Editor’s Comment
In October, Safe Harbor is holding its annual fundraising event. (See article below.) This is the one time of the year when we ask our supporters for the financial input we need to continue to carry out our work.
Rather than give editorial comment in this and the next couple issues, we’ve decided to share with you a few comments from the many calls, letters, and emails we receive.
“I get a patient calling me every few weeks from your directory. One man had been on drugs several years and no doctors would help him come off of them. He had been told he had to stay on them, even though he thought they were unnecessary. After a number of visits to my office, he was weaned off the medication. Recently, in his final visit, I told him we were done. He cried and thanked me profusely.” – Psychiatrist listed on AlternativeMentalHealth.com directory
“After attending your conference (June 2002), I changed my practice and my website. Something had been missing in my work and you showed me what it was. The conference was outstanding – and you can quote me on that.” – California psychologist
“I learned a completely new perspective to mental health issues at your conference. The quality of the program was excellent. I am really looking forward to a longer and more comprehensive course.” B.D., Ph.D.
“Your conference has stimulated my desire to learn much more about this subject. I will start doing lab testing that I learned and try to incorporate these values in my treatment of patients.” California M.D.
“I can’t begin to thank you for the conference. What an absolutely amazing weekend it was for me. The conference far surpassed my expectations which were very high. It was a thrill to be involved in an event of this magnitude.” Family Therapy student
“I will not forget your kindness in talking to me so patiently over the phone. In this sometimes uncaring world, you really show up.” – San Diego caller
Safe Harbor Honors Dr. William Walsh Oct. 24 In L.A.
Dr. William Walsh, Ph.D.
Dr. Willam Walsh, Ph.D. On Thursday, October 24, 2002, at 7:30 PM, at the Bonaventure Hotel in Los Angeles, California, Safe Harbor will have its annual fundraising event, honoring William Walsh, Ph.D., chief scientist of the Health Research Institute and the Pfeiffer Treatment Center in Naperville, Illinois. Dr. Walsh’s work has not only impacted the thousands of people who have been treated at the Pfeiffer Treatment Center, but thousands more through his writings and appearances.
Also honored will be Palm Springs holistic psychiatrist Dr. Priscilla Slagle, author of The Way Up from Down and a pioneer in the field of alternative psychiatry.
Others will be recognized as well.
Psychiatrist Stuart Shipko, one of the nation’s leading experts on the adverse effects of SSRIs, will speak on the hazards of psychiatric drugs. According to Dr. Shipko, “Psychiatric drugs are the leading cause of psychiatric symptoms in the United States.”
Other speakers will include two individuals who have recovered without drugs from debilitating mental symptoms and who now lead full lives.
Hors d’oeuvres will be served with fine jazz music.
Tickets are $65 in advance and $80 at the door.
For those who can’t attend, donations are welcome for those wanting to provide tickets for others or who wish to help underwrite the event. This is Safe Harbor’s only fundraising event for the year so all donations are appreciated.
Tickets or donations may be paid for at https://secure.corpsite.com/secure_alternative/donation.htm or by phone at (818)890-1862. Checks can be mailed to Safe Harbor, 1718 Colorado Blvd., Los Angeles, CA 90041.
Chat Rooms Dramatically Reduce Hospital Re-Admission Rate
A project in Germany revealed that people with mental problems have been able to avoid returning to hospital by using support groups on an internet chat room. The usual 30% re-admission rate for patients during the critical first 3 months after hospitalization is practically eliminated for those taking part.
In November of 2001, approximately 100 patients started to participate in 90-minute chat sessions on one of three chat rooms. Before and after each session, patients were asked to complete questionnaires about how they feel.
Psychotherapy Research Unit in Stuttgart is evaluating the information from the project on a long-term basis, but initial results were released the week of June 13, 2002.
