to implement what should not be a controversial statement – it is better to be on as small a dose as possible. We are caught between competing models of practice and vast territories of the unknown. If someone is started on a dose of medication in a hospital over the course of a short stay, we do not know if that dose is the minimally effective dose.

There seems to be no escaping the conclusion that – at least over the first two years – the relapse rate will be higher when the drugs are stopped. Our current system of care prioritizes preventing relapse over other concerns – metabolic syndrome, tardive dyskinesia, brain atrophy, impaired functional outcomes. Since these drugs have been with us for 60 years and for at least 30 years it has been axiomatic that everyone should be advised to remain on the drugs indefinitely, there are many people who have been taking them for many years. If one begins to question current treatment guidelines, it is unclear how one can safely reverse course or even if it makes sense do this.

I came to the conclusion that the principle of informed consent obligated me to share these questions – proactively, not just when individuals were complaining – with the people I see. As I have done this, I invited people to try – slowly – to reduce their doses and I have been tracking my experience as some people choose to taper their dose and others choose to leave things alone.

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November 14, 2014 by Kathy Brous

How to Use attachmentdisorderhealing.com

OLYMPUS DIGITAL CAMERAFor new readers signing up, bless you for your patience. I’m new to Attachment Disorder Healing, too — and it’s my website.  A note on “How to Use” AttachmentDisorder Healing.com is overdue.

I fell into all this entirely by accident, when attachment disorder hit me upside the head.  Just as the latest brain science on how it works and how to heal was flooding in.  So I’ve been going a bit ape (above), multiplying content here like rabbits — faster than I’ve been able to index it so you can find what you need. 

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November 7, 2014 by Kathy Brous

The Body Keeps the Score, Bessel van der Kolk, MD

Bessel Book bodykeepsscoreI can’t read much due to three recent surgeries, so I won’t wait to finish this book just out– I’ll urge you now to buy it.  “The Body Keeps the Score” will “permanently change how psychologists and psychiatrists think about trauma and recovery,”as trauma scholar Dr. Ruth Lanius writes.  She was the first to call developmental trauma a “hidden epidemic,” source of my book’s subtitle “Silent Epidemic.” Dr. van der Kolk repeats this in his new book.1

And it is about the body. “Infants are psychobiological beings, as much of the body as of the brain,” writes Prof. Ed Tronick, author of the Still Face Experiment. “Without language or symbols, infants use every one of their biological systems to make meaning of their self in relation to the world.  Van der Kolk shows that those same systems continue to operate at every age, and that traumatic experiences, especially chronic toxic experience during early development, produce psychic devastation.”

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October 24, 2014 by Kathy Brous

Dr. Ruth’s Ultimate Trauma Solution

Ruth Bz blog pic… Dr. Ruth Buczynski, that is (so, relax…that’s her at left).  A peek inside the minds of cutting-edge psychotherapists on how to really heal trauma is in her latest blog “Rethinking Trauma: The Third Wave.”

She says the latest “Aha” is that “talk therapy” can’t always cut it — we need body work and other alternative “somatic” therapies such as Dr. Bessel van der KolkDr. Peter Levine, Dr. Dan Siegel, Dr. Stephen Porges, and Dr. Bruce Perry are delivering, as I’ve written for months.

Ruth is starting a new series October 15 by interviewing Steve Porges live, and yes, there is a fee to subscribe if you’d like transcripts and recordings to keep.  And yes, there’s also a free version of the series (detailed links at bottom).

And no, I’m not getting a cent for posting this. No one asked me to; I just wanted to “pay it forward.”

Why? Hey, that story I always tell of how I clicked the wrong link in a friend’s email and ended up on a brain science website that saved my life?  That was Dr. Buczynski’s March 2011 webinar, “The New Brain Science Series – Barrier-Breaking Interviews with the Experts.”1

And she, and they, did save my life, and I do hope you check this out.

