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Archive for the ‘Mental Illness’ Category

Psychopathy: Is It In You?

Posted by dlende on May 3, 2010

By Kevin Brandenberg & J.P. Malette

When one considers crime and its relationship to society, psychopathic behavior remains one of the most mysterious and intriguing conditions of the human mind. Psychopathy describes individuals who, put simply, don’t have a conscience and thus commit actions, often times illegal, without any moral consideration.

Gatorade, the popular sports drink, uses its slogan “Is it in you?” to describe the competitive drive in athletes, which is presumably enhanced by drinking their product. Just like the Gatorade slogan suggests about athletes, is pyschopathy a condition simply found in some and not in others? Or are there other factors that go into this serious mental condition? This post will explore the mental condition behind psychopathic behavior, how it differs from the normal human condition, and how it relates to the treatment of crime in society.

Psychopathy: What Is It?

While not always associated with crime, psychopathic behavior often comes up as a reason for and a cause of both small and horrendous crimes. A recent review indicates psychopathy is an accurate indicator of a person’s susceptibility to criminal behavior and violence.

“Although psychopaths make up only 4% of the total population, they represent about 50% of serial rapists, as well as a significant proportion of persistent wife batterers. Overall, psychopaths are twice as likely to reoffend as other criminals, and three times as likely to commit violent acts again after being convicted.” (Copley 2008)

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Posted in general, Human variation, Mental Illness, Violence | 10 Comments »

Public Release of the DSM-5 Draft

Posted by dlende on February 13, 2010

The draft of the DSM-5, the Diagnostic and Statistical Manual, was released this week. This guide to the diagnosis of mental and behavioral health problems will shape the delivery of psychological, psychiatric, and social care for years to come.

You can access the entire draft here at the American Psychiatric Association DSM-5 Development Website. There the APA writes about the comment policy:

The draft disorders and disorder criteria that have been proposed by the DSM-5 Work Groups can be found on these pages. Use the links below to read about proposed changes to the disorders that interest you. Please note that the proposed criteria listed here are not final. These are initial drafts of the recommendations that have been made to date by the DSM-5 Work Groups. Viewers will be able to submit comments until April 20, 2010. After that time, this site will be available for viewing only.

It is interesting to note that the APA included a press release announcing that the DSM-5 Development Process Includes Emphasis on Gender and Cultural Sensitivity.

Actual proposed changes are set up in an interesting way. The opening tab is the proposed revision, but there is also are rationale, severity, and DSM-IV tabs. So it does provide more information than one might think.

So, as one major example, Major Depressive Disorder, Recurrent, has an extensive draft proposal for the DSM-5. Here the rationale isn’t that great, since it largely focuses on single episodes of depression. On the severity side, it’s clear what the APA group is thinking about in terms of differential ratings. And it’s easy to compare the DSM-5 with the DSM-IV criteria.

Vaughan Bell at Mind Hacks includes some extensive commentary, and a wealth of links, on the DSM-5 Draft in the piece The Draft of the New ‘Psychiatric Bible’ Is Published. He opens by saying:

It’s a masterpiece of compromise – intended to be largely backwardly compatible, so most psychiatrists could just get on diagnosing the few major mental illnesses that all clinicians recognise in the same way they always did, with some extra features if you’re an advanced user.

One of the most striking extra features is the addition of dimensions. These are essentially mini questionnaire-like ratings that allow the extent of a condition to be numerically rated, rather than just relying on a ‘you have it or you do not’ categorical diagnosis.

John Grohol, writing over at Psych Central, also provides an initial overview of the main changes in the DSM-V and then provides a review that features the good, the bad and the ugly.

If you’re looking for just the critical, the Psychiatric Times has a piece Opening Pandora’s Box: The 19 Worst Suggestions For DSM-5. Dr. Allen Frances, who chaired the DSM-IV Task Force, identifies two areas that are quite worrisome (and predictable) for a critical medical anthropologist:

(1) Dramatically higher rates of mental disorder, including “millions of newly misidentified false positive ‘patients’ [and] massive overtreatment with medications that are unnecessary, expensive, and often quite harmful”

(2) Unforeseen consequences, where DSM5 options often have an “insensitivity to possible misuse in forensic settings. Work Group members cannot be expected to anticipate the many ways lawyers will try to twist their good intentions.”

