My Bipolar Mixed State

Hi All! My plan is to give a monthly update rather than a weekly (or biweekly in this case) update, but I had some interesting developments in my life over the last couple of weeks and thought it was a good idea to share – since one of the goals of this blog is to decrease stigma of mental illness, I should share my own experiences.

I got a bit burnt out on all the activities I’ve been participating in as described in my September update. Quick summary, I’d been working full time, volunteering 4 hours a week at a crisis hotline, taking a 3 credit Abnormal Psychology class as well as a 7 credit EMT class. When I first signed up for the EMT class, I hadn’t realized it was 7 credits (that wasn’t mentioned on the class description), so I didn’t realize how hard it would be. After a few weeks of it, I got so burnt out that I got really sick – this was last week.

I decided to drop the EMT class, and they were kind enough to let my tuition transfer to next semester. I will NOT sign up for another class – so I’ll be able to focus on the EMT class in January.

Then on Monday, I had a 3 hour anxiety attack. I’m not sure how many of you have had anxiety attacks before, but they aren’t supposed to last that long. It’s sort of like running a marathon for 3 hours. This happened at work, and because I’m the manager, I can’t call my boss and be like: “oh, gotta go home.” I simply had to finish the work. It was an exhausting day.

The next day, I freaked out on my boyfriend for no reason (other than our political differences), and then when I was trying to sleep I felt like a screaming monster was trying to claw its way out of my brain. That’s when I realized I was in a bipolar mixed state.

Bipolar mixed states have characteristics of both depression and mania. They’re very dangerous because they have suicidal ideation mixed with impulsivity, motivation, and energy. Mixed state people are much more likely to commit suicide than a depressed person, because depressed people often lack the energy and impulsivity, motivation, and energy to commit suicide.

Yesterday, I called my psychiatrist but I got stuck in the labyrinthine maze of monsters that is the Park Nicollet phone reception system. One of the monsters even hung up on me, and I had to proceed to “Go” without collecting my $200. By the time I got through to the nurse (an hour later), I was rather worked up. She calmly told me that this is not a crisis line, and I should call Crisis Connection (where, by the way, I volunteer). I practically yelled at her that I didn’t want a crisis hotline, I wanted to talk to my psychiatrist. She made an appointment for me to see her later that afternoon. I also made an emergency appointment with my therapist, who I haven’t seen since March.

In the end, my psychiatrist tweaked my mood stabilizer and gave me a prescription to Klonopin, which is a benzodiazepine – an addictive sedative. I’m a little worried since addiction runs in my family, and when I start getting symptoms of mania (or apparently mixed symptoms) I start craving alcohol, pain meds, and other such things. I’m not much of drinker, and I’m not in the habit of taking unprescribed pain meds, but I crave them all the same. So getting permission to take a benzodiazepine is a little troubling to me. However, I recognize that I need it in situations like those described earlier in my post.

On a happier note, I was able to go to the Nobel Conference at Gustavus Adolphus College on Tuesday and Wednesday. The theme was addiction, and my Abnormal Psychology prof took a bunch of his students. There were 6 speakers and they were all really interesting.

One of the speakers was Marc Lewis, the author of The Biology of Desire, which I just finished. It turns out Marc Lewis is a bit annoying. He kept trying to push his point (that addiction is a choice and not a disease), until Eric Kandel, the 2000 Nobel Prize Laureate in Medicine, told him “it’s either bullshit or science.” Another speaker, Carl Hart, who is big on social justice, tried to break the tension by saying “I didn’t know we could swear at this conference!” And then the next day during Hart’s speech he said “and to quote Dr Kandel, this is bullshit!” It was a pretty amusing conference. Of course, the science was really interesting too, but I plan on writing a review both of the conference and of Biology of Desire, so I’ll stop here.

I’m currently reading or listening to:

Books completed:

Movies/Shows watched:

September 2015 Update

Favorite picture of the month
my brand new niece Leilani

This has been an incredibly busy month for me. I started my second class of the semester (now I’m taking Abnormal Psychology and an EMT certification class). These, together with my full time job in a nursing home and my volunteer work at a crisis hotline, keep me feeling pretty darned overwhelmed.

My EMT class is a lot of information. As of yet, I’m not keeping up with the reading in the 2000 page text at all, but I’m bumbling along in the class regardless. I am now CPR/AED certified for infants/children/adults. That’s a nice feeling. I think everyone should know how to save a life in this way.

In Abnormal Psychology I have taken my first test and got a fantastic score. I give my blogging complete credit for that score. Writing blog posts about my psychology class is the best studying I’ve ever done in my life. If only I could do the same thing with my EMT text without boring you all silly. This month’s Abnormal Psychology posts are:

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy

My book reviews are:

The Blank Slate, by Stephen Pinker
The Epic of Gilgamesh – Historical Background
Game of Thrones, by George R. R. Martin

My most popular blog post this month was: The Definition of Abnormal

I am currently reading or listening to:

I’m hoping to finish this one in time for Aarti’s A More Diverse Universe

Thought this spooky book would be a good one for October

This month I finished reading or listening to:

This was my RL book club’s choice for September

I read this with Doing Dewey‘s nonfiction book club

Read this to supplement my posts about warehousing the mentally ill in prisons

I think I’m going to a conference on addiction in a couple weeks. Thought this would be a nice supplement.

Next month’s blogging activities include:

Aarti’s A More Diverse Universe at BookLust

The Halloween Reading Challenge at Reading Every Season

R.I.P. X hosted this year by The Estella Society
Picture used by permission by creator Abigail Larson

This post is linked up to the Facebook Group The Sunday Salon. “The Salon is open to anyone who’d like to discuss books of a Sunday (or, frankly, any other day of the week). … Discuss what you’re reading here, or link to relevant blog posts, or comment on one anothers posts. Enjoy.”

