Health

The long-anticipated anthology of mad poems, stories and research is finally out. The book is split between personal mental health narratives and research, a powerfully balanced approach for contending with these issues.

I contributed to two (going on three) chapters of this book - a lightly modified version of the first chapter of my dissertation appears, as well as excerpts from Mindful Occupation, which I helped produce, write and edit.

Pick up a copy at your local bookstore https://www.indiebound.org/book/9781623173616 !

Last weekend I traveled to the lovely city of New Haven for a mental health hackathon hosted by Hack Mental Health Care. I was very pleasantly surprised by the experience, which proved interesting, fun and invigorating (with a few healthy dashes of disappointment and horror). I was mostly expecting undergraduate participants with ideas for mood tracking apps, but the event drew over 200 people, and was quite diverse.  In addition to programmers, designers, product folks and business people showed up. Genders were closely balanced and minorities were represented. Crucially, over 30% of the participants had clinical or lived experience. The event also featured a therapy dog, yoga sessions and a guided mediation. Peer voices and ethics were featured in some of the talks, although due to time constraints, project design was complete and implementation was already underway. And, kudos on the Code of Conduct… next year I would also love to see consent-based photography and sponsored childcare. The organizers worked hard to prompt the participants in advance with these challenges:

Last month the DSM-5 finally launched at the American Psychiatric Association conference. After 13 years and multiple delays, you can now pre-order your copy at Amazon (list price: $150), or just leave a helpful comment. The DSM-5 had been surrounded by controversy, and not just by the usual suspects. Allen Frances, the chairman of the DSM-IV task force, just published a scathing critique of the processes and outcomes of the DSM-5 efforts: Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. Frances has been sounding the alarm about DSM-5 for over a year, raising concerns over the current committee’s secretive methods, conflicts of interest, expansive diagnostic inflation, and the reduction in reliability (the odds of two doctors agreeing on a diagnosis) that DSM-5.  Over 50 Mental Health organizations and almost 15k people signed a petition demanding reform of the DMS-5 drafts. Although this scale of controversy would be scandalous in many fields, the APA barely flinched. The DSM-5 task force moved some of the most troubling diagnoses into the appendix, renamed a few others, skipped a round of efficacy trials to meet their deadline, and otherwise proceeded with business as usual. I have to say my jaw dropped when I learned that the National Institute of Mental Health (NIMH), and it’s $1.5B/year of funding,  was “re-orienting its research away from DSM categories[!]”. The official NIMH announcement, Transforming Diagnosis, posted by their director Thomas Insel on April 29th, was picked up by a wide range of science media (NYTimes, Koplewicz @ The Huffington Post, Chris Lane @ Psychology Today, Psych Central) with headlines such as “NIMH Withdraws Support for DSM-5” and analysis that this was a “kill-shot” for DSM-5. What struck me as most shocking was that the NIMH basically came out and said that the the Mental Illnesses defined in the DSM are social constructs - “the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”  Ironically, the anti-psychiatrist’s arguments have prevailed, although for the wrong reasons. As I interpret this statement, NIMH isn’t denying the existence of mental illness, just our current ability to agree on its nature and manifestations. But, yes, the current definitions are social constructs and continue to defy attempts at validity. Ha! But, before anyone gets too excited, what the NIMH proposes may turn out to be scarier than the system in place. This research is representative of the direction that the NIMH is heading: Suicidal behavior is a disease. Here, disorders will be sliced and diced into their constituent elements, which conform more readily to the instruments and models that scientists (neurobiologists and geneticists) already have at their disposal. I’ve been convinced for a while that within the next 5-10 years the Pharma-Industrial complex was going to invest enough research money to find a definitive neuro-imaging/molecular/genetic/biochemical marker for mental illness (that is, once the marker cast a wide enough net).  However, I wasn’t expecting them to turn the tables and redefine mental illness according to what they could already test. Pretty sneaky. The saddest part of this whole debacle is that instead of seizing this moment of crisis as an occasion to bring together disparate stakeholders - from patients, to consumers, to survivors, to advocates, to caregivers across a range of backgrounds - and work together to develop a new language and paradigm for understanding human suffering and emotional crisis, the NIMH has doubled down on scientific authority. Soon they will be short-circuiting all debate by pointing at pretty false-color pictures and lab results. There will always be a value judgement when evaluating the boundaries of normal experience/behavior, and no scientific instrument will ever be able to tell us when someone’s experience/behavior is deviant, without human interpretation. As the disability right’s movement says: Nothing about us, without us. Somehow, for all of the NIMH’s noble intentions, I have a bad feeling that the treatment side of mental health care is poised to become more oppressive. We’ll likely continue to see the growth of anti-psychotics for everyone, and the pre-cog, pathologizing of risk through predictive and preventative care that will explosively expand the diagnostic reach. This conversation just took a sharp turn past the rhetoric of the last few decades. I hope the psychiatric resistance is following along closely, and updating their arguments accordingly.