You can explore the legal aspects more over at In the News.

For specific diagnoses, Dr. Petra has particularly good coverage on the proposed changes in sexual disorders. Liz Spikol looks at the diagnosis of childhood bipolar disorder with a critical eye.

For more reading, Furious Seasons has some good initial thoughts on the DSM-5. Additional coverage can be found at the NY Times and New Scientist.

Posted in Medical anthropology, Mental Illness | 1 Comment »

Cross-Cultural Psychiatry: A Special Report from Psychiatric Times

Posted by dlende on February 10, 2010


Psychiatric Times issues periodic special reports, and the latest one features a wealth of articles and ideas on cross-cultural psychiatry.

Ronald Wintrob, chair of the World Psychiatric Association–Transcultural Psychiatry Section, writes the Introduction to Cross-Cultural Psychiatry for this special report. He notes how migration has increased over the past 20 years, and that 12.86% of the US population are immigrants. Psychiatrists have put increasing effort into engaging these populations.

One of the most practical applications of cultural psychiatry to clinical practice in all fields of medicine is the open-ended questioning of patients and their families about their personal and family background characteristics. This includes identifying features of race, ethnicity, religion, and socioeconomic class, relevant immigration history, experiences of acculturative stress, and personal and family aspirations. A discussion of these background characteristics can lead naturally to the clinician’s exploration of the presenting clinical symptoms and history. Knowledge of the patient’s background will increase rapport with patients and families and aid the process of collecting a more reliable history. In addition, it will improve the likelihood of treatment adherence. This process has been described as “cultural case formulation.”

Three main articles comprise the special issue:

Religion, Spirituality, and Mental Health by Simon Dein, senior lecturer of anthropology and medicine at University College London. This piece provides an in-depth examination of what is currently known about the relationships between religion and mental health, and also includes a handy set of four check points that summarize the main themes of the article.

Cultural Considerations in Child and Adolescent Psychiatry, by Toby Measham, Jaswant Guzder, Cécile Rousseau, and Lucie Nadeau, all in the department of psychiatry at McGill, which presents a series of guidelines and suggestions for how to handle cross-cultural issues in practice with children and adolescents

Cultural and Ethnic Issues in Psychopharmacology, by Keh-Ming Lin, professor emeritus in psychiatry at UCLA. This piece goes from the placebo effect to genetic variation, and argues that “cultural and ethnic influences… should be regarded as central in determining the success of treatment interventions.”

Under the whole category of cross-cultural psychiatry at Psychiatric Times, you can also find other articles, including this one by J. David Kinzie on A Model for Treating Refugees Traumatized by Violence.

Link to the Introduction to the Special Report on Cross-Cultural Psychiatry.

Posted in Links, Medical anthropology, Mental Illness, Psychological anthropology | Leave a Comment »

Exporting American mental illness

Posted by gregdowney on January 10, 2010

The New York Times Magazine has a great discussion of the effects of the exportation of American ideas about mental illness, titled appropriately, The Americanization of Mental Illness by Ethan Watters, based on his forthcoming book, Crazy Like Us: The Globalization of the American Psyche, coming out this month from Free Press. The article is quite good, offering some intriguing cases, such as the rise of virulent, American-style anorexia nervosa in Hong Kong, the effect of possession beliefs on communities’ reactions to schizophrenia, and how the narrative of mental illness as ‘brain disease’ might actually lead to great stigma as it spreads and replaces local understandings. The article is well worth a read, and I’m looking forward to the book.

graphic by Alex Trochut, NYTimes

The ethnographic record is full of conditions that didn’t make it into the most recent edition of the DSM — amok, nervios, koro, zar — you can check out Wikipedia or some other source on ‘culture bound syndromes,’ such as Introduction to Culture-Bound Syndromes in Psychiatric Times, to get a fuller discussion of some of these conditions. The Psychiatric Times piece suggests that there are at least 200 culture-bound syndromes.

One thing I really liked about the New York Times Magazine article, however (and by extension, Watters’ book, I suspect), is that the discussion of ‘culture-bound syndromes’ usually tends to treat other people’s syndromes as ‘culture-bound,’ Western psychological illnesses as not ‘culture-bound.’ Watters’ work points out that Western mental illness is both itself culture-bound and that persuading people to believe in Western-style mental illness can affect the way that psychic disorders manifest.

