Category: MHP – Mental Health/Psychiatry


Cinema as Therapy by John Izod and Joanna Dovalis

October 15th, 2017 — 12:18pm

This book review originally appeared in The Academy Forum published by the American Academy of Psychoanalysis and Dynamic Psychiatry Vol.62, Number 2,  Fall 2017

Cinema As Therapy: Grief and Transformational Film by John Izod and Joanna Dovalis, published by Routledge, London and New York 2015

Reviewed by Michael Blumenfield, M.D.

Dr. Blumenfield is a Past President of the American Academy of Psychoanalysis and Dynamic Psychiatry and regularly reviews movies at FilmRap.net

This book discusses the following 9 films:

Birth (2004)

Tsotsi (2005)

Million Dollar Baby (2004)

Trois Couleurs: Bleu (1993)

Trois Couleurs: Blanc (1994)

Trois Couleurs: Rouge (1994)

The Son’s Room (2001)

Spring, Summer, Autumn, Winter… and Spring (2003)

Morvern Callar (2002)

The Tree of Life (2011)

I am listing all the films covered because unless you are intimately familiar with these movies (which I was not), I believe it will be very difficult for you to appreciate and follow the detailed discussion of each of them in this book.The authors carefully dissect each movie, often scene by scene, sometimes discussing the camera angles, the music, certainly the dialogue (sometimes word by word), and most important their detailed understanding of the psychodynamics of each character and their interaction with each other. There are frequent references to psychoanalytic writings with a heavy emphasis on Jung.

The difference between this type of an approach compared to a case study is that the latter would be presented in an organized manner where we might have a context to examine the details. In this book, the author assumed that their interpretations and their psychodynamic formulations are correct and they continually build and elaborate on them in their ongoing dissection and discussion of the movie. We have to accept that their understanding of every nuance is valid. Did the screenwriter who created the characters and storyline consciously plan every symbolic twist and turn of the story, choice of phrase, meaningful color of clothes or sky or flowers, appearance of animals or birds, all of which were interpreted by the author of this book as having special meaning. Even if we assume that the psychodynamics are flowing from the unconscious of the screenwriter and director, we still have to do a reality check on how movies are actually made. Sometimes the clothes chosen by wardrobe people based on availability as might be a particular location, which may not be chosen because of symbolic meaning. The red color of the sky may be an artistic coincidence and not a symbolic choice to express anger, etc.

Even if what I believe is a great deal of over interpretation was valid, it would be difficult to understand most of it without knowing the past history and insight into each character. When we are studying a case history in a conference or supervision, the presenter has given us a context by providing the background (parents, youth, previous interaction, etc.) and usually an insight into a psychodynamic formulation, which the presenter wishes us to consider. If we are treating a patient and are formulating our understanding of the psychodynamics, we do this through a process of learning past history and early relationship, transference manifestation and the patient’s response to our interpretations. This is in contrast to having the author unfold a movie story and provide detailed interpretation of nearly every piece of behavior which is unfolding before us on the screen without a previous context.

In the introduction to this book, the authors note that they have chosen to emphasize grief in cinema and they imply (as does the title of the book) that cinema can be used in grief therapy. They seem to be suggesting that transformation and perhaps working through might be achieved by cinema. They note that film allows the viewer to more freely surrender themselves to their feelings. They elaborate that the audience might share a common trait with the character in the movie, which evolves into particular patterns of grieving caused by a devastating and undigested loss. The idea would appear to be that the movie experience would be therapeutic in working through the grief. While some of the movies discussed in the book did have grieving and loss as part of the theme, I did not feel that the authors returned to this idea in any depth in showing how viewing the film might be therapeutic to the audience.

Having said all of the above, I do believe it would be a wonderful experience to attend the movie with the authors and have a subsequent discussion with them about the film that we just experienced. I also believe that the authors would be ideal teachers to discuss the film that students or colleagues who have all viewed the film and could interact with each other about their interpretations. This book could be a textbook for a psychoanalytic class that was going to study one of the movies and have a sophisticated dialogue about possible psychodynamic interpretations. It would be even more of a challenging endeavor if a psychoanalyst would embark upon teaching a group of film students about psychodynamics and use this book and the particular movies as subject matter. In addition, it certainly would be fascinating if the authors could present clinical material where a movie had become a therapeutic experience to a particular patient in helping them work through their grief or other issues.