Dr. Thomas Wangemann, registrar at the “Panorama specialist clinic for psychosomatic, psychotherapeutic medicine, alternative and traditional Chinese medicine” in Scheidegg, Germany, has been acting as a therapist “host” in one room. Dr. Wangemann says that the former patients help each other, sharing strength and determination.
“This has surpassed my wildest dreams,” Wangemann told Reuters Health. “I could not have hoped for better results for the individuals concerned. I have been astonished at how competent some of the patients are at helping each other. We are calling the project The Bridge, and it is limited to a 15-week running time as that is the critical period for the patients.”
“All power to them,” Wangemann said. “They really seem to be helping each other. Of the 15 patients who recently finished their critical period, only one has come back to the hospital and she was deeply psychotic.”
Psychiatrist Challenges “Chemical Imbalance” Theory
Simon Sobo, M.D., a regular contributor to The Yale Review, The Psychoanalytic Study of the Child, and Psychiatric Times, has challenged one of the most fundamental assumptions of orthodox psychiatry – that brain chemical imbalances cause mental disorders – in a long article published on the Internet in 2001 and revised in early 2002.
In his abstract of the article, Dr. Sobo writes:
“Instead of correcting imbalances, it is argued that pharmacological agents may be viewed as inducing particular psychological states which though not specifically related to diagnosis, are nonetheless the basis for the usefulness of the medication… A case is made against the widespread use of medications by non-psychiatrists as well as the 15-minute, once-a-month medication visits that have become standard psychiatric practice, both the product of the chemical imbalance model…
“In the United States, the chemical imbalance argument has proven to be important in winning legislative support for improved insurance coverage that gives psychiatry parity with other medical conditions. One other byproduct of the chemical imbalance model: its simplicity has led to a great deal of comfort, on the part of physicians other than psychiatrists, to dispense psychotropic medications. Believing that they are operating within the logic of cause and effect, they merely have to focus on the improvement of the symptoms of the disorder in question and watch for side effects from the medication. A majority of psychiatrists also work within these parameters. They typically see patients for med checks and that is all.
“There are fundamental crucial problems with this perspective that need to be aired. First and foremost is that, while some day we may accumulate the knowledge to demonstrate the particulars of the chemical imbalance model, no such imbalances have been unequivocally demonstrated for any disorder. We are offered interesting conjectures, educated guesses that are forever shifting as the latest data is accumulated. The continual construction of new hypotheses is how science should proceed. But good science is normally modest. It clearly distinguishes between soft knowledge and what is known. It does not trumpet a few pieces of a jigsaw puzzle that have been brilliantly put in place, as the solution to the entire puzzle. The public (including practitioners) and the media are being misinformed about the state of our knowledge.
“It isn’t that researchers are unaware of the difficulties of integrating current knowledge with theory. Frustration with the ‘chemical imbalance’ neurotransmitter model has, for instance, led certain authors (e.g. Duman, Henninger, Nestler (1997)) to propose an intracellular hypothesis to explain the effectiveness of various medications. Even more to the point, despite the widespread respectability of the chemical imbalance hypothesis it has all along been met with skepticism in some very important places. Thus, the 1992 edition of The Pharmacological Basis of Therapeutics states flatly regarding the ‘neurotransmitter hypothesis of mood disorder’ that ‘the data are inconclusive and have not been consistently useful either diagnostically or therapeutically.’
“I will try to show later in this article that despite the ad nauseam use of the term ‘expert’ to refer to treatment protocols and the like, (which in itself should arouse suspicions that we are dealing with a ‘Wizard of Oz’ phenomenon) adherence to this model in what has become standard psychiatric practice, the once-a-month, 15-minute med check, is not only not ‘expert’ care, but is grossly inadequate care. And, if this is the case, even if one shares a distaste for the hype and psychobabble, ‘the therapy cures all’ excesses that once characterized the worst of psychiatry, the current cursory lip service given in training programs to the role of psychological and social factors in mental illness, is producing psychiatrists unequipped to properly treat patients. That is true even when medications are justifiably the main treatment strategy. Moreover, despite insistence on empirical data, and infatuation with the toys of science, the technological wonders available in modern laboratories, there has not been enough of the most crucial hallmark of ‘science,’ rigorous critical thinking about the basic model.”