This post is also linked up to the Sunday Post at Caffeinated Book Reviewer. “The Sunday Post is a weekly meme hosted here @ Caffeinated Book Reviewer. It’s a chance to share news~ A post to recap the past week on your blog, showcase books and things we have received. Share news about what is coming up on our blog for the week ahead.”

Brave New Films: This is Crazy

In a previous post, I discussed my thoughts on Frontline’s New Asylums documentary, about the overcriminalization of the mentally ill. Millions of taxpayer dollars are being spent on housing the mentally ill in prisons, when they could be treated more affordably (and more humanely) by the community. Because that video (filmed in 2005) left me with a lot of questions, I looked up some more recent resources. Of the videos I watched, my favorite was a series created by Brave New Films.

Brave New Films: Why are we using prisons to treat mental illness?

The video begins by dramatically pointing out a problem: police and correctional officers are not trained to deal with mentally ill “offenders,” which results in unnecessary deaths. This is an issue that I’ve already been seething about in my home suburb here in Minnesota. There have been a few times in recent years when our police have killed mentally ill people that they have been called to help. For instance, an officer shot a knife-wielding suicidal teen after his family called the police for help. Because the police are untrained to deal with mentally ill, families are left in a quandary: they sometimes don’t feel safe around their mentally ill loved one, but they don’t want to call the police for fear that their loved one will either be killed or get tied up indefinitely in a revolving-door judicial system.

The video continues by describing the Crisis Intervention Training (CIT) program. In CIT, officers are trained to drop the authoritative attitude that they are supposed to use in non-crisis occasions. They are trained to use soothing and empathetic tones of voice to disarm the mentally ill. The video included a heartwarming interview with a mother of a schizophrenic man who is grateful for the CIT officers’ treatment of her son during a crisis – how the officers managed to defuse the situation without anyone getting hurt or being sent to jail.

CIT officers in San Antonio can now bring mentally ill people to treatment centers instead of emergency rooms. This change keeps ER and officer overtime costs down. (Officers must be paid overtime because they spend hours in the ER waiting for the “offenders” to get psych evaluations.) An officer on the video claims that in the past 5 years they’ve saved about $50 million of taxpayer money by utilizing CIT and treatment centers.

Watching this video made me feel optimistic about the future of mental health. There’s a lot of work to be done – a lot of training to do, a lot of lobbying to resistant politicians (and an unsympathetic public), a lot of treatment centers to be built – but there is a solution. New Asylums was a fantastic documentary, but it left me feeling hopeless. I’m happy I found the Brave New Films’ snippet.

I also watched this Brave New Films documentary:

Brave New Films: This is Crazy: Criminalizing Mental Health

This video begins in much the same way as Why are we using prisons to treat mental illness, providing different examples. It continues by discussing brutality within prisons, and the over-use of solitary confinement for mentally ill inmates. One mentally ill woman claims that of the 18 years she spent in prison, 4 of them were in solitary confinement. Each person in solitary confinement costs taxpayers $75,000 a year; compared to the $16,000 a year per person in supportive housing.

Finally, This is Crazy discusses the fate of prisoners once they are released from prison. As discussed in New Asylums, prison is like a revolving door for the mentally ill. Most of the homeless population are mentally ill. They break laws either because they are delusional or because they have basic needs. When they are arrested, they spend 3 to 4 times more jail time than “normal” inmates. They often get shuttled back and forth between stabilization hospitals and jail (where their psychiatric treatment, and their mental state, degenerates). When released, they are given 2 weeks’ worth of medication and are left out on the streets again – with nowhere to look for treatment. Despite the fact that community treatment would save taxpayer money, the first item on the political finance chopping block are treatment centers and institutions for mental illness.

The take-home point of these documentaries is that because police are not trained to deal with mentally ill people in crisis, many mentally ill people end up being abused, killed, or put in a revolving door prison system. Once a mentally ill person has a bad experience with cops, he is likely to be fearful and uncooperative in the future. I have seen this myself. I have a mentally ill friend who suffers from PTSD after being brutalized by police for a case of mistaken identity. Now whenever he sees a cop, even if the cop is completely uninterested in him, my friend goes into a blind panic. I strongly suspect that my friend wouldn’t have been brutalized by the cops if he hadn’t been mentally ill. Another important point is that outrageous amounts of taxpayer money would be saved, and deserving human beings would be treated with compassion, if only cities around the US would develop CIT programs and fund more treatment centers. If only the taxpayers and politicians would listen to reason.

This is a series of posts summarizing what I’m learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher’s textbook Abnormal Psychology. To read the other posts, follow these links:

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome – The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression – an Overview
Personality Disorders – Clusters and Dimensions
Personality Disorders – Cluster A
Personality Disorders – Cluster B
Personality Disorders – Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria – Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder – The Basics
Suicide – An Overview

Game of Thrones, by George R. R. Martin

Game of Thrones, by George R. R. Martin

What can I say about Game of Thrones that hasn’t already been said? I’m not even sure how to summarize it properly because there is so much that would be left out. But, briefly, Lord Eddard Stark is swept up into a web of conspiracy when he is suddenly demanded to go to the capital city to be the Hand of the King. He must protect his family, his honor, and the king from enemies – and everyone is an enemy.