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The Wisdom of Psychopaths by Kevin Dutton

July 21st, 2016 — 10:45pm

Screen Shot 2016-07-21 at 5.00.55 PMThe Wisdom of Psychopaths by Kevin Dutton

Kevin Dutton, the author of this book is a PhD research psychologist at the Department of Experimental Psychology, University of Oxford. His principal research interests are persuasion and social influence, and the psychopathic personality. This is his 4th book and 3 of them also clearly deal with psychopaths

This book is all about the Psychopathic Personality. While all aspects of this interesting entity are discussed from many view points, I don’t believe a clear definition was put forth- probably because there are some disagreements about many of the fine points. For the purpose of this review I will go by the definition of Psychopathic Personality as being a personality disorder characterized by amorality and lack of affect; capable of violent acts without guilt feelings. In the psychiatric literature the term was superseded by “ sociopathic personality ” which then evolved to the  “antisocial personality”

In the latest Diagnostic Statistical Manual-5 ( DSM-5), the term antisocial personality is used and defined as “ A persuasive pattern of disregard for and violation of the rights of others, occurring since age 15 as indicated by THREE (or more) of the following:

  • Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
  • Deceitfulness as indicated by repeated lying, use of aliases or conning others for personal profit or pleasure
  • Impulsivity or failure to plan ahead
  • Irritability and aggressiveness as indicated by repeated physical fights or assaults
  • Reckless disregard for safety of self or others
  • Consistent irresponsibility as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
  • Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another

The individual also must be at least 18 years of age, there has to be  evidence of the disorder starting before age 15 and it should not exclusively occur during the course of schizophrenia or bipolar disorder.

The author describes, to my mind, fascinating research by various authors about this entity. Often various scales are used to define the psychopathic personality that incorporate different aspects of the above criteria. Some would appear to emphasize some criteria and others would favor different criteria. Some researchers used very extensive tests and others would just ask a few questions. Before I go further, readers might was to take an 11 question test to see where they fit in on the psychopathic scale as determined by this short questionnaire.

Another test that he uses is a variation of the classical moral dilemma of the overcrowded lifeboat. Either some people have to be thrown overboard and die in the icy waters or they all will die. Various subjects are asked this question and how fast they answer, what their answer would be and perhaps what part their brain was shown to be active while they were deciding, all might be studies and the results would also be analyzed according to their scoring on a psychopathic scale of one type or the other.

Various components of the psychopathic personality are broken down and studied. For example, the author was interested in the fact that college students are trending to be less empathic and more narcissistic in various research studies.

The author is very interested in epigenetics, which is the change in how a gene is expressed without changing the DNA sequence. This would appear to be looking at how environmental factors influence how the gene is going to be expressed. This could occur to the fetus during pregnancy or I would suggest the same definition could occur by experience in childhood but all impacting on some genes that perhaps had a tendency to produce psychopathy. The author considers also how such things as child abuse might even produce an enzyme that in a susceptible individual might make them more aggressive.

The book is a hybrid between an interesting non-fiction discussion of the psychopath and a scholarly textbook. as would be the case in the latter many references are cited but not in the usual scholarly form but rather by an asterix(*), which leads the reader to the appendix where the topic is superficially discussed. Not knowing the research, we are left with the author’s conclusion about it without any critical analysis. For example we are not told the degree of statistical analytic support (or if there was statistical proof or just a trend) nor are we told if there might be other explanations that might shed light on a particular research finding.

There are many interesting questions raised by the author about the psychopath and various characteristics, which make up psychopathy.

For example, the psychopath often has ability to remain calm and objective under stress with razor sharp focus which might be useful in sports as a quarterback under pressure, a fireman in a dangerous situation and maybe even as a Navy Seal. You might want one in your foxhole unless of course there were a situation where only one person could survive.

There are many unexpected angles that the author uses to approach the analysis of psychopaths. He even makes the case that Saint Paul was a psychopath and that there could be a thin line between Saint and a psychopath. After all isn’t mindfulness an altered state where one is present, open, and alert with all judgment and interpretations suspended?

There is a discussion about empathy, something of which we might imagine that the psychopath would be in short supply. However in the riveting discussion about some sadistic serial killers, it was that exquisite ability to feel their victim’s pain, which was converted to pleasure and drove them to their numerous twisted murders.

So whether you are clinician or a layperson that has been fascinated by the characteristics often defined by the term psychopath, this book will hold your interest and even get you to wonder if deep down you have some of these traits.

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Moving Images: Psychoanalytic Reflections of Film by Andrea Sabbadini

June 10th, 2016 — 4:12pm

The following is a book review which I wrote and  appeared in Psychodynamic Psychiatry Volume 41 Number 3  Fall 2016 p 162-166Screen Shot 2016-06-10 at 3.49.26 PM

Moving Images: Psychoanalytic Reflections of Film, by Andrea Sabbadini, Routledge, London and New York, 2014, 140 pp.