Dr. Sobo lists what he considers the four most glaring difficulties with the chemical imbalance model:
Medications such as the Selective Serotonin Reuptake Inhibitors (SSRIs) are finding usefulness in so many disorders that “to consider all of these forms of misery part of the same biological spectrum is stretching credulity.”
Medications that work in completely different ways are comparably effective for the same disorder. For example, antidepressants such as desipramine and bupoprion have little serotonin effect yet are just as effective agents for depression as SSRIs.
“With all that is unknown about the chemistry of mental illness, using the chemical imbalance model, researchers are not shy about concluding that a given disorder is ‘really’ something else on the basis of the effectiveness of a medication. Thus Donovan, SJ, 1998 proposed that a new diagnosis, ‘Explosive Mood Disorder,’ be created and replace Conduct Disorder and Oppositional Defiant Disorder, for ‘children with irritable mood swings’ because Depakote helped his cohort of inner city, out of control, kids. Similarly all kinds of problems with impulse control (called compulsions by laymen) such as overeating, gambling, paraphilias, various patterns of alcohol and drug abuse, and so forth have been labeled Obsessive Compulsive spectrum disorders because SSRIs are sometimes effective. The reason these “compulsions’ were originally excluded from OCD was that they revolved around giving in to temptation, over indulgence of a forbidden pleasurable activity.”
“The chemical imbalance model is not an important part of the basic (animal) research being done to test new potential anxiolytics [anxiety relievers] and anti-depressant agents.”
Dr. Sobo practices psychiatry in Litchfield County Connecticut, having served as Chief of Psychiatry at New Milford Hospital between 1981 and 1998. His Internet article, A Reevaluation of the Relationship between Psychiatric Diagnosis and Chemical Imbalances , is an expansion of a presentation given at Psychiatric Grand Rounds, November 15, 1999, at the University of Alabama Medical School.
Anorexia Linked to Brain Lesions
The June 27, 2002, issue of Acta Neurochirugica reports on the cases of three patients with anorexia nervosa found to have lesions in the frontal lobe of the right hemisphere of the brain. All had associated partial seizures.
Eating disorders are known to sometimes occur in association with tumors involving the temporal cortex, in temporal lobe epilepsy, or in the advanced stage of degenerative diseases involving temporal structures. They can also be triggered by other physical sources such as nutritional imbalances and Lyme Disease.
In this review, one female and two males were found to have intra cerebral (within the cerebrum) lesions. Two of the patients were found to be operable and were seizure-free and gained weight after surgery.
The authors “recommend performing a cranial MRI in all patients with suspected eating disorders, especially if they occur in combination with focal (partial) seizures.”
Placebo Scores High in St. Louis “ADHD” Study
Tenenbaum et al, of the Attention Deficit Center in St. Louis, MO, recently conducted “An experimental comparison of Pycnogenol [an herb] and methylphenidate [Ritalin] in adults with Attention-Deficit/Hyperactivity Disorder (ADHD)” and published the results in the Journal of Attention Disorders, August 2002.
Methylphenidate is a standard pharmaceutical intervention for ADHD. Pycnogenol is an antioxidant derived from the bark of the French maritime pine tree. Anecdotal reports suggest that Pycnogenol improves concentration in adults with ADHD without adverse side effects.
Twenty-four adults, ages 24 to 53, who had been diagnosed with “Attention-Deficit/Hyperactivity Disorder (ADHD), Combined Type,” were studied in a double-blind, placebo-controlled, crossover study of Pycnogenol and methylphenidate.