This is a sweeping epic that jumps from character to character to weave an intricate web of plots, subplots, and sub-sub-plots. The characters are heartbreakingly well developed – and I say heartbreakingly because you fall in love with the “good” ones and hate the “bad ones.” As each character gets thrown into his or her own trap, your heart aches for them. None of the characters are all good or all bad – they’re very human. This is not Tolkien. It’s not a happy story where the good guys always prevail and only a few people die – and that for the sake of heroism. People die left and right. And they don’t necessarily die heroic deaths – they die because that’s what happens in the game of thrones. It’s as bloody and horrifying as the War of the Roses. And I think that’s what makes the book so good: it’s a story about human nature and the struggle between power and honor.

Usually I drag my feet reading long books. No matter how good a book is, it’s hard because I’m such a slow reader that I feel I’m not making progress. Not so with this book. This book was so smooth that I barely noticed the length. I didn’t want it to end. As soon as it ended, I bought the rest of the series so I could start them right away. But this book was also a very difficult read for me. There’s so much sorrow in Game of Thrones. The reality of the suffering attenuates the escapism that one usually feels when reading epic fantasy. And yet I couldn’t stop myself from reading. I was too invested in the characters – both the likable and the detestable ones.

5 snowflakes for sheer awesomeness, intrigue, plot, unexpectedness, character development, world building, battle scenes

Reason for reading: Interest, TBR Pile

Format: ebook

As soon as I finished Game of Thrones, I wanted to watch the first season of the HBO show. I’ve been warned against the show many times because of the graphic violence and sex, which I tend not to like. But I loved the book so much that I just had to watch the show.

The first season of Game of Thrones followed the book perfectly. It managed to get all the important bits from the plot – there were very few times when I turned to my boyfriend and said “it left such-and-such out.” There were no special scenes from the book that I wished the show had included. I hear the show deviates from the books in later seasons, and I’m ok with that. I don’t think a show has to follow a movie perfectly to be a good show. But I’m always impressed when the creators of a show are able to be so devoted to the book’s plot.

In some ways, the show was easier to watch than the book was to read. The jumping around from character to character was more smooth, in the sense that I wasn’t spending time during one chapter wondering what happened to the person in the last chapter. But that also could have been because I knew exactly what was going to happen while watching the show.

I love the opening theme of Game of Thrones – it’s so fitting to the story, and it provides a map that gives you a wonderful visual of where everything is respective to everything else. Of course, George R. R. Martin is so good in his descriptions that I already had a pretty good map in my head, but it’s nice to see a map on a show. I’m glad they found a way to work it in. Very clever.

My favorite character in the show was Tyrion Lannister, who is played perfectly by Peter Dinklage. There’s just the perfect mixture of lovable and detestable characteristics in Tyrion. Tyrion is so funny, so clever, so conniving. He is kind, yet ruthless. I want him to win, even if he’s on the “wrong” side. Please don’t die, Tyrion!

The character in the show that ticked me off the most was Cersei Lannister. Her facial expressions just made me want to punch her. And I guess that means Lena Headey is a fantastic actress. Because that’s exactly how I’m supposed to feel about Cersei Lannister.

Overall, I loved this show, and as soon as I finish Clash of Kings I’ll dive into season 2.

4.5 stars for sheer awesomeness, ability to follow the book perfectly, character development, plot, intrigue, mise-en-scene, visual effects, acting. Loses half a point for sex and violence, though that’s not entirely fair since the book had just as much sex and violence. But I’d rather read it than see it.

Frontline: New Asylums

New Asylums (2005) is a Frontline documentary that delves into the problem of housing the mentally ill in prison systems. Believe it or not, the world’s three largest asylums for mentally ill are the Cook County Jail in Chicago, the Twin Towers of the Los Angeles County Jail, and Riker’s Island in New York. This problem has been escalating ever since the mid 1900’s when deinstitutionalization of mentally ill and intellectually challenged became a popular movement to encourage “humane” treatment of mentally ill and to reduce state expenditures on medical care.

The original plan, as described by the Community Mental Health Act of 1963, was to fund community mental health centers in which the mentally ill could be treated while working and living at home. However, most of the proposed centers were never built, and few of those built were fully funded. As deinstitutionalization accelerated, hundreds of thousands of mentally ill patients were released without a place to go and without adequate access to mental health care. A lot of them ended up on the streets. And on the streets, their mental illnesses flared up, leading to law-breaking. Many of the laws broken were for basic living purposes – theft of food, break-ins to get a place to sleep, stealing blankets out of a car – and many were violent crimes fueled by a desperate situation combined with psychosis. And this is how jails and prisons became the new asylums.

The documentary New Asylums focuses on the Ohio state prison system, which has a relatively well-developed system for dealing with the mentally ill. In 2005, when the documentary was filmed, there were nearly 500,000 mentally ill people housed in America’s prison systems – 10 times more than the 50,000 housed in mental institutions.

The documentary begins with a disturbing scene of “group therapy” in which inmates are locked inside tiny cages, with just enough room to sit in a chair. In this warm, inviting environment, the inmates are encouraged to share their problems with their fellow inmates. I think it is fantastic that group therapy is provided for inmates, but how helpful is it really, in this environment? Can an inmate really share his fears and heartbreaking secrets with other inmates? Wouldn’t rumors get around quickly among the inmates and less sympathetic officers in prison? How much help can group therapy really do these inmates, especially since they are locked in a tiny cage; which probably doesn’t encourage openness?

A while back, I told my therapist that I thought Dialectic Behavioral Therapy (DBT), which I was currently undergoing, would be a world of help to many people in prison. She agreed. But now that I see this video, I realize the limitations of such therapy. Prison does not provide a safe environment to let those feelings out. But what to do? Do we just not provide the inmates with therapy because of these limitations? Clearly, the problem needs to be solved before the mentally ill people are imprisoned, but I don’t know how to solve that problem, other than reinstitutionalization.

