“The reason creativity and craziness go together is that if you’re just plain crazy without being able to sing or dance or write good poems, no one is going to want to have babies with you. Your genes will fall by the wayside. Who but a brazen crazy person would go one-on-one with blank paper or canvas armed with nothing but ideas?”

Author Mark Vonnegut poses this question in the first chapter of his book, Just Like Someone Without Mental Illness Only More So. In this intimate and sometimes comic memoir, Vonnegut goes one-on-one with his past and present struggles with bipolar disorder, his family history, and his qualms with the medical field. His medical background and first-hand experiences provide readers with an eye-opening portrayal of life with mental illness.

In order to understand his own disorder, Vonnegut looks at his family’s history as far back as his paternal great-grandfather. He ventures into his childhood, endearingly poking fun at his not-yet-famous father’s eccentricities and struggles as “the world’s worst car salesman who couldn’t get a job teaching English at Cape Cod Community College.” He also provides honest depictions of his mother’s bouts of depression and paranoia.

“My mother, who was radiant, young, and beautiful even as she lay dying, heard voices and saw visions,” he says, “but she always managed to make friends with them and was much too charming to hospitalize even at her craziest.”

In his twenties, Vonnegut was a self-proclaimed hippie, experimenting with illegal drugs and eventually suffering three psychotic episodes leading to hospitalization. He was diagnosed with schizophrenia, later with bipolar disorder. He found stability in adulthood, graduating from Harvard Medical School, and was eventually named Boston Magazine’s “number one pediatrician.” He was shocked when the voices came back years later, causing his fourth break and ironically leaving him strapped to a bed at the hospital where he works.

Vonnegut’s conversational and often self-deprecating tone has a universal appeal. He shows how mental illness affects the successful and brilliant as well as the poor and disenfranchised. He contends that not any one person is completely sane and that defining insanity is a slippery slope.

“None of us are entirely well, and none of us are irrevocably sick,” he says. “At my best I have islands of being sick entirely. At my worst I had islands of being well…. You either have or don’t have a reluctance to give up on yourself. It helps a lot if others don't give up on you.”

Vonnegut watched his father use writing as tool to deal with posttraumatic stress disorder following his experiences in World War II.  He believes that art and creativity are excellent outlets for those suffering from bipolar disorder and other mental illnesses. When asked about this in an interview with Sliver of Stone magazine last year, he concluded by saying, “Art is a lifeline and a form of insanity.”

Editor’s note: This week, PAR is pleased to welcome guest blogger Grace Gardner. A recent graduate of the University of South Florida with a B.A. in Mass Communication, Grace is working as an editorial assistant this summer in the production department at PAR.

 
In the search for more effective treatments for Alzheimer’s disease, a new clinical trial will test whether a prevention drug has any effect on patients who are genetically predisposed to develop the disease, but who don’t yet exhibit symptoms. In the study, scientists are focusing on members of a large, extended family in Medellín, Colombia, some of whom have a specific genetic mutation that is linked to early-onset dementia. The trial will be “the first to focus on people who are cognitively normal but at very high risk for Alzheimer’s disease,” said Dr. Francis S. Collins, director of the National Institutes of Health (NIH), in a May 15 interview with the New York Times.

Members of the Colombian family who have the genetic mutation begin showing cognitive impairment around age 45 and develop full dementia by age 51. Three hundred family members, some as young as age 30, will participate in the initial trial.

The five-year study is a collaboration between the NIH, the nonprofit Banner Alzheimer’s Institute, Genentech (maker of the drug crenezumab, which will be used in the trial), and the University of Antioquia in Medellín. The trial will help to test the amyloid theory of Alzheimer’s, which holds that the disease is caused by a steady buildup of the beta amyloid protein. Some results of the trial—specifically those that address whether the drug can delay memory decline—may be available in as little as two years, according to study leader Ken Kosik, codirector of the Neuroscience Research Institute at University of California, Santa Barbara.

Although only a small percentage of people with Alzheimer’s have the genetic early-onset form, researchers expect the trial to yield information that will help millions people who are affected more common forms of the disease. “It offers a tremendous opportunity for us to answer a large number of questions, while at the same time offering these people some significant clinical help that otherwise they never would have had,” said Dr. Steven T. DeKosky, an Alzheimer’s researcher from the University of Virginia School of Medicine, in the New York Times article.