The research subjects received Pycnogenol, methylphenidate, and placebo, each for three weeks, in a randomized and counterbalanced order. As measured by self-report rating scales, rating scales completed by the individual’s significant other, and a computerized continuous performance test, the ADHD symptoms improved during treatment. Neither methylphenidate nor Pycnogenol outperformed the placebo control, however.
The authors note, “The conservative dosage levels and relatively brief length of treatment may have contributed to the absence of significant differences among treatment conditions. Implications for future research are noted.”
“My Choice” Campaign Promotes Treatment Alternatives
On February 27, 2002, Mind, the leading mental health charity in England and Wales, launched MY CHOICE — a campaign aimed at increasing the level of choice available to mental health service users at primary care level.
Mind believes that too many people visiting their GPs for mental health problems are offered medication as the only option.
Prescribing of anti-depressants has more than doubled in the last ten years, Mind noted in a press release inviting journalists and Members of Parliament to try out the benefits of therapies including massage, exercise and reflexology at the campaign’s launch event.
Timed to coincide with the restructuring of primary health services in England and Wales, including the creation of the new NHS Primary Care Trusts across England, MY CHOICE highlights the benefits of a whole range of treatments for mental health problems.
Interim results from analysis of 178 respondents to a Mind snapshot survey reveal that:
98% of respondents visiting their GP for mental health problems were prescribed medication, despite the fact that less than one in five had specifically asked for it.
Over half (54%) of respondents felt they had not been given enough choice.
Of those who had tried alternative treatments, over one in three had to take the initiative and ask for it – and often pay for it – themselves.
Almost 10% of all respondents had been unable to access treatments because waiting lists were too long.
The press release included this message from Jacqui Smith, Member of Parliament, Health Minister:
“Patients are the most important people in the health service. However, it doesn’t always appear that way. The NHS Plan makes clear our wish to widen patient choice in the NHS. Patients tell us that they are very interested in complementary and alternative therapies, and demand for these treatments alongside psychological therapies and counseling is high. I welcome this initiative as offering a most important contribution to our thinking on how to strengthen primary care mental health.”
Study Suggests Link between Antipsychotics and Diabetes
A recent study co-authored by Dr. P. Murali Doraiswamy, a psychiatrist at Duke University Medical Center, and Dr. Elizabeth A. Koller, a medical officer at the FDA, suggests a link between diabetes and the drug olanzapine, sold in the United States as Zyprexa. The findings were published in the July 2, 2002 issue of Pharmacotherapy.
Olanzapine, an atypical antipsychotic, is used to treat conditions diagnosed as schizophrenia, paranoia and manic-depressive disorders. Other drugs in this class include clozapine, risperidone, quetiapine and ziprasidone.
Although the majority of the patients studied were not known to be diabetic, the researchers found metabolic abnormalities ranging from mild blood sugar problems to diabetic ketoacidosis (DKA) and coma. Diabetic ketoacidosis is a serious condition in which a person experiences an extreme rise in blood glucose level coupled with a severe lack of insulin. This results in symptoms such as nausea, vomiting, stomach pain and rapid breathing. Untreated, DKA can lead to coma and even death.
The research was conducted by studying eight years of abstracts from national psychiatry meetings. Reseachers identified 289 cases of diabetes in patients who had been given olanzapine. Of these, 225 were newly diagnosed cases. One hundred patients developed ketosis (a serious complication of diabetes), and 22 people developed pancreatitis, or inflammation of the pancreas, a life-threatening condition. Deaths included a 15-year-old adolescent who died of necrotizing pancreatitis, a condition where the pancreas breaks down and dies. 71% of the cases occurred within six months of starting the drug.
“While our report does not prove a causal relationship between the drug and diabetes, doctors should be aware of such potentially adverse effects,” said Dr. Doraiswamy, “We’ve found cases where patients had some very serious problems associated with olanzapine, and at least 23 of them died.”