The documentary only became more horrifying after that. There were scenes in which a naked, frightened, screaming man was resisting being handcuffed. Eventually, a group of 5 men who were dressed like a SWAT team and carrying a riot shield burst into the cell, pinned the man down, and carried him kicking and screaming away. One officer tells the camera “A lot of the mentally ill inmates in here, you gotta use more…I mean, you do have to use force on them.”

Having seen the footage, I understand why the officers feel that they need to use a lot of force. I mean, how else would they get the naked, psychotic, screaming man down to solitary? But don’t you think that the strict and unforgiving culture of prisons is part of the reason these inmates are acting out? Isn’t the fear of solitary, which would certainly exacerbate psychotic symptoms, part of why they’re acting out? Most of them would certainly be better behaved in a healthier, more caring environment. And then force wouldn’t have to be used.

I can see two solutions (both of which I think should be implemented): the number of mentally ill patients housed in mental institutions should be increased, thus decreasing the prison population. And people in prison should be treated with more kindness – providing a rehabilitative instead of punitive justice system.

The documentary continued by describing Oakwood Correctional Facility, which is a temporary housing unit for mentally ill inmates who need to be stabilized. The culture and environment seems so much more caring and open – it appears that inmates who were dangerously psychotic in the general prison are stable and well-behaved at Oakwood. There’s a heartbreaking scene in which one of the inmates is being told by a panel of mental health workers that he’s stabilized and ready to go back to the general prison population. The inmate practically begs to stay at Oakwood. The panel is at first kind, but they become more and more firm. They show a depressing lack of empathy. The tragedy is that they have to. They have to send the inmate back to the general population, because they don’t have enough beds to house all the thousands of mentally ill inmates in the Ohio state prison system.

At this point I got into a discussion with a classmate about why these inmates aren’t all housed in such therapeutic environments as Oakwood. But where would Ohio state get the money to pay for those units to be built? How would they decide who is mentally ill enough to end up in such a facility? And is it ethical to treat some 16% of their inmate population so humanely and ignore the inhumane treatment of all the other prisoners? Do the “healthy” prisoners not matter just because they don’t have a serious mental illness? Once we start creating this humane prison system, where do we stop?

During most of the documentary, I was applauding Ohio state for at least trying to create a therapeutic environment for its mentally ill inmates. But there were a couple of comments which made me rethink. Reginald Wilkinson, the Director of the Ohio Department of Corrections said that he once had a judge mention to him: “Well, I hate to do this, but you know the person will get treated if we send the person to prison.” So judges are more likely to give a prison sentence because they feel there’s better mental health care there? My question was confirmed later in the documentary when it pointed out: “We shouldn’t devote ourselves to continually raising the level of mental health care in prisons because the better you make an institution that shouldn’t be used for the purpose you’re improving, the more you’re ensuring its use.”

It’s a catch-22. If you don’t work to take care of the mentally ill in prisons, they’ll get worse and you’ll have to stash them away in solitary or other “general population” punishment areas. If you do develop a system to care for the mentally ill, then you end up with even more mentally ill people dumped into your system, where they don’t belong. So tragic. I wish enough people cared about this highly stigmatized group so that money could be raised to properly care for both the imprisoned and the unimprisoned mentally ill.

4 snowflakes for interest level, research, approachableness, and subject

Contemporary viewpoints on treating mental illness – psychology

This post will discuss the psychological causes and treatments of mental illness, as described in Butcher’s Abnormal Psychology.

Psychological viewpoints consider humans not only as biological entities but as products of our personalities and experiences. There are three major psychosocial views on behavior: psychodaynamic, behavioral, and cognitive-behavioral.

They psychoanalytical school was founded by Sigmund Freud, as described in my summary of Chapter 2. Freud structured personality into three elements: id, ego, and superego.

The id is the individual’s instinctive drives, and is the first element to develop in infancy. It is separated into life instincts (such as libido) and death instincts (such as aggression). The id can generate wish-fulfilling fantasies but cannot undertake any actions to meet these desires. The superego develops later in childhood, and basically comprises the conscience.

After a few months of life, the ego develops. The ego mediates between the demands of the id, the urging of the superego, and the realistic constraints of the world. For instance, during toilet training, the id tells the child that he needs to go poo, the superego urges the child not to go poo in his mother’s bed because she is annoying, and the ego takes these two drives and determines the right place and time to go poo. Sometimes these three drives can come into conflict because they are striving for different goals. These intrapsychic conflicts can cause mental illness.

Freud also described a set of psychosexual stages, which you can read about on Wikipedia. I do not put much credence in the psychosexual stages, so I will skip them in my summary.

Later, a few psychoanalysts branched off from Freud with the interpersonal perspective. Alfred Adler focused on social and cultural forces instead of instincts. In Adler’s view, humans are social beings, and we are driven to interact effectively with other members of our group. Erich Fromm focused on the dispositions of people, and how that affected their interactions with other members of society.

Despite the current unpopularity of Freud’s psychosexual stages and gender prejudices, Freud is considered the father of psychoanalysis. He developed the groundwork for further psychotherapy. He showed that certain maladaptive behaviors develop as a result of an attempt to cope with difficult problems. He also laid the foundation for the study of unconscious motives of maladaptive behaviors.

Another psychological approach to treatment of mental illness is the behavioral perspective. It is described in my summary of Chapter 2. In addition to Pavlov’s classical conditioning and Skinner’s operant conditioning, we can also learn by observation. For instance, my sister apparently developed a fear of insects only after seeing a friend respond very negatively to an insect that my sister had collected in a jar.

