Friday, December 24, 2010

Ontario's doctors welcome report on mental health



Please click on the image to magnify it.


A December 23rd media release from the Ontario Medical Association:
Ontario's doctors welcome the government's release of Respect, Recovery, Resilience: Recommendations for Ontario's Mental Health and Addictions Strategy, and look forward to reviewing the report in detail. The Expert Advisory Panel and the All-Party Select Committee are to be commended for the extensive work and consultation process that has been undertaken in order to develop a broad range of recommendations. Ontario's doctors are eager to get down to business with a comprehensive plan to help patients access the care they need and deserve.

"Patients with mental illness or addictions and their families have been calling for improvements for far too long," said Dr. Mark MacLeod, President of the Ontario Medical Association (OMA). "With a decade of research already completed, it's time to take action to ensure that patients have timely access to quality care."

The OMA shares many of the same concerns outlined in the report; the existing lack of service integration and access to appropriate treatment and counselling services need serious attention. More needs to be done to ensure there's a program in place to allow for a collaborative approach to coordinate their care.

"For patients living with mental illness and addiction, time is crucial. We have to identify and implement the best methods to reduce wait times for patients requiring specialized psychiatric care to ensure that they receive the care they so urgently need." Dr. Desi Brownstone, Chair, OMA Section of Psychiatry

"Patients deserve a coordinated effort to give them the opportunity to live fulfilling lives which goes beyond the boundaries of medicine. We need to do a better job of providing social supports such as housing and employment for our patients. This will go a long way in addressing the well-being of patients in Ontario. This is important for all patients, but particularly applies to patients with mental illness, where a collaborative approach within and beyond medicine will better meet their needs." Dr. Ross Male, Chair, OMA Section of General and Family Practice

"Children and young adults suffering from mental illness and addictions are falling through the cracks of the health care system. We need to ensure our children have timely access to the care they need which is close to home and coordinated by their community paediatrician, to help manage their illness and their lives. We need to work together to implement a strategy that addresses the gaps in patient care, that children and their families face every day." Dr. Hirotaka Yamashiro, Chair, Pediatrics Section, OMA


For further information:

Contact OMA Media Relations at 416-340-2862 or 1-800-268-7215 ext. 2862

Monday, December 20, 2010

One mom's fight to get her daughter help



And article posted on December 15th by MSN News:
By Michael MacDonald, The Canadian Press

Maureen Bilerman [pictured, left] knew something was wrong when her normally shy 13-year-old daughter suddenly became incorrigible, her thoughts and actions disjointed, sometimes destructive.

"It was a light-switch effect," recalls the mother of two, her even tone hinting she has told this story many times before. "She cut our leather chair ... and became really defiant in a way she never was. Her thinking became skewed, distorted. So we right away tried to get her help."

But Bilerman's sense of urgency soon turned to frustration and anger — raw emotions common among parents and critics across Canada who say provincial governments are failing mentally ill children and youth.

"We're the best-case scenario and she's still falling through the cracks," says Bilerman, a newly minted mental health activist who has struggled for the past three years to get her daughter Sarah the help she needs.

Unfortunately, her story is not that unusual.

In a typical Canadian class of 30 students, six will suffer from some form of mental illness, but only one will receive treatment.

"I don't care in what province you're talking about, what town or what service you're looking for, you will find a waiting list that is unacceptable," says pediatrician Diane Sacks, a mental health expert and a member of the Mental Health Commission of Canada.

"There's just not enough services for kids."

For Bilerman, a writer with a background in marketing and broadcasting, that harsh reality became apparent in the spring of 2008, when Sarah overdosed on a bottle of Tylenol.

At the hospital, she was told all six beds at the Child and Adolescent Psychiatric Unit at the Moncton Hospital were full.

"They said, 'There's nothing we can do.' So they sent us home."

But Sarah was still having suicidal thoughts.

For the next six weeks, Bilerman monitored the girl 24 hours a day.

"She would be at the end of her rope, beyond suicidal, in a total state," Bilerman says, adding that the pair would head to the local emergency ward almost every week.