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Posted in general, Human variation, Medical anthropology, Mental Illness | Tagged: , , | 21 Comments »

PTSD and Traumatic Brain Injury: Trauma Inside Out

Posted by dlende on September 22, 2009

by Drew Matott and Drew Cameron

by Drew Matott and Drew Cameron

By Zoë H. Wool

Jake was fond of saying that even though he had become dumber, he wasn’t quite dumb enough. He knew that the improvised explosive device (IED) in Iraq had mangled his body, brain and self.

Jake (a pseudonym) lost 30 IQ points due to Traumatic Brain Injury (TBI) from that IED blast. According to the military, he was still smart enough to function and hold down a job, so they didn’t plan to include TBI in his disability rating.

He fought them on this, just as he fought them on the decision not to amputate his leg. After countless surgeries and rehabilitation techniques, his leg was almost useless, allowing him maybe 30 minutes of use before it started rebelling against its reconstructed form. The pain that caused was excruciating; he simply couldn’t use it more.

Eventually Jake won his battle to lose his leg. It was the best thing that happened to him during the year I got to know him while doing my dissertation fieldwork at Walter Reed Army Medical Center in Washington, D.C. (yes, that Walter Reed).

Dealing with, or writing about, TBI is rarely as clear as an amputation. The same is true of TBI’s nearly constant companion, Post Traumatic Stress Disorder (PTSD). TBI and PTSD are not injuries that you can see, unlike a lost leg. Despite the high numbers of TBI and PTSD cases from Iraq and Afghanistan, the relationship of these conditions to more obvious forms of combat trauma remains a fraught one: Witness the debate about PTSD and the Purple Heart.

Most people think that the Purple Heart, that most iconic of military honors, is awarded to American military members injured in combat. As with most issues military, it is not quite that simple.

In 2008, after months of consultation, the decision was made not to award the Purple Heart to those suffering from PTSD because, in part, the medal “recognizes those individuals wounded to a degree that requires treatment by a medical officer, in action with the enemy or as the result of enemy action where the intended effect of a specific enemy action is to kill or injure the service member.” PTSD doesn’t count.

Though the decision was officially framed in rather bureaucratic terms, the debate which surrounded it raises much deeper issues about the nature of trauma. Thinking through these issues has led me to think about the Cartesian split between the (internal) mind and the (external) body and the nature of trauma inside and out.

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Posted in Brain Mechanisms, Embodiment, Mental Illness, Psychological anthropology, Violence | Tagged: | 7 Comments »

Daphne Merkin: A Journey through Darkness

Posted by dlende on May 8, 2009

Daphne Merkin

It is a sparkling day in mid-June, the sun out in full force, the sky a limpid blue. I am lying on my back on the grass, listening to the intermittent chirping of nearby birds; my eyes are closed, the better to savor the warmth on my face. As I soak up the rays I think about summers past, the squawking of seagulls on the beach and walking along the water with my daughter, picking out enticing seashells, arguing over their various merits. My mind floats away into a space where chronology doesn’t count…

So opens Daphne Merkin’s recounting of her life with severe depression. A Journey through Darkness is the feature article in this week’s New York Times Magazine. On that sparkling day in mid-June, Daphne was on a “fresh air” break in The Patients’ Park & Garden, the all-concrete highlight of her latest clinic.

Merkin recounts her life, an intractable life, in this moving essay. She mixes in recounting her latest stay in a clinic with reflections on depression and how this illness has shaped her life in such fundamental ways. Here are two pieces that spoke to me.
Daphne Merkin 2

This is the worst part of being at the mercy of your own mind, especially when that mind lists toward the despondent at the first sign of gray: the fact that there is no way out of the reality of being you, a person who is forever noticing the grime on the bricks, the flaws in the friends — the sadness that runs under the skin of things, like blood, beginning as a trickle and ending up as a hemorrhage, staining everything. It is a sadness that no one seems to want to talk about in public, at cocktail-party sorts of places, not even in this Age of Indiscretion.

