Doris Bersing, PhD
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No Magic Bullet for Treating Mental Illness

Copyright by  Piotr Marcinski

Copyright by Piotr Marcinski

On a medical model oriented society, we always look for the magic bullet to cure all our illnesses. Mental Illness has not been spared of such a mythical quest. There is not one size fits all or magic bullet to makes “whole”.  People in the field of healing and psychiatry like Dr. Stan Grof , author of the holotropic paradigm shift, refers to disease like the manifestation of our “body and soul” trying to move towards wholeness. Thus, health is a total state of physical, mental,  emotional, spiritual and social well-being and yet Western medicine is poor at preventing and treating mental distress otherwise called diseases and keeps looking for the “magic bullet” to cure every disease

Referring specifically to HIV/AIDS related mental illness treatment. Dr. Thomas Insel has written “… Universal prevention has been a focus of psychiatric research for the past 4 decades. Using a public health approach, research has shown that mitigating major risk factors, such as poverty and early life stress, and promoting protective factors can improve behavioral outcomes. In other areas of medicine, we have observed how similar preventive approaches have reduced deaths from cancer and infectious disease. By contrast, while reducing environmental stress and providing better maternal support improve general behavioral outcomes (by preventing the development of antisocial behavior, for example), there are few, if any, examples of preventive approaches in psychiatry that reduce either the morbidity or the mortality of our most disabling illnesses—such as schizophrenia and bipolar disorder (Read More)

Dr. Insel expresses the needs of doing the same type of preventive work when approaching HIV/AIDS related mental illness and caution of the myth of the magic bullet. He says “…Imagine for a moment that we had the magic bullet for depression or schizophrenia or anorexia or autism. A single pill, taken once a day, safe and effective, that would immediately and continually keep all of the symptoms at bay. With this magic bullet, an end to episodes threatening job and family, no more hospitalizations, and a chance for a long life not cut short by mental illness and its complications. Now imagine that such a magic bullet existed, but only one in four people received it. Seems impossible?  (See more)

Imagine for a moment that we had the magic bullet for depression or schizophrenia or anorexia or autism. A single pill, taken once a day, safe and effective, that would immediately and continually keep all of the symptoms at bay. With this magic bullet, an end to episodes threatening job and family, no more hospitalizations, and a chance for a long life not cut short by mental illness and its complications. Now imagine that such a magic bullet existed, but only one in four people received it. Seems impossible? – See more at: http://www.psychiatrictimes.com/blogs/couch-crisis/aids-cautionary-tale?GUID=&rememberme=1&ts=15072014#sthash.LXr8RamO.dpuf
Universal prevention has been a focus of psychiatric research for the past 4 decades. Using a public health approach, research has shown that mitigating major risk factors, such as poverty and early life stress, and promoting protective factors can improve behavioral outcomes. In other areas of medicine, we have observed how similar preventive approaches have reduced deaths from cancer and infectious disease. By contrast, while reducing environmental stress and providing better maternal support improve general behavioral outcomes (by preventing the development of antisocial behavior, for example), there are few, if any, examples of preventive approaches in psychiatry that reduce either the morbidity or the mortality of our most disabling illnesses—such as schizophrenia and bipolar disorder – See more at: http://www.psychiatrictimes.com/neuropsychiatry/prevention-preemption-paradigm-shift-psychiatry#sthash.NKRl0BQW.dpu