Again and again, they were told the Moncton facility was full and there was no other place for them to go.

The girl was prescribed drugs to stabilize her moods, but they didn't help much.

Bilerman didn't give up. She pushed hard, finally persuading health officials to admit her daughter to the unit, where a month-long stay produced a diagnosis of bipolar disorder, otherwise known as manic-depressive illness.

By that time, it had been almost a year since Sarah started showing signs of mental distress.

The diagnosis represented a big step forward for the Bilerman family, but it was only the beginning of another difficult journey.

Sarah, now 16, has since overdosed three more times.

Doctors have prescribed 20 different combinations of medication, none of which have stabilized her for very long.

The girl often stays out all night long, leaving her mother worried for her safety.

The constant stress has left its mark on the rest of Bilerman's family, which includes husband Shawn and 13-year-old daughter Rachel.

However, Bilerman's life took a sudden, positive turn four months ago when she heard a radio interview with the province's child and youth advocate, Bernard Richard.

The former cabinet minister, who is pushing for creation of a centre for children and youth with "complex needs," inspired Bilerman to take action.

She later learned that Richard has been advocating for a short-term treatment and co-ordination centre ever since he completed a disturbing report in 2008, titled Connecting the Dots.

"It was like the story of our life," says Bilerman, who recently founded DOTS NB, which stands for Development of Treatment Services for mental health in New Brunswick.

Richard's report includes graphic accounts of the challenges faced by children and youth with mental illness, suggesting too many of them are ending up in jail, penalized for behaviour that requires treatment, not punishment.

The proposed centre would offer a safe place for youth in crisis, intensive help for families dealing with mental illness and programs that would help troubled children and youth make the transition back into the community.

"The response has been amazing," Bilerman says, adding that she has been delivering speeches — up to five a day — to universities, churches, service groups and other groups.

Earlier this month, Bilerman led about 1,000 people in an unusual demonstration that grabbed the attention of the provincial government. At one point, the protesters joined hands, creating a kilometre-long human chain linking Fredericton's community mental health centre with the provincial legislature — a symbolic connecting of the dots.

Later, Bilerman presented Premier David Alward with hundreds of letters that tell stories similar to her own.

Bilerman wants Alward to approve Richard's proposal.

"It's integration of services across the province and closing some of the gaps that we know youth are falling through," she said after the rally.

Richard said the government has to act.

"When we don't provide the right responses to these kids, they end up in the justice system, in the prison system, over and over again costing millions of dollars over their lifetime," he said. "That's not to mention the hurt and damage they cause to their families, to themselves, and their neighbours and friends."

Alward said the province must do better.

"We have a responsibility, certainly as a people in New Brunswick, to move forward," he said.

The province's social development minister, Sue Stultz, says she is awaiting Richard's final report early next year before deciding how to proceed.

Photograph by David Smith, The Canadian Press

Sunday, December 19, 2010

Mental health, the criminal justice system, and you: Understanding the process, and the people that can help



Please click on the image to magnify it.


Posted by the Grand River (Ontario) Branch of the Canadian Mental Health Association:
Published by the Kitchener Human Services and Justice Coordinating Committee, this booklet is an introductory guide to the criminal justice system. With special emphasis on the Region of Waterloo Mental Health Court, this publication is aimed at helping those with mental health issues who have been charged with a criminal offence as they navigate their way through the court process. While it cannot replace the services of a criminal defence lawyer, it does provide basic information and a list of community resources that can help those with mental health issues. The booklet is dedicated to the memory of Martin Tarback, a fixture on the streets of Waterloo for over 20 years, whose schizophrenia pulled him away from a loving family and friends at a young age, but whose spirit and courage was an inspiration to many.

To download the entire booklet, please click here (PDF).

Wednesday, December 15, 2010

Committed to improvement


A letter to the editor published in today's edition of The Chronicle Herald:
I am disappointed in the comments in your newspaper of Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia, that recommendations from the Hyde report will not be instituted quickly and suggesting a lack of action on my part.