While reading this book, I kept pondering the question of who would be the best audience for it. The author, Andrea Sabbadini, is a psychoanalyst who is extremely knowledgeable about film, especially classic European movies. His stated goal for the book is to offer discussion of films from a psychoanalytic perspective and in the process of doing so, to use the films in order to illustrate a number of psychoanalytic ideas and to convey a sense of what analytic work consists. Anyone who is familiar with many of the movies discussed in this book and understands psychoanalytic and psychodynamic theory would be the ideal audience for it. However, even knowledgeable psychoanalysts with out having seen these films would find it difficult to relate to the book. Similarly, students of cinema who may have seen the films mentioned, would probably get lost in the erudite psychoanalytic discussion presented in this book. Unfortunately, that would seem to leave a very small audience for this book. However, I do see an important value for it which I will discuss at the conclusion of this review.

This 140-page soft-covered book has six chapters which I will list below with two of the several movies discussed in each chapter.

Chapter 1: “A Young Profession: Films on Psychoanalysis” Spellbound (Hitchcock, 1945)
Il Postino (Radford, 1994)

Chapter 2: “…and the Oldest One: Films on Prostitution” Nights of Cabiria (Fellini, 1957)
Belle de Jour (Buñuel, 1967)

Chapter 3: “The Young Ones: Films on Children” The Spirit of the Beehive (Erice, 1973)
German Year Zero (Rossellini, 1948)

Chapter 4: “…and Slightly Older Ones: Films on Adolescents” Heavenly Creatures (Jackson, 1994)
City of God (Meirelles, 2002)

Chapter 5: “Between Eros and Thanatos: Films on Love” A Pornographic Affair (Fonteyne, 1999)
Amores Perros (Inarritu, 2000)

Chapter 6: “Watching Voyeurs: Films on Scopophilia” Rear Window (Hitchcock, 1954)
Peeping Tom (Powell, 1960)

The book opens with a discussion of films about psychoanalysis in which the author touches on how the psychoanalytic profession has been depicted in numerous movies, including a mention of the television series In Treatment (2010). There are several flms discussed in this chapter where Freud himself, and other well known analysts, were depicted. We also learned that Freud showed very little interest in the movies of his day and stated in a letter that he did not believe psychoanalytic ideas could be represented by cinema. Alfred Hitchcock’s Spellbound, which starred Gregory Peck and Ingrid Bergman, is described in this chapter as perhaps the most famous of all films about psychoanalysis. Sabbadini spends five pages discussing this film and how this whodunit movie included discussion of dream analysis, anxiety inducing situations, psychopathic devices of amnesia (repression), and guilt complexes. There is also a discussion of how the camera work, light effects, sound track, and editing create the dream-like psychological atmosphere that the director wished to achieve. In the movie Il Postino, Sabbadini justifies that while it is not actively about the psychoanalyst or analysand, the close relationships that gradually develop between Marino, the postman, and Neruda, the poet, shared many features with what normally takes place in our psychoanalytic consulting rooms.

In the chapter about films and prostitution, the author reviews the social complexities surrounding the selling and buying of sexual favors for money. He even considers a common fantasy that there is a close association between prostitution and psychoanalysis. He uses Fellini’s movie, Nights of Cabiria, to discuss the concept of a rescue fantasy. Fetishism and masochism are also analyzed in this chapter in some detail. Catherine Deneuve’s character Severine in Belle de Jour is examined and at one point the author even postulates that the house of prostitution is the metaphoric antithesis of marriage and has the unconscious function of keeping the latter alive and with it the normality it symbolizes.

Chapter three is the longest chapter and discussed fillms about children, which should not be surprising coming from a psychoanalyst who appreciates the importance of early life experiences. The Spirit of the Beehive was an internationally acclaimed film which was described as dealing with innocence, illusions, and isolation. It focuses on two young girls growing up in the Spanish countryside. This movie deals with the fantasy that they have of monsters which occurs after they see the classic horror movie Frankenstein. This certainly can be related to contemporary young women who are constantly bombarded with such horror films. The author examines how the two children’s fantasy world and magical thinking is skillfully explored by this movie movie. The film Germany Year Zero approaches children in a completely different manner. Rosselini visited postwar Germany in 1947 apparently without any story to tell but trying to answer his own troubled question, “The Germans were human beings like everyone else. What could have led them to this disaster?” Sabbadini describes how this film develops the answer to this question from the point of view of children as they find themselves forced by circumstances to behave like adults.

