Subscribe X
Back to Top

Learn

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

For the latest news in mental health subscribe to Rally.


March 2, 2015 by Sandra Steingard, MD

Stimulants and Food

Sandra-SteingardThe FDA recently approved lisdexamfetamine (LDF) for the treatment of the newly minted DSM-5 diagnosis of Binge Eating Disorder. This caused me some consternation and this blog will be as much about my reaction to this news as to the news itself.

The use of stimulants to curb appetite is nothing new. This was a common practice in the 60’s and 70’s and then it was shunned in respectable medical circles because we “knew” amphetamines were dangerous drugs.  We also knew that their effects on dampening appetite tended to wear off over time. This is commonly cited as a reason not to be concerned about their use in youth.

I was introduced to these drugs as being addictive substances that were used to create animal models of psychosis. Yet, there has been an expansion of the use of stimulants in the past decade with very little discussion of the possible risks entailed. Their approval for the treatment of “binge eating disorder” follows the expansion of ADHD from childhood into adulthood. I doubt it is a coincidence that this happened at the time when most of the antidepressants went off patent.

Read More

February 27, 2015 by Kathy Brous

The Adult Attachment Interview (AAI) (Pt.2 of 2)

Mary Main’s Scary Parent Study

Dr. Mary Main

Scary Parents
My last blog Jan. 23 concluded that by 1978, Dr. Mary Ainsworth’s estimate for U.S. babies was (B) Securely Attached 69%, (A) Avoidant 23%, (C) Ambivalent 8%.  In the next 10 years, Ainsworth’s Strange Situation study was done worldwide — with the same three categories — on 2,000 infant-parent pairs in 32 different studies, in 8 countries. Some countries’ results varied, but the global results averaged out the same as Ainsworth’s 1970s studies.1

In 1973, Mary Main became Ainsworth’s grad student at Johns Hopkins in Baltimore, working on the Strange Situation experiments from the start. After her doctorate, Main moved to Berkeley, to see if Ainsworth’s Kampala and Baltimore findings would replicate.8  In 1978, she ran a Strange Situation study of 189 Bay Area infant-parent pairs and had the same findings, reported in Ainsworth 1978.10

But by 1979, Dr. Main was making her own discoveries—out of concern about the parents. “In none of Ainsworth’s original observations was the possibility considered that some mothers… could also be frightening,” Main notes. “For my dissertation at Johns Hopkins, I watched 50 children in the Strange Situation… Using Ainsworth’s three-part classification (secure, avoidant and ambivalent), I found at least five infants could not be classified.”  Ainsworth was concerned, too; in fact, she’d left some babies in her Secure set only since they didn’t fit her other two sets.8

Read More

February 13, 2015 by Kathy Brous

The Adult Attachment Interview (AAI) (Pt.1 of 2)

Mary Ainsworth’s Strange Situation

Mary Main & Dan Siegel December-2010-UCLA

Dr. Main with Dr. Daniel Siegel

Only 55% of us have “secure attachment”– a number which would worry us all if we knew what it meant — according to 1970-1996 research on over 2,000 infant-parent pairs. And the level of attachment we get as infants continues all our lives in our relationships.

The math says the other 45% of us suffer “insecure attachment.”  That means 45% can’t handle a committed, stable relationship with anyone, from childhood to the rest of our lives, as of 1996.  We also pass this emotional pain to our children, who turn out similarly.  A National Institute of Health article summarizes the secure rate:  “Infants with secure attachment greet and/or approach the caregiver and maintain contact but are able to return to play, which occurs in 55% of the general population.” 1

This is the blockbuster result of Dr. Mary Ainsworth’s 1970-1978 “Strange Situation” study of babies.  The work was completed by her student Mary Main, and Main’s research led to shocking conclusions.

Main discovered so many babies were peculiar, she got concerned about the parents. So in 1982, she created the Adult Attachment Interview (AAI) to study the adults, releasing results 1984-96.

Her journey was so “strange” and involved, that it got published in language hard to decipher (or even google) for most folks. The tale took me weeks to unravel (footnotes below).

This huge “insecure” figure is a predictor of broken homes and broken hearts for half the nation. It starts to explain why we’ve got a 50% divorce rate. If you’re like me and have tried “over 40” internet dating after a divorce, it won’t surprise you to hear that science shows 50% of adults out there can’t carry on a secure, committed, loving relationship. You’ve already experienced it.

And if 45% of us were “insecurely attached” in 1996, what’s the percent in 2014?  In 1996 most of us hadn’t heard of the Internet. In almost 20 years since, email, texting, and so on have further trashed our ability to relate in person. Several psychotherapists interviewed for this blog said that a round number of “about 50%” is a  conservative estimate for how many Americans lack secure attachment today. Many believe it’s much higher.