“The average age of adults showing signs of diabetes after taking olanzapine was about 10 years younger than what is generally seen in the community,” said Doraiswamy. “The younger age at onset plus the number of serious complications and the improvements reported when the drug was stopped all suggest a link to the disease. However, until we know if there are risk differences among drugs in this class, it is important for physicians to watch all patients receiving this medication for signs of diabetes so that it can be detected quickly and managed.”
Doraiswamy was part of a team from Duke that first reported a link between the psychiatric drug clozapine and the development of diabetes. This report appeared in a 1994 issue of the American Journal of Psychiatry. In 2001, Koller reported in the American Journal of Medicine that the FDA had received 384 reports of diabetes associated with the drug clozapine. According to the researchers, many cases of diabetes have also been reported with other antipsychotic drugs. Doraiswamy has previously received funding and consulting fees from all companies that currently manufacture antipsychotic medications, including Eli Lilly and Company, the manufacturer of Zyprexa. The current study was self-supported by the authors.
Prisoners Less Violent When Given Supplements
A study published in the July 2002 issue of the British Journal of Psychiatry indicates that the simple use of nutritional supplements can significantly reduce behavior problems among prisoners. The research was carried out by a team led by C. Bernard Gesch of University Laboratory of Physiology, University of Oxford
Basing the study on previous work that has shown the adverse behavioral effects of nutritional deficiencies, the researchers set out to test if adequate intakes of vitamins, minerals and essential fatty acids could improve antisocial behavior.
The experiment was a double-blind, placebo-controlled, randomized trial of nutritional supplements on 231 young adult prisoners, comparing disciplinary offenses before and during supplementation.
Those receiving the active capsules committed an average of 26.3% fewer offenses. Compared to baseline, the effect on those taking active supplements for a minimum of 2 weeks was an average 35.1% reduction of offenses, whereas placebos remained within standard error.
The Therapeutic Effects of Simply “Being There” with Patients
As Dr. Ken Smythe (Doctor of Psychology) of La Canada, CA, was working his way through school and in psychiatric hospitals afterwards, he made a rather startling discovery about his chosen profession: “I saw a lot of people doing things over and over that didn’t work. I did my masters and doctorate on schizophrenia and saw that nothing really seemed to work. Few articles in the literature showed any hope. I think there is a fixed ideology about schizophrenia – a fixed hopelessness.”
He decided to do something about it after 10 years of work in psychiatric hospitals, including managing partial hospitalization programs.
“So much else needs to be done that is not available,” said Dr. Smythe. “I searched to find things that work. This led me to putting together the Being There program. Nothing out there provides this.”
He looked into his own life to see what he valued. He looked at coaches, teachers, neighbors – people who had an unconditional positive presence. “So many therapists can present with a non-emotional affect but they really hate the patient,” he observed. “When that happens, patients don’t do well. Staff who can maintain that unconditional positive presence are usually aids and staff and mean a lot to patients.”
So what does “being there” mean? It means spending time with the person, being aware of any conflicts, yet maintaining a positive presence. It means doing things, going places, being with.
As an example, said Dr. Smythe, if a person refuses to shower, threats and force only create conflict. “Use loving persistence to get them to do it and they will not be upset. A lot of people dealing with patients meet their needs and not patients’. Many patients end up with a stalemate of conflict.”
Dr. Smythe hopes to expand his Being There 121 organization to include a residential facility that is healthy and positive and provides for growth and improvement. He also would like to provide a mentoring program for adolescents and young adults where they do work or leisure activities for 16 hours a month.
Dr. Smythe works with clients on medication or not.
Back in the 1970s published studies by psychiatrist Loren Mosher at his famous Soteria House showed that non-medicated clients recovered just as readily as drugged ones (without the side effects) when supervised by a nonmedical staff instructed to simply “be with and do with” the patients.
“This work has lead for a lot of personal growth in myself as well,” said Dr. Smythe, “because I have to look within myself to see how to improve my tolerance.”
Further information is available at (818) 957-8737, http://www.beingthere121.org, or ken@beingthere121.org.