It is only natural that the author progresses to the next chapter and discusses films on adolescents. He tries to put a perspective on child development theory by noting that it is only in the course of the last 30 or so years that a radical shift has taken place in relation to our understanding of adolescence. One of the films which he focuses on in this chapter is Heavenly Creatures where two adolescent girls, when not immersed in their fantasies, would become obsessed with a plan to murder the mother of one of them. This movie is actually based on the diaries of a person in a real life event which took place in New Zealand. Sabbadini describes how the film attempts to show the conflict between adults and adolescent children. The Oedipus complex and “passing phases of homosexuality” are some of the themes analyzed in this movie. Another film discussed in this chapter is City of God which is also based on an actual event that happened in Rio de Janeiro in the 1960s and 1970s. It looks at the role of young people in the Brazilian slums and is described as a “part tender Coming of Age film and part Gang-Warfare Epic.” The author uses this film to further expound on Oedipus theory.

Chapter 5 tries to look how the cinema often tackles issues of love. The author notes how films have explored most variations of this theme often throwing new light on the more bizarre and unusual aspects of it rarely considered anywhere else. He also states that psychoanalysis has done likewise focusing more often on the pathological deviant or perverse side of it rather than the so-called normal one. Sabbadini uses A Pornographic Affair and the relationships of the two characters Elle and Lui to study the deeper emotional meaning of their liaison. He discusses psychoanalytic constructs to understand them such as triangular constellations, regressive tendencies, voyeuristic fantasies (of the audience), and the unseen pornographic components of the main characters’ love affair. Sabbadini returns to the concept of the rescue fantasy as he then analyzes the Mexican film, Amores Perros. This movie consists of three stories which he tells us involve transgressive passion and almost intolerable violence as well as profound humanity. He breaks down each story and explains and interprets the fantasies involved. He explains how he feels that there is a universal fantasy and an important emotional complex both in the conscious and unconscious and that it is often related to primary narcissism.

In the final chapter titled “Watching Voyeurs, Films on Scopophilia” perhaps the most interesting chapter in the book. Sabbadini recognizes the cinema goer or film lover as a voyeur and he quotes Freud stating that the scopophilia drive is autoerotic. Therefore the movie-going experience is a source of both voyeurism and exhibitionism. By bringing the viewers into the equation, he is in a sense recognizing one of the analyst’s most powerful instruments and that is a recognition and utilization of our countertransference. One of the examples that he uses is Hitchcock’s Rear Window. In this film, through one of the main characters played by James Stewart, we watch through his rear window, what goes on in an apartment house opposite his home. Sabbadini discusses that what we see through the voyeur’s eye is a projection of our own desires. He also describes this movie as a dream. He goes on to use Freud’s essays on the theory of sexuality to analyze the movie and also brings in the witch hunts of the McCarthy era which were occurring when the film was made and he believed may have influenced it. There is no shortage of films for Sabbadini to use to further explore this topic. He analyzes the film Peeping Tom which allows him to discuss an array of different forms of deviant sexuality, psychopathology, scopophilia, obsessions with pornography, and sadism, not to mention a further description of the presence of a deep depression underlying everything else.

I believe that the real value of this book will be as a textbook for the study of the cinema from a psychoanalytic point of view. A group of psychoanalytically minded people could choose one of the films mentioned in this book for each group discussion and view it individually or together prior to a discussion of it. They could consider the observations and the thoughts of Sabbadini as well as their own reactions and interpretations of the film viewed. One person could lead the discussion of each film. Since most members of such a group would likely not have previously seen most of these films, this would enable them to now view them and participate in a study of them. I am sure these films are readily available on Netflix.

A second group that may want to use this book as a guide to understanding the films discussed in it might be film students or people who enjoy classic films. Assuming that most of these people who join such a discussion group would not be psychoanalytically trained, the leader or guide for such a discussion group could be a psychoanalyst who is skilled at explaining these concepts as they apply to this film, to a lay audience. The students in such a class would already have a keen interest in how movies convey psychological issues and would value seeing this film again (or for the first time) and would most likely be very receptive to having the meaning put in a psychodynamic and psychoanalytic context. Once again this book would be a marvelous textbook for the leader and the group to use after they have seen the film under discussion.

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Getting The Most From Your therapy by Jeffery Smith, M.D.

February 14th, 2016 — 10:50pm

Screen Shot 2016-02-13 at 9.17.25 PMGetting The Most From Your Therapy by Jeffery Smith, M.D.

Instead of a written review of this book, I have conducted an interview with Dr. Smith in a podcast. Please click the following line to hear this broadcast: Interview with Dr. Jeffery Smith.