Read More

February 4, 2015 by Sandra Steingard, MD

Drugs and Dementia

Sandra-Steingard

This study of the risks of developing dementia among those who take anticholinergic drugs has serious implications for psychiatry.

This week, JAMA Internal Medicine published online an interesting paper, “Cumulative Use of Strong Anticholinergics and Incident Dementia: A Prospective Cohort Study.” They found that exposure to anticholinergic drugs significantly increased the risk of developing dementia. This study has important implications for those who prescribe and take psychiatric drugs, but it is worthwhile describing the study in some detail before discussing those implications.

First, some context. Acetylcholine (ACh) is a neurotransmitter (a chemical that propagates a nerve signal from one cell to the next) that is found throughout the body. It is involved in gut motility, visual acuity, heart rate, and secretions. In the brain, its activity is linked to memory and movements. There are many drugs that block ACh receptors (the proteins that allow nerve transmission to occur). In psychiatry, anticholinergic drugs are used to combat some of the neurological effects of the neuroleptic drugs such as muscle stiffness and tremor. But there are also many drugs used to treat depression and psychosis that have anticholinergic effects.

Read More

January 30, 2015 by Bob Nikkel, MSW

Why Mental Health Systems Should Be Organized Under Alcohol and Drug Systems

bnikkel_miaceWhile I was in charge of the public systems for both mental health and addictions in Oregon, I found it a challenge to maintain an equal focus on alcohol/drug problems compared to mental health. One big reason for the emphasis on mental health was that the mental health budget was big, about 6 times greater than that for addictions. And that doesn’t even count the hidden funding for psychiatric drugs which probably added another 30 or 40% to mental health—atypical antipsychotics are a lot more expensive than Antabuse.

Although there was a huge difference in state financial support for the two areas, it always seemed to me that the social consequences were just as large and challenging in addictions as in mental health. Partly for that reason, when asked to recommend a new name for an integrated office blending the two previously separated program areas, I chose to put addictions first–the Addictions and Mental Health Division. The state legislature agreed and it became the agency’s name and, at least for the time being, still is. It may have been only symbolic but it was an attempt to stop seeing alcohol and drug services as the “little brother.”

Having stepped back and out of the line of fire now for several years, I’ve become more aware of the ways in which addictions may be a better conceptual umbrella than I’d considered in the naming process. Consider that the dynamics of “denial” and “enabling” are powerful themes in addictions treatment. Denial is the marked tendency for people struggling with addictions to believe that their drinking or drug use is really under control and that everyone around them is over-reacting. Enabling is the flip side of that coin in which those around them unwittingly play into the denial and without consciously trying actually make it easier for the addicted person to keep using.

Read More

January 29, 2015 by Larry Davidson, PhD

Yale Symposium April 24, 2015

Larry-Davidson-PhDOn April 24th, the Foundation for Excellence in Mental Health Care is sponsoring an all-day symposium at Yale University entitled “New Data and New Hopes Call for New Practices in Clinical Psychiatry.” The symposium is co-sponsored by the Yale Program for Recovery and Community Health and the Department of Mental Health and Addiction Services for the State of Connecticut. Speakers include scientific advisors and board members of the Foundation, Yale Psychiatry faculty, and leading researchers and thought leaders from the U.S. Substance Abuse and Mental Health Services Administration, the University of Groningen in the Netherlands, and several other American universities.

Read More

January 29, 2015 by Larry Davidson, PhD

Turning Lived Experience into Lived Expertise

Larry-Davidson-PhDThe International Leadership Academy Fund has been established at the Foundation for Excellence in Mental Health Care. It aims to prepare persons with lived experiences of mental ill health and recovery to take on leadership roles within their own local, regional, and national systems of care across the globe. The idea for this fund, and the program it seeks to develop, emerged from a meeting of prominent system leaders and advocates with lived experience who came together at Yale University in May of 2014. The meeting was sponsored by the International Institute for Mental Health Leadership (IIMHL), directed by Foundation Chair Fran Silvestri, and was held to invite input from leaders with lived experience as to how the work of the IIMHL could benefit from the wisdom they and others had accrued through their own personal experiences of recovery and mental health system transformation efforts. The meeting was co-chaired by Larry Davidson, a professor of psychology at Yale and member of the Foundation Board, and Anthony Stratford of MIND Australia, and included lived experience leaders from Scotland, England, the Netherlands, New Zealand, Canada, Australia, and the U.S.