To learn more about this and other ongoing studies of Alzheimer’s disease, visit the NIH’s National Institute on Aging Web site.
Posttraumatic stress disorder (PTSD) now affects one in 29 Americans, reports Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, in a June 6 statement. An anxiety disorder, PTSD affects not only combat veterans but also crime and abuse victims, disaster survivors, first responders, and others who have experienced trauma in their lives.

Symptoms of PTSD can include sleep problems, irritability, anger, recurrent dreams about the trauma, intense reactions to reminders of the trauma, disturbances in relationships, and isolation. The good news is that PTSD is treatable, and new research is helping to identify the kinds of treatment that are most effective.

“The Department of Health and Human Services, along with the Departments of Veterans Affairs and Defense, are supporting new research to reveal the underlying causes of PTSD and related conditions, develop better tools to identify those at highest risk of developing the disorder, and develop new and better treatments and preventive interventions,” says Sebelius.

The National Institute of Mental Health is also funding research—including both evaluation and intervention studies—on a wide range of PTSD topics. Current NIMH studies are focused on:

  • Teens coping with parental military deployment

  • The effectiveness of a Web-based intervention for guardians of children whose one parent has murdered the other

  • The effects of stress in pregnancy

  • Cognitive behavioral treatment for PTSD in people with additional serious mental illnesses

  • Comparing behavioral therapies for treating adolescents with PTSD related to sexual abuse

  • The development of magnetic resonance imaging techniques for studying mood and anxiety disorders

  • Group intervention for interpersonal trauma

  • Prazosin for treating noncombat-trauma PTSD

  • Psychobiological mechanisms of resilience to trauma


To learn more about these studies, or for information and resources to share with your clients, visit the PTSD Web site at the NIMH.
Why are lying and cheating so prevalent? Is dishonesty just a part of human nature? What can be done to encourage people to be more truthful?

In a recent interview on National Public Radio’s “All Things Considered,” Dan Ariely, a professor of psychology and behavioral economics at Duke University, talked about his new book, The (Honest) Truth About Dishonesty: How We Lie To Everyone—Especially Ourselves, which was published on June 5. Ariely is interested in the psychology behind lying, and he has conducted a number of experiments over the years that were designed to get at why—and how—people lie. His experiments, which to date have involved more than 30,000 subjects, show that although very few people lie a lot, most of us lie “just a little.” Ariely also discovered some very simple ways to encourage people to be much more honest.

Why do we tell only little lies, or cheat only in small ways? “We want to view ourselves as honest, wonderful people and when we cheat ... as long as we cheat just a little bit, we can still view ourselves as good people,” Ariely told NPR’s Robert Siegal, in the June 4 interview. “But once we start cheating too much ... we can’t view ourselves as good people and therefore we stop.”

One of Ariely’s favorite experiments involved simple arithmetic problems and a paper shredder. “We give people a sheet of paper with 20 simple math problems and we say, ‘You have 5 minutes to solve as many of those as you can, and we'll give you $1 per question.’ We say, ‘Go!’ People start, they solve as many as they can, at the end of the five minutes, we say, ‘Stop! Please count how many questions you got correctly, and now that you know how many questions you got correctly, go to the back of the room and shred this piece of paper. And once you've finished shredding this piece of paper, come to the front of the room and tell me how many questions you got correctly.’”

Ariely explains that the subjects in this experiment typically claimed that they solved six problems, which they were paid for. What he didn’t tell the subjects, however, is that the shredder was modified so that it only shredded the sides of the paper, leaving the main part of the page intact. On average, people solved four problems, but claimed that they had solved six. “We find that lots of people cheat a little bit,” says Ariely, but “very, very few people cheat a lot.”

In his May 26 Wall Street Journal essay, “Why We Lie,” Ariely discusses some of the reasons that people behave in dishonest ways. Conventional wisdom suggests that when faced with a choice to be honest or dishonest, people weigh the costs (such as getting caught) against the benefits (such as gaining something useful or helping another person) and make their choice logically. Ariely’s research shows, however, that this is rarely the case. In fact, he found that level of cheating is generally unaffected by the probability of getting caught.