Judge Anne Derrick’s first recommendation in her report was that the provincial government needs to develop a mental health strategy. Before her report was even written, I had appointed a mental health strategy advisory committee representing a board spectrum of people with first hand-knowledge of the justice system, schizophrenia and other mental illnesses and disorders. Work on the strategy is well underway and we will provide for consultation in the New Year. The president of the Schizophrenia Society of Nova Scotia is on this committee.

Additionally, I have visited Mental Health Services at Capital Health and at the IWK Health Centre to discuss what can be done to improve wait times and program outcomes, and steps are being taken on these fronts. Our government’s first budget included funding for an expanded Mobile Crisis Service here in the Capital District.

Is there more to do? Absolutely, and I am committed to seeing that it is done. Mental health services are an integral part of Better Care Sooner, our plan to implement the Ross report. Judge Derrick’s extensive recommendations offer an opportunity for Nova Scotia’s justice and health care systems to make real and positive changes — and we will.

Maureen MacDonald, Minister of Health

Monday, December 13, 2010

Changing attitudes about mental illness


An article published in today's edition of The Chronicle Herald:
Hyde Report a positive step, says schizophrenia society boss

By Ian Fairclough | FIVE QUESTIONS

Last week, a provincial court judge released a long-awaited report from the inquiry into the death of Howard Hyde, a Nova Scotia man with schizophrenia who died in jail a day after being arrested by police.

The report contained 80 recommendations and was welcomed by Stephen Ayer [pictured], the executive director of the Schizophrenia Society of Nova Scotia.

Q: What’s the most important lesson to be learned from the death of Howard Hyde?

A: There are three really important lessons; it’s hard to pick one of them.

The most important lesson is a combination of the need for increased education around mental illness and what to do when encountering a person who is in a state of psychosis.

There is also the need for communication not only with the individual who is in the psychotic state, but also communication between different agencies that would be interacting with that person, from the mobile mental health crisis team to 911 to the responding officers. Communications has to be better.

In relation to that is response. If we could increase the education and training of people who respond to situations where an individual is in a crisis with a psychotic episode, they would be able to communicate effectively between themselves and the other agencies or services involved, and then the response would be the most appropriate response for that individual.

Q: What’s the first thing that should be done?

A: We have to have some empathy and some humanity in terms of dealing with people who have a psychiatric emergency, no matter what the circumstances may be.

Q: What do you think it would take to change the way police and the justice system deal with mental health consumers?

A: One of the deputy sheriffs did a great job trying to calm Mr. Hyde down to the best of his ability. He took two hours to talk to Howard Hyde to get some insight into what was going on, so there are people who are understanding and empathetic within the system already.

I’m sure there are more than (him). I think police and correctional services need to take a look at their staff and identify people who would be most appropriate for training in regard to working with people who are having a psychiatric emergency and being able to understand how to deal with it appropriately and get the person the help they need.

Q: How are the supporters of people with schizophrenia reacting to the results of the inquiry?

A: Very positively, and I am as well.

As I reflect now on the report and having delved deeper into it over the last couple of days, my response is the same as it was initially. This is an incredible piece of work by an incredible person — Judge Derrick — and when this was released, I said it’s a watershed day for the people of Nova Scotia and all people who live with mental illness in their families. It’s so comprehensive and the recommendations are so thorough and so important. I continue to believe that and hope the report will be taken seriously by government and others who need to make changes within the way they provide services.

Q: How optimistic are you that at least some of these recommendations will be instituted quickly, and how likely do you think it is that they’ll all be accepted?

A: In terms of the word quickly, I’m not very optimistic at all. In fact, I’m quite pessimistic, because this government has shown that even though it talks the talk, so to speak, and we have a health minister who is a former social worker and who worked at the Nova Scotia Hospital years ago and campaigned on the fact that mental health was going to be a high priority, when push comes to shove and the rubber hits the road, she’s nowhere to be found in terms of making some changes.

That includes support for community organizations such as ours that are on the front lines dealing with crisis calls.