Universal prevention has been a focus of psychiatric research for the past 4 decades. Using a public health approach, research has shown that mitigating major risk factors, such as poverty and early life stress, and promoting protective factors can improve behavioral outcomes. In other areas of medicine, we have observed how similar preventive approaches have reduced deaths from cancer and infectious disease. By contrast, while reducing environmental stress and providing better maternal support improve general behavioral outcomes (by preventing the development of antisocial behavior, for example), there are few, if any, examples of preventive approaches in psychiatry that reduce either the morbidity or the mortality of our most disabling illnesses—such as schizophrenia and bipolar disorder – See more at: http://www.psychiatrictimes.com/neuropsychiatry/prevention-preemption-paradigm-shift-psychiatry#sthash.NKRl0BQW.dpu
Universal prevention has been a focus of psychiatric research for the past 4 decades. Using a public health approach, research has shown that mitigating major risk factors, such as poverty and early life stress, and promoting protective factors can improve behavioral outcomes. In other areas of medicine, we have observed how similar preventive approaches have reduced deaths from cancer and infectious disease. By contrast, while reducing environmental stress and providing better maternal support improve general behavioral outcomes (by preventing the development of antisocial behavior, for example), there are few, if any, examples of preventive approaches in psychiatry that reduce either the morbidity or the mortality of our most disabling illnesses—such as schizophrenia and bipolar disorder – See more at: http://www.psychiatrictimes.com/neuropsychiatry/prevention-preemption-paradigm-shift-psychiatry#sthash.NKRl0BQW.dpuf

Mental Illness in HIV and AIDS: Interesting Podcast

HIV-AIDSAs we know, Mental illnesses are both caused by and causes of HIV transmission and morbidity. On a podcast published by the Psychiatric Times Magazine, Dr. Treisman from John Hopkins Hospital states”…A risk factor for HIV infection, mental illness brings a number of behavioral correlates that put patients at risk for getting infected. As HIV infection worsens, it begins to affect the brain, and a cyclical relationship between the disease and mental illness begins.

Here, Dr Glenn Treisman provides an overview of the treatment of psychiatric disorders in patients with HIV. Dr Treisman is associate professor of psychiatry at Johns Hopkins School of Medicine and Director of the AIDS Psychiatry Service at the Johns Hopkins Hospital in Baltimore. Listen to the podcast

sychiatric illnesses are both caused by and causes of HIV transmission and morbidity. A risk factor for HIV infection, mental illness brings a number of behavioral correlates that put patients at risk for getting infected. As HIV infection worsens, it begins to affect the brain, and a cyclical relationship between the disease and mental illness begins.

Here, Dr Glenn Treisman provides an overview of the treatment of psychiatric disorders in patients with HIV. Dr Treisman is associate professor of psychiatry at Johns Hopkins School of Medicine and Director of the AIDS Psychiatry Service at the Johns Hopkins Hospital in Baltimore.

– See more at: http://www.psychiatrictimes.com/dementia/treatment-psychiatric-disorders-patients-hivaids#sthash.leR9P3S0.dpuf


Chemical Imbalance and Mental Issues: An Oversimplification?

17800976_sIn Psychology and Psychiatry, there are theories of brain malfunctioning and chemical imbalance to explain the presence of symptoms or alterations we would call mental illness, too easily.  Nonetheless, beware, neurochemistry, neurophysiology, chemical imbalances, neurotransmitters have being all explanations that had tried to become the panacea that would help us understand what is inextricable and simplify the grasp of it. The most fatal blow to this “brain disease” model has been dealt by the inability of the research to validate the brain disease hypothesis. The most severe mental disorders such as schizophrenia, bipolar disorder, and major depression have been the primary targets of attempts to validate the medical model of mental suffering. Billions of dollars and thousands of research studies have gone into exactly this quest, and yet, according to a large number of highly experienced researchers, scholars and clinicians none of it is substantial. Many claim, in fact, that because the disease model continues to be unsupported in spite of the enormous amount of research that has been conducted in an attempt to validate it, the implications point strongly in the opposite direction—that these types of mental disorders are not caused by a disease of the brain.