–//–

This was enraging in and of itself — the fact that severe depression, much as it might be treated as an illness, didn’t send out clear signals for others to pick up on; it did its deadly dismantling work under cover of normalcy. The psychological pain was agonizing, but there was no way of proving it, no bleeding wounds to point to. How much simpler it would be all around if you could put your mind in a cast, like a broken ankle, and elicit murmurings of sympathy from other people instead of skepticism.

Link to A Journey through Darkness

Posted in Mental Illness | 15 Comments »

The Foundation for Applied Psychiatric Anthropology

Posted by dlende on January 31, 2009

fapaThe Foundation for Applied Psychiatric Anthropology (FAPA) is a new organization founded by the anthropologist and social worker Rebecca Lester and the psychiatrist Davinder Hayreh.

The Foundation “promotes the use of ethnographic research and mixed-methods approaches to improve understandings and treatments of mental illness, broadly defined. FAPA facilitates collaboration among scholars and practitioners who wish to integrate clinical work with ethnographic research and advocacy initiatives related to culture and mental health.”

FAPA also offers reduced-fee psychotherapy services to residents in the Saint Louis, Missouri area. To find out more, check out FAPA’s description of its clinical services and approach.

Rebecca Lester is a professor of anthropology at Washington University in Saint Louis. You can read about her treatment philosophy. For researchers, Rebecca has put together a great list of books in psychiatric anthropology.

And here’s Davinder Hayreh’s LinkedIn profile. He is presently nearing the finish of his residency in psychiatry at Barnes-Jewish Hosptial in Saint Louis.

For more information, you can contact them at office @ psychanthro.org [remove spaces].

Posted in Links, Mental Illness, Psychological anthropology | 4 Comments »

Forever at War: Veterans’ Everyday Battles with Post-traumatic Stress Disorder

Posted by dlende on January 26, 2009

ptsd-iwo-jima“To this day, every time I smell firecrackers or fire arms being shot, I feel like I am right back there. All I have to do is close my eyes and I see the whole scenario over and over again. I can’t erase it.”

Hundreds of thousands of US veterans are not able to leave the horrors of war on the battlefield. They bring the combat home and re-experience it in their minds each and every day, no matter how much time has passed.

“I don’t like people. I just live my life.”

Many PTSD veterans live a life riddled with divorce, unemployment, and loneliness because they are unable to form lasting social networks within civilian life. It is not uncommon for a war veteran plagued with PTSD to desire a solitary life in the mountains. One informant described Montana as the ideal locale – far away and quiet.

“I should have buried him.”

This veteran is still tormented by the fact he did not give an honorable burial to a fellow soldier. He knows he would have met a similar fate if he tried to leave his foxhole; yet his inability to act haunts his memory. He asks himself everyday why he didn’t even try to honor his fallen comrade. He also has never been able to justify why he wasn’t the soldier left unburied on that remote Pacific island.

“I didn’t even have the motivation to kill myself.”

Many of these men and women believe their situation will never improve. Some contemplate suicide as their only relief from the symptoms of PTSD. A number of the veterans we spoke with had thought about or even tried to end their own lives. They also participate in risky activities, threatening their life in a deliberate yet indirect way.

“I always feel like there is someone behind me – following me.”

Being on edge is the only way to survive in combat. Unfortunately, many PTSD veterans are unable to readjust within the civilian world. Everyday life becomes a battlefield.

Something as mundane as walking through a crowded grocery store aisle can be a source of intense anxiety for a veteran suffering from PTSD. Overwhelmed by a feeling that the shoppers behind them are enemies, PTSD veterans always feel as if they are under attack. A trigger as simple as the clashing of shopping carts can make them jump in fear of an imminent explosion. They are forever at war.

OUTREACH

Over the course of 4 months, South Bend veterans with Posttraumatic Stress Disorder (PTSD) have revealed their daily realities to us, five undergraduates at the University of Notre Dame. In conjunction with a course taught by Dr. Daniel Lende entitled Researching Disease: Methods in Medical Anthropology, we have engaged in community-based research with members and supporters of PTSD, Vets, Inc. Here, with the approval and encouragement of these vets, we seek to give their experiences a well-deserved voice.