BY THE NUMBERS
  • About one per cent of Nova Scotians are living with schizophrenia.
  • About 23,000 family members are affected by schizophrenia in that they are trying to help their loved ones deal with it.
  • About 30 per cent of people with schizophrenia completely recover, and another 40 per cent recover well enough to work with limitations. The other 30 per cent are so affected they are difficult to treat.
  • The Hyde Inquiry [report] contained 80 recommendations among its 462 pages.
  • In the past year, the Schizophrenia Society of Nova Scotia answered more than 500 crisis calls and provided advice, information and assistance.
Source: Schizophrenia Society of Nova Scotia


(ifairclough@herald.ca)
Photograph by Peter Parsons, The Chronicle Herald.

Saturday, December 11, 2010

Hyde report: Call to action



An editorial published in the December 10th edition of The Chronicle Herald:
In Judge Anne Derrick, Howard Hyde finally has an advocate who sees the bigger pic­ture. Sadly, proper perspective is the very thing he desperately needed from someone — anyone — the day he died three years ago.

That much is obvious from reading Judge Derrick’s findings into the chain of events that led to the death of this emotionally disturbed man. But those who comb through the inquiry report looking to pin blame will be disappoint­ed. Howard Hyde — who suffered from schizo­phrenia, was off his medications and experi­encing psychosis — was not a victim of in­competence. He was a victim of incoherence.

During every step of his odyssey in police, medical, court and correctional custody, Mr. Hyde came across professionals acting profes­sionally. Even the most controversial and publi­cized episode — which led to Mr. Hyde’s mul­tiple Tasering at a Dartmouth police station — is not a slam-dunk of police misbehaviour.

Judge Derrick notes that the booking officer who produced a tool with which to cut the lace on Mr. Hyde’s shorts before putting him in a cell did not mean to provoke or panic him.

“S/Cst. MacCormick uttered the words: ‘We’ll have to cut one of those balls off’ innocently, with no appreciation of the effect they would have on Mr. Hyde," she wrote.

Judge Derrick makes it clear that the Taser­ing did not cause Mr. Hyde’s death. Nor did he die of schizophrenia, as the medical examiner unhelpfully concluded. He did die some 30 hours later as a result of a struggle with Burn­side jail correctional officers whose use of force, and of a restraint hold, she determined to be “reasonable and proportionate."

Ultimately, the real problem was not the performance of Mr. Hyde’s custodians per se, but crucial omissions cascading through the chain of custody. From the moment he was first picked up by police on a domestic abuse com­plaint, a pattern developed whereby relevant facts weren’t passed along. Legal and medical professionals got their wires crossed, made incorrect assumptions, acted on incomplete information. Cops were unaware of mental health resources available to them and guards didn’t know how to de-escalate confrontations with the emotionally disturbed.

Clearly, the province must begin by training its sights on retraining front-line staff.

(edits@herald.ca)

Friday, December 10, 2010

Hyde’s partner praises inquiry findings


An article published in today's edition of The Chronicle Herald:
By Clare Mellor

Karen Ellet [pictured] says she still mis­ses Howard Hyde’s amazing voice.

“I miss his voice, his beauti­ful singing voice," the Dart­mouth woman said Thursday.

Ellet, who was Hyde’s com­mon- law wife, said she has been dealing with her grief since he died on Nov. 22, 2007, after a violent conflict with jail guards at the Central Nova Scotia Correctional Facility in Dartmouth.

But she is taking comfort in the recommendations result­ing from the provincial inquiry into his death.

If the suggestions outlined in a report released Wednesday are adopted, they will make a huge difference in the way mentally ill people in crisis are dealt with, Ellet said.

“I am very pleased. She is a very compassionate judge," she said of Anne Derrick, the provincial court judge who helmed the 11-month fatality inquiry.

She said Hyde would be pleased with Derrick’s report, too.

“He would be ecstatic about it," Ellet said. “He would like to see (the recommendations) implemented, so the (report) is not sitting on a library shelf."

In her report, Derrick rejected a medical examiner’s conclusion that Hyde died of excited delirium and found in­stead that the struggle with the jail guards played a role in his death.

Hyde, a 45-year-old musician who was diagnosed with schizo­phrenia in his 20s, was having a psychotic episode at the jail when he was forced to lie on his stomach with his hands behind his back. The restraint technique may have interfered with his ability to breathe, Derrick found.