Moreover, some doctors believe that they will help the patient feel less blameworthy by telling them,  Dr. Ronald Pies, MD wrote “You have a chemical imbalance causing your problem.” It’s easy to think you are doing the patient a favor by providing this kind of “explanation”, but often, this isn’t the case. Most of the time, the doctor knows that the “chemical balance” business is a vast oversimplification…(Read Dr. Pies’ article)

Could we say, what was first? the chemical imbalance, the symptoms, the wounds, the disease? Cd not this be a minimization of a bigger reality. What’s next? It seems that the only way to deal with this tragic dilemma is to ironically create genuine brain disease (through brain-damaging drugs, electroshock therapy, and/or other similarly harmful means) in an attempt to “deaden” you to your unbearable suffering. What came first? The egg or the chicken?


Good or Bad for Patients to Know What Therapists Think of Them?

Copyright : Steven Frame

Copyright : Steven Frame

About 700 patients at Beth Israel Deaconess Medical Center are participating in a novel experiment. Within days of a session, they can read their therapists’ notes on their computers or smartphones. It seems like open notebook study aims to improve trust, communication between patient, doctor. Some professionals oppose such an idea :…Sounds like a great idea. But when rules were changed about academic job referee reports some years ago so that the candidates could read them, all information about candidate shortcomings disappeared and only praise (sincere or not) remained. The reports became useless and appointments committees quickly learned to ignore them. The candidates who were disadvantaged were those who would have received honestly favorable reports.

One can expect an analogous effect on therapy notes that are released to the patient. Some therapists may resort to a second set of “honest” notes, the existence of which will remain secret. Or, worse for the patient, rely on their memory of the sessions. Read the article and the comments by Jan Hoffman in the New York Times


When Love Matters: Same-Sex Couples’ Children Have a Lot

                                Copyright : Maria Dubova


Copyright : Maria Dubova

The largest-ever study of same-sex parents found their children turn out healthier and happier than the general population. A study of 315 same-sex parents and 500 children in Australia found that, after correcting for socioeconomic factors, the children fared well on several measures, including asthma, dental care, behavioral issues, learning, sleep, and speech.

“…what this means is that people take on roles that are suited to their skill sets rather than falling into those gender stereotypes…At the same time, two-thirds of the parents reported a perceived stigma on at least one issue tracked by the survey. These stigmas ranged from other people gossiping about an LGBT family to same-sex parents feeling excluded at social gatherings due to their sexual orientation…” Read More

Published in Australia, the study proposes children of same-sex parents enjoy better levels of health and wellbeing than their peers from traditional family units, new Australian research suggests. Read the article So no surprises that when chosen, cherished, and desired, parenting produces more opportunities to love our children despite the gender of the parents.

 


Another Take on ADD: Trauma During Childhood

ADDAs a very good friend of mine, said when seeing this article:”…It’s about time!

People have had different takes on ADD from stating there is not a real mental illness to advocate for a cure through food and exercise. No matter what approach one takes the truth is that untreated ADD can devastate a person’s life and how helping them get on track quickly provides the biggest chance of success. Obviously there are many interventions but analyzing the cause can be a good start.

For instance, Dr. Nicole Brown’s quest to understand her misbehaving pediatric patients began with a hunch: Inattentive, hyperactive, and impulsive behavior may mirror the effects of adversity, and many doctors don’t know how—or don’t have time—to tell the difference. Brown was completing her residency at Johns Hopkins Hospital in Baltimore, when she realized that many of her low-income patients had been diagnosed with attention deficit/hyperactivity disorder (ADHD). These children lived in households and neighborhoods where violence and relentless stress prevailed. Their parents found them hard to manage and teachers described them as disruptive or inattentive. Brown knew these behaviors as classic symptoms of ADHD, a brain disorder characterized by impulsivity, hyperactivity, and an inability to focus.

When Brown looked closely, though, she saw something else: trauma. Hyper-vigilance and dissociation, for example, could be mistaken for inattention. Impulsivity might be brought on by a stress response in overdrive…” (Read More)


Because freedom can’t protect itself!