Behavior theory was not well-received by psychoanalysts, but it provided several important views of the causes of mental illness. It suggested that maladaptive behaviors develop when a person fails to learn the adaptive behaviors, or when he learns maladaptive solutions.

The third psychological viewpoint is my favorite – the cognitive-behavioral perspective. Albert Bandura developed an early form of cognitive-behavioral theory when he suggested that people learn by internal reinforcement rather than external reinforcement – we choose to perform a difficult task because we can visualize the negative outcomes of not performing that task. For instance, I’m writing this blog post despite the fact that I’m so tired my eyes are blurring over and I’m not sure my sentences make sense because I can envision the negative consequence of doing poorly on my upcoming exam.

Today, cognitive behavioral therapy focuses on how distorted perspectives can influence maladaptive behaviors. For instance, if I’m walking down the street, and I see a friend getting on a bus…I wave at that friend, and he doesn’t wave back. I might have the distorted perspective that the friend hates me, and I might consequently be rude or abusive to that friend. The maladaptive cognitive process is called assimilation, where I gather new information (the friend didn’t wave at me) and distort it to fit my existing self-schema (nobody likes me).

The adaptive cognitive process that our therapists attempt to elicit is accommodation, in which we change our existing frameworks to incorporate new information that doesn’t fit. In this case, my self-schema might be “nobody likes me,” but for some reason I’ve been asked out to prom. Instead of distorting the friendly behavior (he’s only asking me to prom so that he can dump pig’s blood on me in a highly public setting), the therapist encourages me to accommodate the information (he might actually like me).

Chapter 3 finished its description of the psychological causes of mental illness by describing some of the events that can lead to a predisposition to mental illness. It discussed early deprivation or trauma, inadequate parenting styles, marital discord and divorce, and maladaptive peer relationships. I found this section interesting since I’ve just finished reviewing The Blank Slate, by Stephen Pinker, which discussed Pinker’s views of the relative influences of parenting styles verses peer relationships on a child’s behavior. Pinker claimed that parenting style had much less to do with the child’s ability to adapt than peer influences did. He implied that the reason we don’t accept that peers have a greater impact than parents is because parents don’t want to think that all the love they’re pouring into their child doesn’t matter. (He also points out that such a worry is silly, since we’d never say that all the love we’re pouring into our spouses doesn’t matter.)

Butcher’s text, on the other hand, spent a lot of space discussing the different parenting approaches (authoritative, authoritarian, permissive/indulgent, and neglectful/uninvolved) and their effects on child development. Despite Pinker’s strong arguments, I’m still convinced that parents have just as much impact on a child’s development as his peers.

Contemporary viewpoints on treating mental illness – biology

Chapter 3 of Butcher’s Abnormal Psychology has too much information for me to adequately summarize in one post. Therefore, I will break it into a few posts. So please bear with me. Of the chapters so far, this chapter was the longest and the least interesting to me. Which is unfortunate, because it’s also the chapter that has the highest distribution of points in the upcoming exam.

The main purpose of this chapter is to review the three contemporary viewpoints on treating mental illness – biological, psychological, and social. This post will review the biological causes of mental illness.

From the biological viewpoint, there are four commonly accepted causal factors of mental illness: neurotransmitter and hormonal abnormalities, genetic vulnerabilities, temperament, and brain dysfunction and neural plasticity.

The reason scientists believe that neurotransmitter imbalances lead to mental illness is the success of serotonin reuptake inhibitors (SSRIs) and similar drugs on alleviating symptoms. Serotonin is a molecule which is released by neurons to send signals to other neurons. The other neurons have serotonin receptors, which stimulate the neuronal response. They also have serotonin reuptake molecules, which bind to the serotonin and remove it from the system. An SSRI inhibits the reuptake of serotonin, thus increasing the length of time serotonin is present and able to bind the serotonin receptor.

According to the book, sometimes psychological stress can lead to neurotransmitter imbalances. There could be excessive production and release of the neurotransmitter, dysfunction in the reuptake or enzymatic breakdown of the neurotransmitter, or problems in the neurotransmitter receptors which may be overly- or under-sensitive.

My professor suggested during last week’s lecture that he doesn’t think the theory of “chemical imbalance” is necessarily plausible. Just because an SSRI decreases symptoms, doesn’t mean that the symptoms were caused by abnormally low levels of serotonin; anymore than the fact that Aspirin decreases certain symptoms means that those symptoms were caused by abnormally low levels of Aspirin. My professor even said that the “chemical imbalance” theory is just as well-founded as the ancient Greek humor imbalance theory (discussed in my summary of Chapter 2). I admit that I’m not familiar with the neurotransmitter research, so I can’t say whether my professor’s reservations are well-founded. But he certainly made me think critically about the subject.

Hormonal imbalances can cause mental illness; an example is hypothyroidism leading to depression because it causes fatigue and slows the body down. My textbook focuses on the hypothalamic-pituitary-adrenal (HPA) axis. This focus seems to be because the HPA axis can release the stress hormone cortisol.

The genetic effect on mental illness seems fairly straight-forward at first glance. Some mental illnesses can be heritable. This heritability is because of genes that can, when activated by the right stressors, cause mental illness. If someone has such a gene, she has a preinclination for the mental illness but doesn’t necessarily develop symptoms.