This season Fox premiered a new television series called Mental (this post has nothing to do w/ AMC’s fabulous Mad Men):

a medical mystery drama featuring Dr. Jack Gallagher, a radically unorthodox psychiatrist who becomes Director of Mental Health Services at a Los Angeles hospital where he takes on patients battling unknown, misunderstood and often misdiagnosed psychiatric conditions. Dr. Gallagher delves inside their minds to gain a true understanding of who his patients are, allowing him to uncover what might be the key to their long-term recovery.

What happens when the Swine Virus breeds with the Avian Flu? Pigs Fly, of course.  Welcome to the end of time. I’m off to collect a few debts. This latest data point is the most recent in a string of bizarre crimes that I have been tracking in my capacity as a double agent (in the Kierkegaardian sense). Consider these events from last year’s news:

1. The Aqua Teen Hunger Force Mooninite Bomb Scare in Boston
2. The Rat poison in the Cat and Dog Food triggering an FDA recall (it only affected wet food)
3. And, the E-Coli in the Spinach resulting in CNN journalists looking directly into the camera and instructing kids not to eat their green leafy vegetables.

Given everything I know about reality, there is only one man who is sinister and brilliant enough to execute this sequence of terrorist punchlines… Good riddance to the age of Biblical Myth. Welcome to the Age of Marvel and DC. Now, if only I could figure out which organization this intentionality emerged from.

A recent post at Furious Seasons on the spooky future of psychiatry prompted me to dig a little deeper into the origins of prodromal diagnoses. A prodrome is “a symptom or group of symptoms that appears shortly before an acute attack of illness. The term comes from a Greek word that means “running ahead of."” A spooky emerging trend in clinical psychiatry is the appropriation of this concept under the paradigm of “early intervention in psychosis” for “at risk” patients. Psychiatrists are preventively diagnosing mental illness and treating people prior to them exhibiting any behavioral symptoms.

As I’ve claimed previously, Big Pharma’s crimes and cover-ups will soon make Big Tobacco’s scandals look like jaywalking. AstraZeneca’s Seroquel trial began last week, and the industry’s criminal antics surrounding anti-psychotics are coming into better focus.  Documents introduced as evidence are confirming that, like Eli Lilly with Zyprexa(Kills), AstraZeneca knowingly downplayed the fatal side-effects of their toxic pills. They covered up the fact that Seroquel causes diabetes and massive weight gain, and have been gaming the drug approval process to expand the diagnostic reach of their drugs. In a move which hits new lows, even for Pharma, documents introduced into evidence reveal sex scandals and conflicts of interest in the approval of Seroquel for treating depression, the burying of unfavourable studies, and deeper insight into the pathological cognitive dissonance underlying Pharma’s logic. Get ’em while they’re hot! 43_Exhibit 15.pdf

A few months ago the giant pharmaceutical company Pfiezer laid off 10,000 people, or about a tenth of its global workforce. There are many factors that are draining the industry of profits including the fact that patents eventually expire allowing generics to compete, it is extremely costly to develop new drugs, and the industry is caught in a vicious advertising/marketing arms race that is diverting significant percentages of development costs (in similar proportions to the marketing of a big budget Hollywood movie). There is plenty to chew on here in terms of how intellectual property laws are impacting human rights (keeping lifesaving drugs out of many patient’s reach) and the notion that as “mission critical” drugs come out of patent, drug companies are busy inventing new “lifestyle illnesses” for which they conveniently sell the cure. The concept of illness has become a major US export, as the documentary Does Your Soul Have a Cold? begins to explore. But what really caught my attention in this story is the idea that the pharmaceutical industry is witnessing a phenomena that is becoming familiar to the media/entertainment industry - the death of “hits” or the multi-billion dollar blockbuster.

The state of health coverage in the U.S. is absolutely appalling. Consider the recent incident involving Blue Cross/Blue Sheild that my friend at Interprete has had to endure, at great expense of her time and patience - Blue Cross, Blue Shield Chronicles. The notion that a latent condition is a preexisting one is preposterous - it’s like saying you were fated to have this condition, so it was pre-existing. The citizen journalism angle to this story is interesting too. It is quite remarkable how powerful google alerts can be in the hands of a PR rep or an investigative journalist, and how a mouse can roar in a way that demands a response (let’s hope that we can help insure a positive one). Subversive tactics which emply tools like Google alerts and ad-words style targeted advertising potentially refute Sunstein’s argument in republic.com about disjoint sets of users in cyberspace. His argument basically discounts the ability to spam for your cause and the value in tracking all communications around a particular issue or theme and confronting opposing viewpoints where they occur.

Freeculturenyu.org is covering an unfolding story laced with greed and deciept in the pharmaceutical industry. The freeculture angle here is that Lilly will predictably try to control this information by abusing copyright laws. However, there is another important angle to this story relating to the relationship between anonymity and free speech, especially in a world of omniscient surveillance. Tor users must remember to install both Tor and Privoxy (instructions). There is also a firefox plugin, torbutton, which makes using Tor a bit easier. From freenetproject.org’s philosophy section