“He did not die because he was mentally ill," she wrote in her report.

Ellet said she still has difficulty thinking of the emotional and physical pain that Hyde endured in the last 30 hours of his life.

On the night of Nov. 21, 2007, Ellet called a crisis hotline to complain that Hyde had assault­ed her while in a psychotic state.

Police arrested Hyde, but not before Ellet told them her hus­band had not been taking his medication and needed psychiat­ric help.

“Howard didn’t understand why he was in jail," she said. “He couldn’t comprehend his sur­roundings."

Ellet said she has been keeping a low profile due to her grief, but she believes it is important for her to speak up about the changes she thinks Hyde would have wanted to see in the justice system and in society at large.

“I believe he would want to have a professional such as a mental health provider to be with people who have a mental illness when they are in crisis, to speak on behalf of them," she said.

Ellet said Hyde would want all professionals to be issued hand­books so they could learn more about the signs and symptoms of mental illness and how to handle somebody who is having a psy­chotic episode. “Howard would want more housing available (for mentally ill people)," she said. “Howard found it horrific to know that people with mental illness are living in shelters and on the streets. It really upset him. He wished he could have done something but he didn’t know what to do."

Ellet said Hyde also would have wanted more research into the development of psychiatric drugs.

“Not all medications agree with each particular person," she said. “There are so many side­effects."

More mental health funding and clubhouses, support groups and associations in support of the mentally ill would also be on Hyde’s list, Ellet said.

“I believe there is a large amount of fundraising that can make miracles happen to help (prevent) people with mental challenges from living on the streets," she said.

“Mental illness is no different from somebody walking around with diabetes."

Some of Derrick’s recommen­dations concern stun guns — she said they should not be used on people in a state of agitation due to a psychological disturbance, and changes should be made in the training for how to use them.

The judge also recommended that crisis intervention training be provided to all correctional officers at the Dartmouth jail and that several aspects of training in general be improved for jail guards in the province and for front-line police officers and doctors.

Ellet said it is poignant that the report on Hyde’s death came out on the 30th anniversary of the murder of John Lennon.

Hyde, who sang and played the saxophone, was also an extraor­dinary musician, she said.

“Howard had the musical ability to play anything," she said. “He had the most astound­ing voice you can imagine."

Also like Lennon, Hyde de­spised war. “He just wanted peace in the world," Ellet said.

(cmellor@herald.ca)

Also see:

N.S. to factor Hyde inquiry into mental health plan


Photo credit

Thursday, December 9, 2010

Culture shift needed in society, system


An opinion piece published in today's edition of The Chronicle Herald:

By Marilla Stephenson (pictured)

In the end, who failed Howard Hyde?

Perhaps, to some degree, we all did.

There is really no way to dress up the realities of mental illness. It is not pretty, and it can be a very tough challenge to support people in crisis. The people who live closest to those who suffer from mental illnesses are victims of the illnesses, too.

There is also no way to disguise or excuse how our society has continued to respond to people who experience mental illnesses. The stigmas are clear and well understood, even by young children in our schools. The branding begins early.

Hyde is the Dartmouth man who died in custody in 2007. He suffered from schizophrenia. The police were told of his mental illness when he was taken into custody over allegations of domestic abuse. He later died after an intense struggle with prison guards.

Provincial court Judge Anne Derrick released the fatal inquiry report into Hyde’s death on Wednesday. She firmly rejected a previous finding by a pathologist that he had died due to a condition termed "excited delirium."

Derrick dismissed that finding as a "red herring" that did not exist in Hyde’s case.

She also found that while the repeated use of a Taser on Hyde during his time in police custody "worsened the situation," it was not the cause of his death. She did, however, remind justice officials that so-called stun guns are to be used as an alternative to lethal force rather than as a front-line option to subdue suspects who are emotionally disturbed.

His death was accidental, Derrick found, but it came as a direct result of his struggle with prison guards.

In the comprehensive list of 80 recommendations, Derrick tossed the ball firmly into the hands of the provincial government.