 

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What She Left Behind by Ellen Marie Wiseman

January 13th, 2016 — 11:06pm

Screen Shot 2016-01-12 at 10.53.06 PMWhat She Left Behind

By Ellen Marie Wiseman

This book is composed of two interweaving stories. Clara, a woman who lived in the 1930s was committed to a mental institution against her will based on her wealthy father’s unhappiness about her Italian immigrant boyfriend and her refusal to marry the rich guy that her father picked out for her. The other story is about a current day teenager named Izzy who is a foster child of Peg and Harry after having lived with several previous foster parents since her mother unexplainably murdered her father. Peg is working on a museum project examining newly discovered suitcases of belongings of former patients (including those of Clara) of a now closed psychiatric facility, in order to gain some understanding of their lives. Izzy helps out with this project and finds the diary of Clara and becomes interested in her life.

Being a psychiatrist, I was initially drawn to this book with the idea that I would gain some insight into the lives and treatments of psychiatric patients living in the first half of the twentieth century. This was the case and it included vivid description of the treatment that was done at that time such as ice baths, insulin shock therapy and electroconvulsive therapy (ECT).

Although I never worked in a state hospital, when I toured them in the late 1960s, such treatments except occasional ECT under humane conditions were things of the past. As far as the possibility of someone spending most of their life committed to a mental institution based on the word of her father when she clearly did not have a mental illness, I would like to think that this would not have been possible. Certainly, in modern times from my experience someone being hospitalized against their will would have to go through a legal hearing with the patient being assigned an attorney if they don’t have one. Once in a hospital with treatment with modern-day medicines (which were not really available until the 1950s) most mental illness can be put at least in temporary remission with such treatment. Today, there would be reviews by multiple doctors with no mandate to keep the person in the hospital against their will unless they were a danger to themselves or others due to a mental illness. I would hope that nothing like Clara’s situation could occur today. Obviously, I can’t speak for every state hospital in the United States and certainly things were different in the 1930s.

There was another aspect of Clara’s case was particularly disturbing to me in that the psychiatrist in charge of her care was depicted as a mean, cruel, selfish man who was mainly responsible for Clara’s lost life. I felt it was an unfair indictment, which suggested all psychiatrists of that time might have been of the same cloth. I understand that the author has the creative choice to develop characters in whatever fashion she chooses. I probably would not be complaining if the character were a dishonest lawyer who did unsavory things in the interest of an interesting storyline but nevertheless, I felt that this book was stigmatizing my profession.

There was particular theme of this book, which also had a special interest to me. Three characters in the book were driven to try to understand their early origins. Izzy, understandably could not fathom why her beloved mother murdered her father. This ultimately led her to empathize with a schoolmate who had some parental trauma. It contributed to her mission to find Clara’s daughter who was essentially separated from her at birth, and hand over her mother’s diaries so she could know about her mother’s story. Clara’s daughter led a life of yearning to know what happened to her mother and Clara similarly went through life wanting to know what happened to her daughter. This is a variation of a theme, which I have seen played out in many people’s lives as well as in some interesting movies. Persons, sometimes separated at birth or when they are quite young often yearn to know their biological parent or parents with whom they may have had no relationship for decades. I have reflected on the psychodynamics of these issues in a psychiatry blog that I write. Therefore, I was particularly interested to see how they played out as major motivating factors in the characters in this book.

I believe the author Ellen Wiseman has created an intriguing story that will hold the interest of the reader whether or not you come from a psychiatric background.

Comment » | FG - Fiction General, FH - Fiction Historical, MHP - Mental Health/Psychiatry

A Common Struggle: A personal Journey through the Past and Future Mental Illness and Addiction by Patrick J. Kennedy and Stephen Fried

December 9th, 2015 — 11:56pm

Screen Shot 2015-11-18 at 6.27.58 PMA Common Struggle: A personal Journey through the Past and Future Mental Illness and Addiction   By: Patrick J. Kennedy and Stephen Fried

This is a story, told in the first person of Patrick J. Kennedy. It is really two stories presented to us simultaneously. It is about Patrick Kennedy, son of Edward Kennedy and nephew of JFK and Bobby Kennedy. He has been a US congressman from Rhode Island for eight terms and was one of the staunch advocates for parity legislation, for mental illness, and addiction. Yet at the same time that he was leading the fight in the United States Congress to bring about these major changes in our healthcare system, he himself was secretly battling mental illness and addiction.

An important part of his personal story was a discussion of alcoholism in his family. Not only was the author an alcoholic but his brother, mother, and father, Ted Kennedy also struggled with this condition. It is significant that all of them except his father ultimately recognized their problem and entered various programs to help themselves. His mother battled alcoholism for a prolonged period of time and yet her condition was not recognized by family members despite the fact that they knew about several hospitalizations and treatment programs that she had undergone.

One of the most revealing insights about his father that he revealed in this book is how Ted Kennedy was traumatized by the tragic death of his three brothers, JFK, Bobby Kennedy, and his oldest brother, Joe Jr., who was killed in World War II. An additional major trauma for Ted Kennedy was the death of the young woman in Chappaquiddick, an incident well covered by the press.