Our civil responsibility is to stay informed and support THOSE projects that represent our values. The ones that represent mine and they are not necessarily the ones to represent of all yours… but it shows one starting end to the fight and some common ground. For instance, the gossipLGBT Project works for an America free of discrimination based on sexual orientation and gender identity. This means an America where LGBT people can live openly, where our identities, relationships and families are respected, and where there is fair treatment on the job, in schools, housing, public places, health care, and government programs. Read more

We have the tendency to forget the origins/ancient institutions that fought fr our rights…only to realize that those are still the same ones that continue fighting for the same inequalities. Thus the work of the he ACLU has a long history defending the LGBT community. We brought our first LGBT rights case in 1936 and founded the LGBT Project in 1986. The ACLU’s LGBT rights strategy is based on the belief that fighting for the society we want means not just persuading judges and government officials, but ultimately changing the way society thinks about LGBT people. To end discrimination, the ACLU seeks both to change the law and to convince Americans that sexual orientation and gender identity discrimination is wrong. The ACLU carries out this work in five priority areas: Basic Rights and Liberties, Parenting, Relationships and Marriage, Youth and Schools, and Transgender Discrimination. Read More


Time To Heal: What Psychotherapy to Use?

Psychotherpay: Finding Nemo!

Copyright Teerayut Yukuntapornpong

Many patients or clients often ask what is the difference between different approaches of psychotherapy and although much has been written about, there’s no simple answer. Just as people respond differently to different drugs, you might do better with one type of therapy than with another. Many people find that a blended approach — one that draws on elements of different schools of psychotherapy — suits them best. There are many forms of psychotherapy, but some of the most popular forms are psycho-dynamic therapy, cognitive behavioral therapy, humanistic, and couples therapy, which in reality can be based on any other theoretical approach but emphasizing systems oriented therapy.

Although embracing a particular approach of psychotherapy, as a clinician, has to do with your philosophical values and your concepts of health and human potential, knowledge of what can work better or not with your clients is needed. Remember it is not about what you want or like but what could be more efficient and meaningful to your clients.

Cognitive-behavioral therapy (CBT)

CBT helps you identify self-defeating thoughts and start to develop behaviors that are more constructive. And unlike, psycho-dynamic approaches you do not need to explore into issues of the past. CBT is about what happens in your mind, now and how it affects your behavior.

Psychodynamic therapy

In contrast to CBT, which focuses on conscious thoughts, psycho-dynamic therapy emphasizes feelings that are often beneath the surface yet still influence your behavior. The goal: to help you recognize how old, unresolved problems shape the way you operate today. The therapist will guide you to recognize the links between past and present so you can become more self-aware to avoid same patterns or connections. For a comparison between psycho-dynaminc and behavioral therapy click here The Huffingon Post gave it a try as well (Read more)  And my colleague Peter Strisik, Ph.D from Alaska did a more extensive job (Read his take on it). In my own practice, I called myself a humanistic-existential psychotherapist, practicing frequently the tenants of Gestalt Therapy. Of course, at this point, they seem confused and ready to run away from something so esoteric and unpractical. Yes indeed, perhaps the big difference is we do not focus on the past but on what happens in the here and now.

Humanistic therapy

This approach establishes you as the main tool in therapy, your own healer with the potential to achieve your ultimate goals. Human resilience and self-healing are at the core of this approach. The process helps unfold your self-healing potential, stimulates creativity, and promotes personal growth.

A very simplistic way to explain it is that the existential approach in psychotherapy is organized around life on earth itself and the social, cultural and spiritual ramifications of it, that is, the “human condition.” People’s existential issues are related to their mortality and impermanence, their experience of freedom of choice (or lack of it), their sense of worthiness, and their sense of separation/connection with others. We review the contributions of Kierkegaard, Nietzsche, Heidegger, Sartre, Bugental, Binswanger, Fromm, Laing, Sullivan, May, Frankl, and Yalom. We identify five themes that pervade existentialism:

  1. Meaning in life is found in the living of each moment;
  2. Passionate commitment to a way of life, to one’s purpose and one’s relationships, is the highest form of expression of one’s humanity;
  3. All human beings have freedom of choice and responsibility for our choices
  4. Openness to experience allows for the greatest possible expansion of personal expression; and
  5. In the ever-present face of death itself, we find the deepest commitment to life itself.