She begins by calling for the establishment of a long-promised, but still absent, mental health strategy. It is clearly not by accident that this basic framework is at the top of the list as a necessary building block from which other improvements would naturally evolve.

The judge also calls on the province to increase funding for mental health, but not to do it by reallocating funds from within the existing envelope of health-care funding. This reflects the fact that mental health issues have for too long languished on the list of health-care priorities.

We are left with a fractured, often inaccessible mental health system where vanishing waiting lists are proudly waved around by government as proof of treatment for patients. Improvements are being made, and Derrick’s report makes note of policy changes that have already occurred in the justice system in the wake of Hyde’s death.

But it is hard to comprehend that none of the guards involved in the struggle with Hyde minutes before he died had any training to help them deal with prisoners who suffer from mental illness.

One seemingly innocuous recommendation, No. 49 on Derrick’s list, speaks volumes. Directed at justice system staff and other front-line officials who are in contact with prisoners who suffer from mental illness, it is brief and to the point:

"Training should have, as its overarching purpose, the development of a culture of respect and empathy for persons with mental illness in the justice system."

This is a statement that reaches beyond the justice system and into our society as a whole. While mountains have been moved in reducing the acceptance of stereotypes linked to mental illnesses, many of the most basic government services — justice and health among them — are still handcuffed by systemic ignorance.

The judge called for alternatives for people with mental illness who come in conflict with the law, and says the responsibility reaches well beyond the justice system.

"As the evidence before the inquiry has vividly illustrated, grasping this nettle is not just the responsibility of the justice system; creativity and commitment to change are required of the health system and the community, too."

The principles of respect and empathy provide a good place from which to start.

( mstephenson@herald.ca)

Also see:

Howard Hyde Inquiry Ignores Ableism As Cause of Death


Photo credit

Report: Fatality Inquiry into the Death of Howard Hyde


The Honourable Judge Anne S. Derrick (pictured) filed her report from the Fatality Inquiry into the Death of Howard Hyde on Wednesday, December 8th, 2010.

The report is available by clicking here (PDF).

Video recordings of all the Inquiry hearings are available by clicking here.

Image credit

Also see:

Jailhouse restraint blamed

Sunday, December 5, 2010

Patients' Souls Called Medicine's Missing Link

An article published in the December 3rd edition of Psychiatric News:
By Mark Moran

Small changes, beginning with the attitude clinicians bring to a patient encounter, can transform psychiatric and other medical care.

The notion that your patients have a “soul” and that your treatments can touch or transform something less (or more) substantial than a neurotransmitter may sound, in the context of modern biomedical science, quaint today.

But author and psychotherapist Thomas Moore, Ph.D. {pictured], believes the souls of patients in the care of modern medicine are in need of urgent attention. And so too, he says, are the souls of their doctors.

Moore is the bestselling author of The Care of the Soul: A Guide for Cultivating Depth and Sacredness in Everyday Life, the 1992 book that asserted that the greatest poverty in today's technologically triumphant culture is a lack of attention to the soul.

In a new work, Care of the Soul in Medicine, published this year by Hay House Publishers, Moore asserts that this soul-poverty extends to modern medicine.

In an interview with Psychiatric News, Moore said modern medical care has come to be dominated by a highly mechanistic philosophy deriving from the relatively recent 18th century while jettisoning a far more ancient wisdom about care of the soul that dates to the time of classical philosophers.

Much of his new book is focused on care of the soul in general-medical settings, especially in hospitals and in the care of the dying. But Moore said the message of his book should resonate with psychiatrists.

“I understand the field has become more biological,” he said. “My sense is that people entering medicine today get this very intelligent, up-to-date training in biomedical science. And when I talk to psychiatrists about a spiritual approach to healing, it doesn't seem to them to have that intelligence behind it.

“But I would want psychiatrists to know there is a whole world of knowledge and wisdom outside the biological tradition that goes back several thousand years,” Moore said. “They should give a philosophical and spiritual approach to the patients in their care another look, and they may find that it can be very substantive and would complement their biological work.”

Transforming the Medical Setting

But what is the “soul,” and how does one care for it?