It was not a simple pathway for the author to recognize his own problems. Even after a period of therapy with Psychiatrist Peter Kramer, author of the well known book (Listening to Prozac). Kennedy felt this treatment was helpful but did not eliminate his addiction problem or allow full acceptance of his bipolar condition. He vividly described how he would convince himself that he didn’t have any problems if he didn’t drink in public or take “illegal” drugs.

Patrick Kennedy served in the Rhode Island legislature and was elected as the youngest member of the US Congress in 2004 during a period that his addiction and mental illness was hidden from the public. It was also pretty much hidden from himself.

His colleagues in the US Congress ultimately became aware of his attempts to hide his drinking problem. Kennedy describes an important event for him when in 1996, Minority Leader, Dick Gephardt, offered him the prestigious chairmanship of the Congressional Campaign Committee on the condition that he stop drinking. This made him realize how he was denying that he had a problem that was known to others.

It wasn’t until 2005 that he publicly admitted that he was suffering from a mood disorder that was being treated by a psychiatrist. While his own struggle continued, he became more effective in his advocacy in the US Congress. One misconception he believed had to be clarified concerned Nancy Reagan’s “Just Say No” campaign against drugs. He felt that this missed the main point that addiction is not something you can simply say no to, just as you can’t say no to cancer. It is a disease and by implying you can just say no stigmatized people who have the genetic propensity to have this disease.

As much as the story of Kennedy’s recognition of his own illness of addiction and mental disease and how he battled it is quite enlightening, the battle for a definitive bill in the US Congress is just as revealing.The events leading up to the 2008 Wellstone and Domenici Mental Health Parity and Addiction Equity Act are quite interesting and complicated. They are also quite personal to Patrick Kennedy. It took place at the time that he was relapsing to alcohol and painkillers and also was having an exacerbation of his bipolar condition. While Patrick Kennedy was one of the leading champions in the House of Representatives for this legislation, his father, Ted Kennedy, was a major supporter of this bill in the US Senate. This was also at a time that the senior Kennedy was dying of a brain tumor. Compromises had to be made in the bill and the Senate was reluctant for the legislation to be as comprehensive in various aspects and details of the bill as was wanted by the House of Representatives. There also was a question how the legislation would deal with the new surge of mental health problems occurring in soldiers returning from the war. There was a concern that it should cover PTSD as well as addiction in the returning servicemen. Patrick Kennedy described the dramatic moment that his dying father came to the senate floor to vote for the final version of the bill to the applause of the US Senate.

Even with the passage of this extraordinary legislation, the battle for adequate parity for healthcare support was far from over. The proof and the success of this landmark bill would depend on the implementation by the federal and state governments and certain local rulings are expected to eventually reach the Supreme Court. The 2016 presidential race can certainly also be expected to impact the success of implementation of this legislation. As of this writing, it appears that the Republican candidates may be reluctant to support the implementation of this legislation and provide funding for new programs.

Patrick Kennedy decided to leave the United States Congress in 2010. Since departing from Congress, he has continued to be a leading advocate to bring about implementation of the 2008 legislation for mental illness and addiction. In this regard, among many other things, he has worked with two important organizations in which he plays very active roles. The Kennedy Forum (kennedyforum.org) gathers experts in mental health and addiction and holds important conferences that they hope will ensure implementation of the 2008 legislation. They are also committed to promoting a translation of neuroscience into the preventative and treatment interventions for mental health and addiction. The second organization in which Patrick Kennedy is involved is One Mind (onemind.org), which is dedicated to the promotion and support of “brain health” and creating a fast track for treatment. Their current focus is on new approaches to treat and cure PTSD but they look forward to applying solutions for all brain disease including depression, Parkinsons, ALS, dementia, Alzheimer’s disease, and addictions.

Patrick Kennedy does not bemoan problems. He is clearly a man not only with a vision but with plans and solutions. He concluded his book with a scorecard of how we should rate our public officials who have the opportunity to pass legislation and make changes. Also at the end of the book, he had a section for people who are dealing with their own mental illness and addiction. He tells them not to be alone in this struggle and how important it is to get treatment. Finally, sandwiched in this book was a series of photographs of many well known members of his family. It brought back many memories to this reader of the great accomplishments of many members of the Kennedy family and of the tragic events that they experienced.

It should be noted that at the time that Patrick Kennedy wrote this book, he was three and a half years sober. He has shown that he is a very accomplished and insightful man. I believe we are going to hear a great deal about him in his advocacy. He has provided in this book a valuable historical account of the reasons to fight for the proper care of mental illness and addiction. I am sure he has a bright future and many people will benefit by his skills and his passion.