We also address the relationship between experiential psychotherapy, the existential approach, and Heart-Centered therapies. Needless to say that there is not a system that can really explain the complexity to f the human phenomena and of course, there is not a system that alone can give you a quick fix or a cure. The solution is in the phenomenological understanding of the situation and of the human being involved, the comprehensive analysis of the situational elements, and of the comprehensive concept of care -versus cure- that we clinicians take into account to provide the bio-psycho-social-spiritual dimensions of care.

Nonetheless, there is enough research about the patient/client being the best agent of change and the personality of the therapist being more important than the “approach” itself. Interesting, isn’t.

You can always try to do some research when trying to find the right therapist for you but let’s say that is you are ready and the therapist has enough empathy and active listening, compassion, and of course knowledge, you will be safe independently of the “approach” she/he uses.

Good Luck and do it, it is worth it… Go find Nemo!


A Victory for Therapists and LGBT: U.S. Supreme Court Says No To Conversion Therapy

NCLR June 30, 2014

NCLR June 30, 2014

I was so happy when earlier today, I received, like many of us, an email from Kate Kendell, Esq, the fabulous executive Director for The National Center for Lesbian Rights (NCLR) saying “…Earlier today, the United States Supreme Court declined to review a challenge to California’s law—which NCLR and Equality California helped draft, pass, and defend—that protects LGBT children from conversion therapists. The decision clears the way for enforcement of the first law in the nation that protects kids from unethical counselors and therapists who engage in these dangerous practices to try to change their sexual orientation or gender expression.

For therapists all around the globe these are GREAT NEWS, as NCLR picture shows “…you can not switch off who you are…” While as many as 1 in 3 LGBT people have been subjected to conversion therapy, whether by a licensed clinician, a religious leader, or another trusted adult, the trauma of these experiences can make it difficult to come forward. (Read some survivor stories)

It is really scaring to think that professionals who had studied the harmful effects of pushing a personal agenda into a psychotherapy client can be unethically oblivious of the devastating effects of conversion therapy (Read More About Conversion Therapy

What is next? Converting people of color into white or converting right brain people onto left-brain for the sake of somebody’s new agenda or bias? Give me a break. We therapists are supposed not to harm and be the catalyst for our clients’ process, it is not our place to change anybody but help them to explore their path and desires.

NCLR has launched the project NCLR has launched Born Perfect: The Campaign to End Conversion Therapyin the next five years by passing laws across the country to protect LGBT kids, fighting in courtrooms to ensure their safety, and raising awareness about the serious harms caused by these dangerous practices.


The Forgotten Elders: They Also Benefit From Psychotherapy.

Elder WomanGeorge Kraus, a geriatric clinical psychologist debunks the stereotypes about working with elderly populations, and shares his discovery of the joy and gratitude that come from intimate contact with wise elders. He, wisely, address three important myths regarding psychotherapy and/or counseling with seniors:

  • Myth #1: Psychotherapy with the elderly is time wasted, because the elderly client has so little time to enjoy any gains that might be made.
  • Myth #2: The grief, loss, and somatic and socioeconomic burdens of the elderly are too excessive to warrant believing they could get better.
  • Myth #3: Old people are staid in their ways; they are too stubborn to change. Dr. Kraus emphasizes the fact that In America, “…we honor the young for their beauty, strength, and vitality. However, in other places on the globe, old men and women are objects of veneration. This leads to a curious consequence: the less we acknowledge what can be respected, admired, or even venerated in the parents and grandparents of the world, the more we make ourselves orphans who lose a piece of our faith, security, and connection to a past that we risk repeating. This has been part of my joy in working with older adults: I am able to honor them, to sit at their feet, marvel, and learn. As their therapist, I have become their faithful student, their privileged witness, and my life is ever richer because of it…” Read his article

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