What factors cause people to cheat more or cheat less? In a variation on the math/paper shredder experiment, Ariely had the administrator of the test take a cell phone call while giving instructions to the participants, engaging in a distracting, unrelated conversation and seeming to ignore the test subject. In this case, subjects cheated, on average, twice as much. “I think this goes back to the law of karma, right?” says Ariely. “If somebody has mistreated you, now you can probably rationalize [your cheating behavior] to a higher degree.” Cheating also seems to be infectious: If another participant was flagrantly cheating, other subjects in the room cheated more.

If “getting caught” is not a disincentive to lie or cheat, then what is? For many of us, a simple reminder about honesty—a reminder of the moral code—can make a big difference. In an experiment at UCLA with 450 subjects, Ariely and his colleagues conducted another variation on the math problem experiment. This time, before the subjects began, they asked half of the participants to recall the Ten Commandments and half to recall ten books they’d read in high school. In his Wall Street Journal essay, Ariely explains the results. “Among the group who recalled the 10 books, we saw the typical widespread but moderate cheating. But in the group that was asked to recall the Ten Commandments, we observed no cheating whatsoever. We reran the experiment, reminding students of their schools’ honor codes instead of the Ten Commandments, and we got the same result.” Even a simple statement such as “I promise that the information I am providing is true” is often enough to encourage most people to be honest, according to Ariely.

If you have read Dr. Ariely’s book, or if you have other ideas about the psychology of dishonesty, PAR wants to hear from you—leave a comment and join the conversation!

*Nineteenth century British Prime Minister Benjamin Disraeli is perhaps better known for his literary career than his political accomplishments. He once quipped, “There are three types of lies: lies, damn lies, and statistics.”
A recent study suggests that children diagnosed with mental disorders are more susceptible to developing ongoing physical disorders later in life. A diagnosis of depression or anxiety combined with instances of abuse or criminal activity in the home gives children a higher chance of developing diabetes, osteoarthritis, and heart disease in adulthood.

The study, conducted by researchers at the University of Otago, Dunedin, New Zealand in conjunction with the World Health Organization (WHO) Mental Health Surveys program, analyzed data from a cross-sectional survey spanning 10 different countries. The survey sought to prove that a concrete relationship exists between mental disability and physical abuse leading to chronic physical conditions. Previous studies had failed to look at mental disability as a factor, which authors claim was an “important oversight.”

Kate M. Scott, an associate professor in the department of psychological medicine at the University of Otago, organized a team of interviewers to facilitate the survey’s two-part analysis. The first part looked for people who met the criteria of a mental disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV™). The second part evaluated childhood adversities such as “physical abuse, sexual abuse, neglect, parental death, parental divorce, other parental loss, parental mental disorder, parental substance use, parental criminal behavior, family violence, and family economic adversity.” These two factors were then used to evaluate the onset of physical problems.

In the study, published in the August 2011 Archives of General Psychiatry, authors point out that this was the first time scientists have analyzed data looking at the relationship between early mental illness and physical factors.

“In prior research that has considered the influence of the early psychosocial environment on later physical health, mental disorders have generally been out of the frame of consideration…. These results are consistent with the hypothesis that childhood adversities and early-onset mental disorder have independent, broad-spectrum effects that increase the risk of diverse chronic physical conditions in later life.”

Pre-1990s data shows that physical illnesses such as asthma were the most common disabilities diagnosed in children. However, in a recent article in The Future of Children, published by the Princeton University and the Brookings Institution, authors Janet M. Currie and Robert Kahn found that in 2008-2009, asthma had fallen to sixth on the list. After speech problems, the most common diagnoses were learning disabilities, affecting 23 percent; ADHD, affecting 22 percent; “other mental, emotional or behavioral problems,” affecting 19 percent; and “other developmental problems,” affecting 10 percent.

If the shift in diagnoses of children from physical to mental disorders continues, are children now facing a two-part challenge? Are there preventive measures we can take now to help children avoid physical issues later? PAR wants to hear from you, so leave a comment and join the conversation!

Editor’s note: This week, PAR is pleased to welcome guest blogger Grace Gardner. A recent graduate of the University of South Florida with a B.A. in Mass Communication, Grace is working as an editorial assistant this summer in the production department at PAR. 
Director John Huston’s film Let There Be Light, a documentary about the psychological issues of soldiers returning from World War II, has recently been restored and released by the National Archives and Records Administration. Produced by the U.S. Army in 1945, this controversial film was censored for more than three decades. By the time it was finally given a public screening in 1980, the quality of the then-available print was so poor that it was very difficult to view and understand. In this new restoration, the technical problems have been resolved, and many of us will now see this important piece of history for the first time.