Comment » | AM - Autobiography or Memoir, MHP - Mental Health/Psychiatry, P - Political

How We Heal and Grow: The Power of Facing Your Feelings by Jeffery Smith, M.D.

October 7th, 2014 — 9:00am

Screen Shot 2014-09-30 at 5.38.33 PMHow We Heal and Grow: The Power of Facing Your Feelings by Jeffery Smith, M.D.

I was recently asked by my colleague and friend Dr. Jeffrey Smith, to write the Foreword for this new book that he has written. I was pleased to find it an excellent book. He offers a fresh and sensible way to look at how people develop dysfunctional patterns and facing feelings that have been avoided is the pathway to healing growth. He covers the full range of human problems from quirks to serous personality issues. He discussed the work of Freud, Mahler, Kernberg and many others including his own work. Interestingly the book is directed towards the lay public and I am sure will be received. However it really also belongs in the hands of therapists and any mental health professional who is involved with therapy. Dr. Smith has been teaching this subject to psychiatry residents and other psychotherapists for many years and is always very well received. He approaches the subject from a development al point of view. He points out how most of us have pockets of immaturity and how to outgrow them. Dr. Smith  discusses how and why the minds resist change. One of the central themes of Dr. Smith’s explanations is the phenomenon of catharsis where our underlying raw unprocessed feelings emerge and lose their power over us and are transformed when we share them with a therapist in the context of connection and safety. He describes this process and how it brings about an almost immediate change to the pathological emotions. I tend to look at the need for catharsis as something that has to occur over and over again which we often refer to as working through process. We do both agree that catharsis is an ongoing part of therapy. While this therapeutic work does require the empathic presence of the therapist. Dr. Smith also examines how some of this work may be able to done singularly when the person is trained in mindfulness in the Yoga and Buddhist tradition. The range and scope of the book is quite wide. He includes discussion of anxiety symptoms, trauma and depression although I felt he was little light on this latter subject particularly in regard to the role of loss. There is fascinating discussion on the dynamics of Multiple Personality Disorder in which he is a one of the few therapists with significant experience treating patients with this condition. Dr. Smith also brings his rich  experience in treating addiction into the book. He shares where dynamics and developmental experience is important and where the here and now social interaction is crucial. Included in the book is one of the best discussions of conscience and superego that I have ever come across. There is also and excellent section on the narcissistic personality and a description of how to understand a parent who had this condition and how to deal with important people in your life who have it. This is really a unique book that should have great appeal to therapists, students learning therapy and people interested in understanding their own emotional issues as well as those around them. I can also picture how this book may be very useful for people entering therapy, It will alert them to what to look for in themselves. It may very well facilitate the therapeutic process. In fact, I plan to give a copy of it to some patients who enter therapy with me. I am very pleased to conclude that Dr. Smith has made an outstanding contribution to our profession and to the education of the public.

 

 

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Thank You For Your Service by David Finkel

March 16th, 2014 — 3:11pm

Screen Shot 2014-03-16 at 12.05.26 PMThank You For Your Service by David Finkel– This is a nonfiction account, which reads more like a novel, of the story what happens to the soldiers who return from Iraq and Afghanistan after being mentally injured in combat. The author David Finkel previously wrote a well-received book, The Good Soldier, about his observations as an embedded war correspondent. Now he closely follows a group of soldiers most of whom know each other as they came home to their families, some with physical injuries but all with post traumatic stress disorder (PTSD). He writes in the third person and there is no trace of the author’s actual presence although it is like he is a fly on the wall, reporting dialogue in their homes, bedrooms, etc. and in the various treatment programs, which attempt to rehabilitate them. The book takes us back to their combat experiences in foreign countries as well as to their battles with their spouses and with their demons. This is a close up view that can get you inside the head of these men and their spouses. It is as if you were the trusted therapist who was being told all. In fact, clinicians in training or those wanting to get experience with this population of people, psychologically impaired by war would certainly benefit by reading this book. There was clear insight into the thinking of all the subjects but there was no simple answer how to treat them or how they can live with the sequelae of this war experience.

The known connection between TBI ((Traumatic Brain Injury) and PTSD is repeatedly demonstrated although it is not invariable. The soldiers bring back tremendous guilt for what they have seen and done which is not easily alleviated by a rational analysis. Seeing buddies maimed and violently killed in a split second, no matter how conscientiously they tried to hold their fellow soldier’s body together while waiting for a medic or intellectually knowing they had no realistic way to avoid these events does very little to mitigate their guilt. One soldier was faced with an enemy firing a deadly weapon at him while holding a 3-year-old child in his arms. It was a self-preservation act to fire his own weapon and kill his enemy and the child but nevertheless the guilt continues to haunt him. It should not be surprising that the families of the wounded warriors also experience emotional damage. This pain is not only psychological but also physical in the form of what at times is severe domestic violence. There is also the suggestion that the participants in today’s volunteer army may be more likely to have had some emotional instability prior to enlisting. There are no statistics given to support this nor does this diminish the responsibility that we have to the all the heroes whom we meet in this book.