What makes genetic effects complicated is that genes can interact with the environment. For instance, a person with a gene for depression might also have depressive parents who create an environment that is less nurturing and functional, thus providing stressors which may lead to depression in the child. This is considered a passive effect. On the other hand, the child’s genotype may actively affect her environment. For example, a sulky child may have trouble making friends, thus changing her environment to be one that increases likelihood of depression. There is also an evocative effect, in which parents may react negatively to sulky babies, leading to a less healthy relationship and more likelihood of depression. (I admit I’m having difficulty distinguishing between an active effect and an evocative effect – unless it is simply whether the child’s temperament affects the parent’s behavior or not.)

Psychologists study the genetic factor in mental illness using three models: pedigree analysis, twin studies, and adoption studies. In pedigree analysis, a psychologist can determine the strength of heritability within a family by comparing incidence within a family versus incidence within the community at large. The problem with this method is that families not only share genes, but also environments.

Thus, the other two methods are used to tease out the environmental factors from the genetic factors. Looking at the concordance rate in identical twins (the percentage of twins who share the disorder), compared to the concordance rate in siblings or fraternal twins could indicate how big of a role genetics plays.

Another method to tease out environmental factors from genetic factors is studying siblings (or better yet, identical twins) who are adopted into different families – and thus different environments. If identical twins who are adopted into different families have a high concordance rate for a mental illness, then it is likely that the genetic effect is strong.

An environment that is often forgotten is the womb during pregnancy. The child of a mother who was undergoing intense stress during pregnancy may have an inclination to respond strongly to stressful situations. The stress during pregnancy could be the cause of epigenetic changes – in which the genes themselves don’t change, but there are changes in the chromosomes, such as the binding of certain molecules which change the expression of a particular gene (or set of genes).

Abnormal Psychology in Contemporary Society

Our class only read part of chapter 17 of Butcher’s Abnormal Psychology: a section about inpatient mental health treatment in contemporary society and another about controversial legal issues and the mentally ill.

Mental health treatment in contemporary society

In the late 19th century, mental hospitals were filled with patients. Many of these patients lived in a horrific environment that was unhealthy both physically and mentally. In those hospitals that had humane treatment of patients, there was a concern that patients would get “institutional syndrome” – in which people lost their ability to socialize and live independently because they had been in a mental hospital for so long.

In the mid-to-late 20th century, a movement to deinstitutionalize the mentally ill gained momentum. It began in the 1950s and 60s, when antipsychotic drugs were developed. These medications made it possible for patients to leave hospitals and live independent lives. Later, a desire to rescue people from inhumane environments and to keep them from getting “institutional syndrome” accelerated the rate of deinstitutionalization. Another consideration in deinstitutionalization was the desire to decrease medical expenditures. As mentioned in my earlier post on Chapter 2, deinstitutionalization was detrimental to many mentally ill people. One third of the homeless population is comprised of mentally ill people, and a horrifying number of the mentally ill are incarcerated with little to no mental health treatment (which, by the way, means that society is still doling out the bucks to pay for the housing of mentally ill).

In contemporary American society, if a person is unable to care for himself, or if he is a danger to himself or others, he can be placed in a psychiatric hospital. Such a commitment can be voluntary, but if someone is considered a danger to himself or society and he refuses hospitalization, civil commitment procedures can be undertaken, and he can be confined involuntarily in a mental hospital.

Such hospitals generally combine traditional forms of therapy with a constructive social environment. A study in 1977 by Gordon L. Paul and Robert L. Lentz compared the relative effectiveness of three treatment approaches.

Milieu therapy, which focuses on providing the patient with a very clear idea of what the staff expectations are and providing feedback about compliance with those expectations, encouraging the patients to be active in their own treatment decisions, and providing social groups for support and “positive” peer pressure.

Social-learning, in which the patients learn socially acceptable behavior through a token economy (they get tokens when they behave well). With tokens, the patients can buy privileges.

Traditional treatments, with pharmacotherapy, occupational therapy, and individual group therapy. For instance, a friend of mine was recently released from a mental health ward which had psychological therapy, psychiatry, yoga, prayer meetings, knitting classes, and all sorts of social groups.

Paul and Lentz studied 28 schizophrenic patients for resocialization, learning new roles, and reducing bizarre behavior. From the social learning program, 90 percent of the patients remained in the community after release; compared to the 70 percent who’d had milieu therapy, and the less than 50 percent who’d had traditional therapy. I haven’t read it, but there’s a review of Paul and Lentz’s study available here.

All of these programs seem like a positive change from the early 20th century, but in order to voluntarily get into one of these hospitals, the patient must have both resources and mindfulness of illness. In order to get involuntarily committed, the patient must have an advocate willing to report his danger. Most of the homeless do not have such advocates, and thus they slip between the cracks.

Controversial legal issues and the mentally ill

In recent years news reports have sensationalized grizzly murders committed by sociopaths and psychotic people. In fact, one such grizzly murder was just discovered in the Twin Cities (where I live). It’s easy to say that if only the mental health system were better, we could prevent such tragedies. But how do you really know when someone is dangerous before they actually do anything? A mental health professional is authorized to make such a judgement call, though the dangerous person must first be seeing a mental health professional before any judgement can be made. And often a patient gives no hint of his violent thoughts.

If the patient does give a hint of violent thoughts, the mental health worker (or even a priest during confession), has the duty to report the dangerous individual to the authorities, and in some states to warn the individual who has been threatened.

One huge controversy about dangerous mentally ill people is the insanity defense (or not guilty by reason of insanity, NGRI). Someone can be successful with this plea if he is thought to not know right from wrong or if he was compelled irresistibly to perform the violent act. The defense attorney must obtain the testimony of a mental health professional who convincingly claims that the accused was insane at the time of the crime.