Read More

January 29, 2015 by Beatrice Birch

The Inner Fire Story

Beatrice Birch

Inner Fire Co-Founder Beatrice Birch

The catalyst for Inner Fire was a thirty-eight year old man named Zach, who while struggling with mental health challenges, tragically took his own life.  Zach did not know he had a choice to recover free from the harmful and stultifying side effects of psychotropic medications. Instead of connecting with his inner fire using holistic therapies, Zach chose to end his suffering amidst a fog of pain. Zach is but one of a multitude who gave up hope because he experienced no progress toward healing and no other choice for recovery was evident.

While working together at a treatment center in Vermont serving adults with serious psychiatric and addictive challenges, Beatrice Birch, a Hauschka Artistic Therapist and Jim Taggart, then Executive Director of the center, were distressed by the limited and often counter-productive treatment options for people like Zach. From Beatrice’s thirty years combined experience working in anthroposophical (complimentary) medical and therapeutic clinics in both the UK and Holland and her private practice in the USA, she knew  there were options for those who wanted to be proactive in their recovery process without using psychotropic medication.

Read More

January 26, 2015 by Sandra Steingard, MD

Bring Back the Asylum?

This week, a commentary written by members of the University of Pennsylvania Department of Medical Ethics and Health Policy and titled “Improving Long-term Psychiatric Care Bring Back the Asylum,” was published in JAMA online. I share my perspective on this provocative suggestion which is influenced by recent dramatic changes in my home state.

Sandra-SteingardThis week a commentary, written by members of the University of Pennsylvania Department of Medical Ethics and Health Policy and titled “Improving Long-term Psychiatric Care: Bring Back the Asylum,” was published in JAMA Online. The senior author, Ezekiel Emanuel is former Special Advisor for Health Policy in the Obama administration and brother of Rahm, Mayor of Chicago and Obama’s former Chief of Staff. This commentary with its provocative title published in a high impact journal by a well connected physician is sure to garner considerable attention and influence.

As the title suggests, the authors recommend a return to asylum care, albeit not as a replacement for but as an addition to improved community services and only for those who have “severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community based treatment.”

The authors seem to accept the notion of transinstitutionalization (TI) which suggests that people who in another generation would have lived in state hospitals are now incarcerated in jails and prisons. This notion arose from two sets of statistics. The first is that, as rates of psychiatric hospitalization declined, rates of incarceration increased with the total in 2000 being about the same as it was in 1960. It gives the appearance that we just transferred people from one setting to another.

Read More

January 17, 2015 by Bob Nikkel, MSW

2015 Edition of Early Psychosis Intervention Projects National Directory

bnikkel_miaceThe Foundation for Excellence in Mental Health Care is very pleased to announce the arrival of the second edition of the Program Directory of Early Psychosis Intervention Projects, a joint venture of Portland State University’s Regional Research Institute and the Foundation. This national listing has contact and some basic program information for about 70 projects in 18 states.

Most of the credit for creating the directory goes to Elinor Taylor at Portland State University. She has constructed and updated this work on top of a heavy academic and clinical workload and deserves recognition for this important document.

As described in the introductory section, the purpose of the directory is to create a database and list of early intervention programs for psychosis within the U.S. Additional goals include facilitating a communicative network among these programs, creating tools for referral, comparing outcome measurements, and determining potential future research studies. This information is up-to-date as of January 2015.

My hope is that in a few years, we will have hundreds of projects in all 50 states. When that day comes, we will realize the expectation that young people will recover their lives and never give credence to the all-too-common and destructive “diagnosis” of a “chronic mental illness.” It’s the system that’s been creating that tragic, unnecessary outcome.

Read More


Related Blogs

  • Dr. David Healy

    Dr. David Healy

    Dr. Healy is a professor of psychiatry at Cardiff University in Wales and an author on the history of pharmaceuticals and government regulation.
    READ BLOG
  • ISEPP Chronicles

    ISEPP Chronicles

    The International Society for Ethical & Psychiatry blog.
    READ BLOG
  • Mad In America: Robert Whitaker

    Mad In America: Robert Whitaker

    Journalist and author Bob Whitaker distills the latest in pharmaceutical and mental health research.
    READ BLOG
  • Selling Sickness

    Selling Sickness

    Creating a new partnership movement to challenge the selling of sickness.
    READ BLOG
  • Kathy Brous

    Kathy Brous

    A serial of Kathy's recovery journey as an adult with attachment disorder.
    READ BLOG
  • Nev Jones

    Nev Jones

    Exploring the intersections of psychiatry, philosophy, neuroscience, cultural theory, critical community psychology and the mad/user/survivor movement.
    READ BLOG
  • 1boringoldman

    1boringoldman

    Retired psychiatrist and raconteur offers insightful analysis of the day's events from the woods of Georgia.
    READ BLOG