Here’s a clip of Dr. Porges’ interview airing October 15: http://www.nicabm.com/nicabmblog/reframing-a-patients-response-to-trauma-so-they-can-heal/

Dr. Porges even brings in Bach, Beethoven and music in general as the most powerful healing there is — after live in-person human support, of course.

Ruth adds:  “What trauma therapy owes to Beethoven and Bach…  According to Stephen Porges, PhD, classical composers knew something hundreds of years ago that could be so helpful in trauma therapy . . .  in today’s webinar, he outlines how playing and listening to music, and even the design of the rooms where we deliver services, can shift the physiology of our patients. Stephen also goes into how to work with neuroception, the “personal risk detector” in the nervous system, as well as powerful, concrete suggestions for incorporating Polyvagal Theory into clinical work.”

We can watch or listen free in real time (schedule below). These free broadcasts reach many more than can afford subscription (to me, an insanely reasonable fee, considering what I got out of it).  Transcripts, video, mp3s of  all speakers, and more extras come with subscription.

 Schedule: Wednesdays at 5pm EST & 6:30pm EST

Wed, Oct 29th: Bessel van der Kolk, MD: How to Help Patients Rewire a Traumatized Brain – Applying the Latest Strategies to Speed Healing and Reduce Symptoms for Even the Most Traumatized Clients

Wed, Nov 5th: Pat Ogden, PhD: Why A Body-Oriented Approach Is Key for Treating Traumatized Patients (and What It Looks Like in Practice)

Wed, Nov 12th: Daniel Siegel, MD: The Neurobiology of Trauma Treatment: How Brain Science Can Lead to More Targeted Interventions for Patients Healing from Trauma

Wed, Nov 19th: Peter Levine, PhD: Getting to the Root of Trauma: Why It’s Critical to Understand the Role of Memory in Trauma Therapy

Here’s the link to see Ruth’s full promo with important details on each of the speakers and what they’ll cover:
http://www.nicabm.com/treatingtrauma2014/info/?del=10.11.14blog

Register here to watch or listen free at time of broadcast:http://www.nicabm.com/treatingtrauma2014/freesignup/

Register here for a subscription Gold Membership ($197) with all items noted above: https://www.nicabm.com/treatingtrauma2014/register/

———————————

Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

 

Footnotes

  1. This 2011 series is over, but a subscription to it for transcripts and recordings is still at http://www.nicabm.com/thebrain2011/

___________________________________________________________

About the Author

Kathy BrousTechnical writer and author of the upcoming book Don’t Try This at Home: The Silent Epidemic of Attachment Disorder –  How I accidentally regressed myself back to infancy and healed it all. Raised on Long Island, New York, Kathy survived a 30-year career in the fast lanes of New York City and Washington DC.  Starting on Wall Street researching South African gold stocks, she was an international economist for 18 years, using her Japanese language skills to write and consult on U.S.-Japan trade and finance.  In Washington, she became a technical writer, producing complex documents for Pentagon subcontractors, her line for the last 12 years, while pursuing her hobby as an opera singer. She was busy flying around the world instead of having children and building a family. Suddenly in 2007, Kathy faced divorce from her 27-year marriage to her college sweetheart, leaving her bankrupt.  A move to California was followed by the death of both her parents and then two bad rebound affairs – five life disasters in two years. Those crises started her down a path of discovery and healing that she is now able to share with others.

Kathy’s “News Blogs” expand on her book “DON’T TRY THIS AT HOME:  The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.”  Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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October 14, 2014 by Sandra Steingard, MD

Rethinking Psychiatry

FilmFestivalI was honored to both attend and participate in the recent Mad In America Film Festival. I was one of three psychiatrists who were asked to respond to the themes and questions explored in the festival. What follows is a lightly edited version of my remarks.

First of all, I want to thank Laura Delano for inviting me. She is a woman of great fortitude and bravery.

I also want to thank Robert Whitaker, our moderator and the inspiration for this festival. I first wrote to Bob on May 29, 2011. I had never written to an author before. I went back to look at the first of a long and ongoing correspondence. This is how I concluded that first e-mail:

“I am almost immobilized at this point.”

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