Because it is very difficult to be acquitted as NGRI some people plea “guilty but mentally ill (GBMI).” With success of this plea, the convicted would be found guilty but placed in a mental institution instead of a prison. Many hope that this plea will decrease the number of patients who are found not guilty by reason of insanity, are confined to a mental institution, soon judged to be in recovery, and are unconditionally released into society. When a person is found guilty but mentally ill, he remains for his entire sentence in the mental institution.

A third way that a mentally ill person can protect himself from unethical treatment is to claim incompetence to stand trial. If a person is charged with a crime but is unable to understand the proceedings due to mental health, he can postpone the trial until they have recovered sufficiently to understand. Such people can be hospitalized until they are deemed competent.

An interesting point that the authors brought up was about patients diagnosed with disassociative identity disorder, DID – formerly known as multiple personality disorder. If one personality commits a crime, is it ethical to punish all personalities? This is a question that first occurred to me several years ago while reading A Fractured Mind, by Robert B. Oxnam. Oxnam gave a few examples of when one personality did something “wrong,” and Oxnam implied that he, himself, was not guilty of those transgressions, because it was his other self that committed them. The two examples I remember are when one of his personalities cheated on his wife and when one of his personalities stole a bunch of stuff from a boating store. It peeved me that Oxnam thought it was ok to brush off those acts by saying “the other (bad) me did it.” But perhaps that is because I’m skeptical of true multiple personalities that are unaware of, and unable to control, the others’ actions. If it does exist, I’m sure it’s very, very rare.

On the other hand, I do know someone who has disassociative episodes and was caught doing something illicit during an episode. But my friend has never blamed the “other” guy – he seems quite willing to step up and take the blame. Somehow that willingness to accept the blame makes him seem less culpable, in my eyes, than Oxnam.

What do you think? Do you believe that people with DID can have completely separate identities that are unaware of, and unable to control, each others’ actions? Do you think the entire set of identities should be punished if one personality commits a crime?

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 17: Contemporary and Legal Issues in Abnormal Psychology. Abnormal Psychology, sixteenth edition (pp. 583-607). Pearson Education Inc.

The Epic of Gilgamesh – Historical Background

History of the epic

The Epic of Gilgamesh is the oldest epic still in existence. Coming from the third millennium BCE, it predates Homer’s epics by at least one and a half thousand years. It is from a time long forgotten by historians – only rediscovered in the last century by archaeologists in the Middle East. The fascinating part about the Epic of Gilgamesh is that even though it is 5 millennia old the humanity and passion of the story still resonate with readers today.

The most complete version of Gilgamesh yet discovered is a series of eleven tablets in the Akkadian language found in the library of Ashurbanipal in Nineveh. Ashurbanipal (668-627 BCE) was a great king of the Assyrian empire and a collector of literature from all over the Middle East. His library disappeared after the fall of Nineveh in 612 BCE, and was uncovered by archaeologists in 1839. The tablets were transferred to the British Museum where they received little attention until 1873, when a scholar named George Smith realized that they included an account of the flood (recounted in the Bible as the story of Noah’s ark). This announcement set off an immediate sensation because it suggested that the authors of the Bible might have been familiar with Gilgamesh’s story (though possibly both versions come from an earlier source). After this discovery, archaeologists dug up more and more tablets and scholars busied themselves with translations. Unfortunately, some of the tablets are fragmented, and the story has to be pieced together from different versions. This leaves the story very open to interpretation.

Who was Gilgamesh?

The character of Gilgamesh is thought to be based on a real king of the Mesopotamian city of Uruk (Erech in the Bible). The historical Gilgamesh probably raised up the famous walls of Uruk, described in glorious detail in the epic. The walls had a 6 mile perimeter and more than nine hundred towers. Its ruins are near the town of Warka, in southern Iraq. Archaeologists date parts of the wall to around 2700 BCE, so they believe Gilgamesh may have lived around then. According to the “Sumerian king list,” Gilgamesh was the fifth king of the founding dynasty of Uruk.

Gilgamesh was clearly a great builder – not only building the great wall, but also restoring the shrine of the goddess Ninlil. He very likely led a successful expedition to retrieve timber from the lands to the North – a story which was related in the epic.

This is a series of posts about The Epic of Gilgamesh. Here is a list of all posts thus far:

The Epic of Gilgamesh – Analytical Summary

The Epic of Gilgamesh – Historical Background

The Epic of Gilgamesh – Translations

The Gilgamesh Epic and Old Testament Parallels, by Alexander Heidel

The Archetypal Significance of Gilgamesh, by Rivkah Scharf Kluger

A History of Abnormal Psychology

Chapter 2 of Butcher’s Abnormal Psychology is a bit harder to summarize than Chapter 1. It covered the reactions of people towards the mentally ill throughout history. There were lots of names mentioned, and trends galore. But I will try to focus on the ones that I found most interesting.

During the classical age of Greek and Roman philosophers, mental illness began to be viewed more as a physiological trait than as demonic possession, which was the common viewpoint before this time. Hippocrates, a Greek philosopher considered the father of modern medicine, believed that mental illnesses were due to brain pathology. He recognized heredity, predisposition, and head injuries as common causes of mental illness. The doctrine of the four humors was related to Hippocrates and later to the Roman physician Galen. These four fluids in the body could combine in different ways to regulate the personality of an individual. Hippocrates promoted healthy living as a remedy to mental illness.

Plato, also, supported the kind, empathetic treatment of mentally ill individuals. He suggested that mentally disturbed individuals were not responsible for criminal acts. However, Plato viewed mental illness, at least partly, as an effect of spirituality. Hippocrates’ and Plato’s support of humane treatments for mental illness influenced later Greek and Roman philosophers.