Let There Be Light deals with “shell-shock,” or in today’s terms, post-traumatic stress disorder (PTSD), among returning soldiers. Huston, who is best known as the director of such classics as The Maltese Falcon (1941), Key Largo (1948), and The African Queen (1951), was serving as a major in the U.S. Army Signal Corps when he was given the assignment to create the documentary in June 1945. Its working title was The Returning Psychoneurotics. Although by current standards, the psychiatric methods and therapeutic “cures” are dated and perhaps unrealistic, the film captures some historically significant aspects of military psychiatric practice during the 1940s.

Huston later described the project:

I visited a number of Army hospitals during the research phase, and finally settled on Mason General Hospital on Long Island as the best place to make the picture. It was the biggest in the East, and the officers and doctors there were the most sympathetic and willing…. The hospital admitted two groups of 75 patients each week, and the goal was to restore these men physically, mentally and emotionally within six to eight weeks, to the point where they could be returned to civilian life in as good condition—or almost as good—as when they came into the Army…. I decided that the best way to make the film was to follow one group through from the day of their arrival until their discharge. (Source: National Film Preservation Foundation, Film Notes)


Let There Be Light was ground-breaking not only in its use of unscripted interview techniques, but also because of the mix of racial groups represented in the film. Although the U.S. military would remain largely segregated until President Truman’s executive order of 1948, a few Army hospitals had begun integrating in 1943. Huston’s film shows African American and white soldiers being treated side-by-side, an unusually progressive choice at that time.

To view this documentary now, visit the National Film Preservation Foundation and click on the link for Let There Be Light. And let us know what you think—leave a comment here to join the conversation!
Want your voice to be heard when the American Psychiatric Association (APA) publishes the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)? The organization is now taking comments on its most recent draft and welcomes opinions until June 15, 2012. Simply register to participate in the public commentary period. This will be the third time the draft has been made available for comment and will be the final opportunity for feedback on the text. A final version of the text will be presented to the Board of Trustees of the American Psychiatric Association later this year in order to meet a May 2013 publication date.

Interested in reading what is new in the DSM-5? APA provides an ongoing list of the proposed updates.

The World Health Organization (WHO) will be releasing the eleventh edition of the International Classification of Diseases (ICD-11) in 2015. If you are interested in participating in the revision, making comments, or reviewing proposals, visit the WHO site to register. Want more information about how the ICD-11 update will affect you? Visit the ICD-11 fact sheet for more information.
Black and Latino Students Suffer When Teachers Give Too Much Praise

A new study indicates that public school teachers may be failing to challenge minority students, giving them more positive feedback and less criticism than they give to white students, for work of equal merit. The study, led by Rutgers University psychology professor Kent D. Harber and published in the April 30 issue of the Journal of Educational Psychology, involved 113 white middle school and high school teachers in two public school districts located in the New York/New Jersey/Connecticut tri-state area, one middle class and white, and the other working class and racially mixed.

Teachers read and responded to a poorly written essay, which they believed was composed by a student in a writing class. Some teachers thought the student was black, some thought the student was Latino, and some thought that the student was white. Teachers believed that their feedback would be sent directly to the student, so that the student could benefit from their comments and advice. In fact, Harber and his colleagues had written the essay and were using it to see if the race of the student affected the way that teachers responded to subpar work. As predicted, the teachers displayed a “positive feedback bias,” giving more praise when they thought the essay was written by a minority student and more criticism when they thought the student was white.

Positive feedback bias may be one explanation for the academic performance gap between minority students and white students, according to Harber. Through the years, studies have examined other factors that contribute to this performance gap, including inequalities in school funding, racism, and a distrust of academia in some minority communities.

“The social implications of these results are important; many minority students might not be getting input from instructors that stimulates intellectual growth and fosters achievement,” says Harber, in a recent Rutgers University news release. “Some education scholars believe that minorities under-perform because they are insufficiently challenged—the ‘bigotry of lowered expectations,’ in popular parlance.”

What do you think? Can praise be a disguise for lowered expectations? PAR wants to hear from you, so leave a comment and join the conversation!