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Posted in Applied Anthropology, Medical anthropology, Mental Illness, Stress, Violence | Tagged: , , | 24 Comments »

Body Swapping

Posted by dlende on December 2, 2008

Do psychotherapists now have a new trick? Or is it all smoke and mirrors? The New York Times reports today on Standing in Someone Else’s Shoes, Almost for Real, where neuroscientists have shown that “the brain, when tricked by optical and sensory illusions, can quickly adopt any other human form, no matter how different, as its own.”

The article “If I Were You: Perceptual Illusion of Body Swapping” by the Swedish researchers Henrik Ehrsson and Valeria Petkova appears this week in PLoS ONE, and is ably summarized over at Neurophilosophy. You can also read Ehrsson’s previous article on the virtual arm illusion and his Science piece on the experimental induction of out-of-body experiences.
out-of-body-illusion
The approach in all of this research is rather simple. You can see the out-of-body experiment design pictured to the right. Body swapping adds another person with goggles.

A subject stands or sits opposite the scientist, as if engaged in an interview.. Both are wearing headsets, with special goggles, the scientist’s containing small film cameras. The goggles are rigged so the subject sees what the scientist sees: to the right and left are the scientist’s arms, and below is the scientist’s body. To add a physical element, the researchers have each person squeeze the other’s hand, as if in a handshake. Now the subject can see and “feel” the new body. In a matter of seconds, the illusion is complete.

body-swap-by-niklas-larsson
This “switching” happens because the brain is literally embodied – after growing up with this particular body, it’s a fair assumption to assume that one’s eyes and one’s hand are getting feedback about the same interactive phenomenon. For a first-person view of this, see Karl Ritter’s AP article today on the body-swap illusion, which includes this photo of the two-goggle set-up.

Ehrsson is excited about being able to trick the brain in this way: “You can see the possibilities, putting a male in a female body, young in old, white in black and vice versa.” The NY Times article pushes the uses body swapping can have in therapy.

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Posted in Brain Mechanisms, Mental Illness, Perception and the senses, Psychological anthropology, Relationships | 1 Comment »

Demons on the Web

Posted by dlende on November 14, 2008

vaughan-bell-by-paul-smith
Vaughan Bell of Mind Hacks makes the New York Times today! So finally a picture of the man! He is seated in the garden outside the Department of Psychiatry at the Universidad de Antioquia, where he now works in Medellin, Colombia.

The NYT piece Sharing Their Demons on the Web begins:

For years they lived in solitary terror of the light beams that caused searing headaches, the technology that took control of their minds and bodies. They feared the stalkers, people whose voices shouted from the walls or screamed in their heads, “We found you” and “We want you dead.”

When people who believe such things reported them to the police, doctors or family, they said they were often told they were crazy. Sometimes they were medicated or locked in hospital wards, or fired from jobs and isolated from the outside world.

But when they found one another on the Internet, everything changed. So many others were having the same experiences.

The article goes on to discuss this “extreme” online community that gives peer support a whole new meaning! Mind control, stalking and paranoia become the delusions of the net. “The views of these belief systems are like a shark that has to be constantly fed,” Dr. Hoffman said. “If you don’t feed the delusion, sooner or later it will die out or diminish on its own accord. The key thing is that it needs to be repetitively reinforced.”

On the other hand, Derrick Robinson, a janitor in Cincinnati, says “It was a big relief to find the community. I felt that maybe there were others, but I wasn’t real sure until I did find this community.” Mr Robinson has gone on to become the president of Freedom from Covert Harassment and Surveillance.

Vaughan estimates that there are a small number of these intense sites that are frequented around the Internet. I ran across a similar phenemenon exploring pro Ana websites that support anorexia a couple years back. But Vaughan has published everything! The article ‘Mind Control’ Experiences on the Internet: Implications for the Psychiatric Diagnosis of Delusions (pdf) appeared in Psychopathology (also available here through Scribd).

As expected, Vaughan documents the NY Times article over at Mind Hacks. He described the outcomes of this research in an earlier post on Internet mind control and the diagnosis of delusions. As Vaughan concludes about this research:

This is interesting because the diagnostic criteria for a delusion excludes any belief that is “not one ordinarily accepted by other members of the person’s culture or subculture”, whereas these individuals have formed an online community based around their delusional belief, creating a paradox.

Posted in Mental Illness, Psychological anthropology, Technology | 6 Comments »

 
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