The question itself invites speculation that has kept philosophers busy for centuries. But for the purpose of his book and his message to physicians, Moore speaks of the soul as where one cradles the meaning of one's relationships and memories, the sense of mystery about one's own life, and one's understanding of the meaning of illness and death.

To care for the soul in medicine then would be to adopt practices that seek not just the “cure” of disorders, but care for and attention to patients' significant relationships, poignant memories, spiritual quests and interests, as well as their understanding of their illness. Such an approach, he believes, calls for changes in the way doctors are trained and in the way they approach their patients, but it also entails a transformation of the settings in which care is provided to include incorporation of nature, art, and music into the architecture of hospitals and doctors' offices.

His remedies for what ails modern medicine may seem to some either quixotic or “unscientific” (or even “antiscientific”), but his thoughts echo those of such respected thinkers as biomedical ethicist Daniel Callahan, Ph.D., who has written extensively of the need to return to “caring over curing.”

“You don't have to talk too long to patients and their families, as well as doctors and nurses, before they express a common feeling that contemporary medicine, for all its technological virtuosity, lacks something,” he said. “Patients and families will talk about how the medical establishment is just so huge and they feel like a piece of machinery. When I tell them about how images and architecture can transform a healing environment—about how the way a hospital room looks and feels can be a part of healing—they are a little surprised, but they know what I am saying. So I seem to be giving people a language for talking about things they know intuitively.”

Moore is careful not to be critical of physicians — “they get enough criticism,” he said—and noted that after the success of his 1992 book, it was the medical establishment that came to him. As part of his research for the book, he was invited to spend two days each month over a two-year period at St. Francis Hospital in Hartford, Conn.

“When I first wrote Care of the Soul, I didn't have medicine in mind at all,” Moore said. “But I began getting invitations to talk at medical schools, and right up to the present time I have been visiting medical schools, hospitals, and cancer wards all over the country and in Ireland.”

Reclaiming an Ancient Wisdom of the Soul

What does Moore, an admirer of Carl Jung (but he is not, he said, a Jungian), think of the widespread use of pharmacologic agents to treat psychiatric disorders?

“It's a complicated issue, and I have nothing against the use of pharmacologic treatments in conjunction with other approaches,” he said. “But I think it goes hand in hand with the prevailing philosophy of our time that is based on treating people as mechanical systems. If you see the brain as a collection of neurochemicals, you are going to use chemicals to treat people.

“That's the underlying mythology of our time. It is useful as far as it goes, but I think it leaves much to be desired and ignores a vast trove of wisdom about the soul that predates the 20th century.”

His recommendations for reform seem to require changes in a medical system that is itself vast and unwieldy. But Moore believes that even small changes—beginning with the attitude clinicians bring to a patient encounter—can be transformative, even of a 15-minute med check.

“I think psychiatrists would find their work so much more pleasurable and fulfilling if they could reach past the prevalent biological view of a human being and enjoy the complexity of human life,” Moore said. “They could allow themselves to be instructed by the arts, by fiction and drama, painting and music and allow those to inform their practice. It would humanize their work so that they would have a warmer and more fulfilling experience in a context that would be incredibly rich, even if they only had 15 minutes.”

It's not the amount of time spent with a patient that's key, he said. “I can spend 50 minutes with a patient and it seems like nothing. It's where you are coming from that makes the difference.”

Photo courtesy of Thomas Moore, Ph.D.

Saturday, December 4, 2010

Gene-Environment Interactions Could Influence Several Psychiatric Disorders; 'Schizophrenia Gene' May Also Trigger Anxiety, Depression


A December 3rd media release from Johns Hopkins University:
BALTIMORE, Dec. 3 (AScribe Newswire) -- Male mice born with a genetic mutation that's believed to make humans more susceptible to schizophrenia develop behaviors that mimic other major psychiatric illnesses when their mothers are exposed to an assault to the immune system while pregnant, according to new Johns Hopkins research.