During the Middle Ages, the belief that mental illness had physiological origins almost disappeared in Europe. The texts of the Greeks and Romans survived in Islamic and Middle Eastern regions, but very few Europeans of this time were able to read Greek or Roman texts. The Middle Ages marked a regression in both scientific and philosophical thought. The Greek and Roman texts weren’t “rediscovered” until the Renaissance.

Supernatural explanations for mental illness gained popularity, and treatment was left mainly to the clergy. At least the treatment of the mentally ill by the clergy was mainly humane.

It is commonly thought that the mentally ill were often accused of being witches during the Middle Ages, and were thus cruelly executed. However, recent research suggests that witchcraft was not believed to be an effect of possession, as mental illness was. Usually the accused were ill-tempered, impoverished women.

Scientific explanations for mental illness reemerged in the late Middle Ages and Renaissance. Even some of the clergy were falling away from possession as the cause of mental illness. Saint Vincent de Paul declared “Mental disease is no different than bodily disease and Christianity demands of the humane and powerful to protect, and the skillful to relieve the one as well as the other.”

Despite the resurgence in the belief of physiological explanations for mental illness during the Renaissance, inhumane asylums for the storage of individuals who could not care for themselves were on the rise.

In the late 1700s, humanitarians began to intervene on behalf of the mentally ill. Physicians began to experiment with more humane treatment of individuals. The French physician Philippe Pinel demonstrated that the removal of chains, and introduction of healthy living in an asylum had extraordinary effects on the recovery of mentally ill individuals. English Quaker William Tuke later established a pleasant retreat for mentally ill patients, with similar positive results.

The success of Pinel and Tuke led to a period of humanitarian reform and the use of moral management. This movement promoted the rehabilitation of moral and spiritual character, as well as manual labor. Moral management was highly effective. Recovery and discharge rates increased dramatically.

Unfortunately, moral management made way to the mental hygiene movement, which emphasized the physical (rather than spiritual) treatment of institutionalized patients. Although hygiene and the belief in physiological as well as spiritual causes of mental illness were important, improving the hygiene of the patients alone was not successful, and recovery rates plummeted. However, the mental hygiene movement was meant to create a more humane environment for the institutionalized – so in that way it was progress.

The number of institutionalized patients increased throughout the 19th and 20th centuries, but during the late 20th century humanitarians began to support deinstitutionalization of the mentally ill. Popular culture seems to believe deinstitutionalization to be a good thing – and for many, it was. Reintroduction of the mentally ill and developmentally challenged to their supportive families was a huge success when that family had the resources to care for its loved one. However, deinstitutionalization occurred too quickly, leaving many people without shelter, and of those who had shelter, many families didn’t have the resources to care for the patients. Many of the shelterless people became homeless, and others were quickly shunted off into prisons.

During the 19th and 20th centuries, four major themes in psychology developed: 1) biological discoveries, 2) classification system for mental disorders, 3) the emergence of psychological causations and views 4) experimental and research psychology.

The first major breakthrough in biological treatment of mental illness was the discovery that a form of paresis was caused by syphilis. This discovery boded well for the discovery of more biological treatments for other illnesses. Later discoveries showed deterioration of the brain led to senility and that some disorders could be caused by exposure to toxic substances. Biological treatments also had some mishaps – such as surgical removal of body parts including tonsils, part of the colon, gonads, and the frontal lobe of the brain.

Emil Kraepelin, a German psychiatrist, pioneered classification of mental illnesses, and his system became the forerunner to the DSM.

The Nancy school began a movement exploring psychological causations of mental illness. Two scientists in Nancy, France, discovered that some of the traits observed in hysteria – psychological paralysis, blindness, deafness, and pain – could be introduced in healthy patients through hypnosis. These symptoms could also be removed by hypnosis. Therefore, the Nancy school believed that hysteria, and later other disorders, were a form of self-hypnosis. Jean Charcot, a French neurologist, disagreed with the Nancy School. His research suggested that mental disorders were caused by brain degeneration. Toward the end of the 19th century, it was accepted that mental disorders could have a psychological basis, biological basis, or both.

Sigmund Freud was a student of Charcot, but later leant more towards the psychological causations mental illness. Freud discovered that if patients were encouraged to discuss their problems under hypnosis, they felt considerable emotional release. The patients, upon awakening, made no connection between their problems and their disorder. This led to the discovery of the unconscious mind. Freud also discovered that free-association and dream analysis had the same cathartic effect on his patients.

By the first decade of the 20th century clinical psychology labs, which performed experiments on causes and treatments of mental illness, were on the rise. Soon, the behavioral perspective developed. This perspective emphasized the role of learning in disorders. It began with Ivan Pavlov’s serendipitous discovery that he could condition dogs to salivate upon the ringing of a bell. Watson used Pavlov’s discovery to develop behaviorism – the belief that humans gain personalities through changes in their environments. Watson believed that he could train a child to become anyone he wanted the child to become simply by creating the right environment. (Stephen Pinker’s argument against this belief is discussed in my review of The Blank Slate.)

B. F. Skinner developed his own form of behaviorism in which consequences of behavior influenced subsequent behavior. This type of learning was named “operant conditioning.” For example, positive conditioning occurs when someone is rewarded for a behavior, such as when we give a treat to a potty-training child who has successfully used the toilet. Negative conditioning occurs when a child receives a shock when sticking his finger into an electrical outlet.

And thus abruptly ended Chapter 2 – after a long list of names and dates that the book thought were important for us to remember.

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 2: Historical and Contemporary Views of Abnormal Behavior. Abnormal Psychology, sixteenth edition (pp. 29-53). Pearson Education Inc.