 
What’s in a name? For young veterans and others coping with post-traumatic stress disorder, a name could mean the difference between seeking treatment and suffering alone. Psychiatrists and military officers are now considering the implications of a name change for PTSD in an effort to reduce the stigma associated with this diagnosis. The new name under consideration? Post-traumatic stress injury, or PTSI.

“No 19-year-old kid wants to be told he’s got a disorder,” said General Peter Chiarelli, in a May 5 interview with the Washington Post. Until his retirement in February of this year, Chiarelli was the nation’s second-highest ranking Army officer, and he led the effort to reduce the suicide rate among military personnel. He and other supporters of the name change believe that using the word “injury” instead of “disorder” will reduce the stigma that stops soldiers and others from seeking treatment. According to Chiarelli, “disorder” suggests a pre-existing condition that “makes the person seem weak.” “Injury,” on the other hand, is appropriate because the condition is caused by the experience of specific trauma, according to supporters of the change. Injuries, they point out, can often be healed with treatment.

This issue is coming to a head because the American Psychiatric Association is working on a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), expected in May 2013. Not everyone is in favor of the name change; one of the major concerns, according to psychologist Sherrie Bourg Carter, is that “altering a diagnostic label may have far-reaching financial implications for health insurers and disability claims. Specifically, some insurers and government agencies may not be willing to reimburse mental health providers for a condition that isn’t considered a disease or disorder” (Psychology Today blog, May 6).

American Psychiatric Association President Dr. John Oldham has suggested that he would be open to considering the name change. “If it turns out that that [the word ‘injury’] could be a less uncomfortable term and would facilitate people who need help getting it, and it didn’t have unintended consequences that we would have to be sure to try to think about, we would certainly be open to thinking about it,” Oldham told PBS NewsHour in a December interview.

What do you think? Would a name change help reduce the stigma associated with post-traumatic stress and encourage people to seek the help they need? PAR wants to hear from you, so leave a comment and join the conversation!

 
Researchers at Northwestern University Medical School have suggested that depression in teens could be diagnosed with a simple blood test. Their study, published in the April 17, 2012 issue of Translational Psychiatry, identifies 11 biomarkers for early-onset major depressive disorder—one of the most common yet debilitating mental illnesses among young people. If the results are confirmed in larger populations, diagnosis could become a much simpler process, and one that might help teens avoid some of the stigma currently associated with a depression diagnosis.

Early-onset major depressive disorder is a serious mental illness that affects mainly teenagers and young adults. Although 2 to 4% of cases are diagnosed before adolescence, the numbers increase dramatically to 10-25% with adolescence, according to lead researcher Eva Redei, professor of psychiatry and behavioral sciences at the Northwestern University Feinberg School of Medicine. “Not diagnosed, depression affects how teens relate to others. The No. 1 cause of death among the depressed is suicide,” explained Redei in a recent interview with CNN. “If teens are depressed and not treated, there can be drug abuse, dropping out of school. Their whole lives can depend on these crucial and vulnerable years.”

In the study, researchers tested the blood of 28 teens, ages 15 to 19. Fourteen had been diagnosed as depressed, and the others were healthy. The researchers examined a panel of 28 markers that circulate in the blood; results showed that 11 of these markers could, with a high degree of accuracy, predict major depression in the subjects. Depression is currently diagnosed through psychological evaluations conducted by health care providers.

A blood test to diagnose depression could help reduce the stigma associated with this mental illness and help depressed teens to get the treatment and support they need. For many teens who are too embarrassed to ask for help, this blood test could be a huge step in the right direction. “Once you have a measurable index of an illness, it’s very difficult to say, ‘Just pull yourself together,’ or ‘Get over it,’” Redei explained recently to the Los Angeles Times.

Others are cautious in their response to the study. Dr. Lloyd Sederer, medical director of the New York State Office of Mental Health, suggests that this study could give parents and teens false hope about treatment. “When something like this comes out and gets a lot of attention, it’s a false promise to parents, because it’s nowhere ready for prime time,” he said in an interview with the Huffington Post. “Some of the risks have not been considered yet. And does it really shape, in any way, how effective your treatment is going to be now?”

What do you think? In what ways could a diagnostic blood test for depression affect treatment for your clients? PAR wants to hear from you, so leave a comment and join the conversation!