What was most surprising to researchers was that the mental illnesses the mice developed didn't look like schizophrenia, which they were genetically predisposed to, but more like mood and anxiety disorders, suggesting that one gene mutation can lead to different mental illnesses when influenced by the same environmental factor.

"Psychiatric diseases have genetic roots, but genes alone do not explain the entire disease," says Mikhail V. Pletnikov, M.D., Ph.D. [pictured], an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the study's leader. "When we study genes in conjunction with environmental challenges, we can better understand how diseases develop."

Pletnikov hopes his research, which appears in the December issue of the journal Biological Psychiatry, may be a small step toward eventually finding ways to prevent mental illnesses in humans. "The main goal here is to understand how gene-environment interactions take place on the molecular level so that you can find suitable drug targets, ultimately stopping these diseases before they happen," he says. "It all can start before birth."

Pletnikov and his team studied a mutant human form of the Disrupted-in-Schizophrenia 1 gene (mhDISC1), breeding mice in the laboratory with this mutation. This genetic variation is believed to be associated with vulnerability to major mental illnesses in humans. The mhDISC1 mice were impregnated, and at the ninth day of gestation (the equivalent to the middle or end of the first trimester in a human pregnancy), one group was given a drug to stimulate the immune system, forcing it to react as if it had been exposed to a virus like influenza or a parasite like toxoplasma. The rest of the pregnant mice - whose fetuses also had the mutated gene- were kept as a control group and their immune systems were left unchallenged.

The study found that prenatal immune stimulation in mhDISC1 mice produced behavioral abnormalities that were not present in the unchallenged mice: elevated anxiety, depression-like responses, an altered pattern of sociability and a weakened response to stress. The unchallenged mice did not show those behaviors, even though they also had the mutant gene. Pletnikov says the findings suggest that the same mutation, in this case mhDISC1, can lead to different illnesses, depending on interactions with environmental factors.

This may provide an explanation, he says, for why the extended Scottish family in which scientists first discovered this genetic mutation had members who suffered not solely from schizophrenia but also from major depression and bipolar disorder. "This one gene mutation can lead to very different clinical manifestations," Pletnikov says.

Along with the behavior differences, Pletnikov and his team also found that parts of the brain, including the amygdala and the hypothalamus, were smaller in the mice that had been prenatally challenged. A similar abnormality can be found in those same areas of the brain in humans with major depression and bipolar disorder.

Previous studies have suggested that the prenatal immune response to a microbe - be it a major illness or just transient flu-like symptoms barely noticed by the pregnant woman - may be responsible for the increased incidence of adult psychopathology in humans. But this hypothesis, Pletnikov says, has been difficult to prove. Using this mouse model, he suggests, is a valuable way to study the relationship between gene-environment interactions and mental illness, and should be replicated to find more of these interactions to gain a better understanding of these relationships.

Future studies, he says, will try to sort out whether different timing or stimulating different parts of the immune system might lead to specific types of mental illness, as well as explore the consequences of other environmental adverse events such as stress or drug abuse.

Other Johns Hopkins researchers on the study include Bagrat Abazyan, M.D.; Jun Nomura, Ph.D.; Geetha Kannan; Koko Ishizuka, Ph.D.; Kellie L. Tamashiro, Ph.D.; Frederick Nucifora, Ph.D.; Vladimir Pogorelov, Ph.D.; Chunxia Yang; Carlos Pardo, M.D.; Susumu Mori, Ph.D.; Atsushi Kamiya, M.D., Ph.D.; Akira Sawa, M.D., Ph.D.; and Christopher A. Ross, M.D., Ph.D.

The study was supported by the National Institute of Mental Health, Autism Speaks, the National Alliance for Research on Schizophrenia and Depression, the Mortimer W. Sackler Foundation, the Cell Science Research Foundation and the National Institutes of Health/National Institute on Drug Abuse-Intramural Research Program.

For more information: http://www.hopkinsmedicine.org/psychiatry/research/neurobiology/research_labs/behavioral_pletnikov.html

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CONTACT: Stephanie Desmon, Johns Hopkins Medicine Media Relations and Public Affairs, 410-955-8665, sdesmon1@jhmi.edu

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Friday, December 3, 2010