The undercurrent of this book is the subject of suicide. Such thoughts lurk in a large number of these injured soldiers and there are numerous examples of serious contemplations to end their own life with some cases where they carried out this deed. I well remember following the rising statistics several years ago as the number of suicides among active duty soldiers and veterans gradually increased until they were more than the civilian population and then ultimately exceeded the number of combat deaths. This book illustrates the stories behind these numbers by not only recounting the suicidal thoughts and near acting out of them by some of the subjects of the book but also by describing a special conference call held on a daily basis. This was the meeting run by a high ranking General linked to military bases around the world during which every suicide committed by a soldier was reviewed. At one point this was more than 22/day. The goal was the valiant but obviously unsuccessful effort to extract suicide prevention measures from this deadly experience to significantly eliminate this deadly situation.. Although not mentioned in this book, this was during a time that many people including this writer were advocating that families of soldiers who suicide should receive an official letter of condolence by the US President which is done for every fallen soldier and which was not happening at that time.

I came away  away from this book hoping that the emotional toll that warriors of war will pay be factored in along with the loss of life and limb, when anyone on this planet contemplates actions that will lead to armed hostilities.

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Ido in Autismland by Ido Kedar

May 13th, 2013 — 11:08am

Ido in AutismlandIdo in Autismland by Ido Kedar – Although I am not an expert in this area, I believe that this will be a landmark book for families, educators and any professionals who work with young people with autism. It is a book of short essays written by a 15 year old about his experience with his condition starting with some pieces written when he was 12 years old.

What is unusual, unique and very important about this author is that he cannot speak and only when he was about 11 years old did he begin to communicate by pointing to letters on a letter board. Up to that point no one had any idea that he was an above average intelligent kid who began to read when he was about three years old.He was terribly frustrated by being treated by well meaning experts in autism and education by drilling him on simple exercises meant for a three year old child who was having trouble learning. He was asked to point to his nose which he often could not do and was judged accordingly.  Even when he began to point to letters and make intelligent sentences, just about everyone thought that his mother was guiding his hand since she had to steady it for him to point. It took his father, who is a scientist, two more years before he was convinced that his son was truly communicating fully formed intelligent sentences. The problem would seem to be that he could not control his body. He often would have great difficulty even signaling that he could make even  simple calculations or understood basic concepts.  This was further complicated by his arm flapping which would occur when he was anxious which he referred to as “stims“ . Other times he would do unexplainable pieces of behavior such as pulling his Mom’s hair or that of beloved aide when he was frustrated or embarrassed. This pattern of behavior is common in many children who fall under the rubric of autism except they are usually not recognized to understand things and mainly have trouble in controlling their bodies to communicate. Instead they are often deemed “retarded” and/or  “developmentally handicapped.”

Ido believes that he is not “one in a million” and that he has had indication that many of his friends with non verbal autism are as frustrated as he used to be. Once Ido proved he could communicate with a letter board and then on the keys of a computer, a new world opened up to him. He was put in mainstream classes which he would attend with an aide and has entered high school with the aspiration to go to college. It is a constant uphill battle, as while the administrators of his middle school were very supportive, he found that was not the case of the first high school which he entered. Obviously, it did takes a great deal of resources and some special accommodation to allow him to function in a regular high school environment. After transferring to a second high school he seemed to be quite adjusted as he continues forth.

This book traces his progress as well as clarifying many of his characteristics and experiences. For example he sees people in different colors such as red blue, yellow etc. which are related to their emotional state perhaps in relationship to himself. He is also  is very sensitive to sound and appears to have very keen hearing . He therefore at times gets overwhelmed by loud noises, certain music. being in the presence of multiple people talking . These and other situations can cause him to have what would appear to be overwhelming panic attacks. This is not only experienced as severe anxiety but it intensifies uncontrolled movements of his body. Over the years he has found that various types of physical training and exercise actually improved his self control, something that was not initially recognized as it was neglected in any attempts to assist him.

I found it interesting, as a psychiatrist,  that he did not mention whether or not he was given a trial on any anti-anxiety and anti-panic medications which are believed to directly  effect various pathways in the brain which are involved when people have such overwhelming emotions. I would imagine that the medical experts in this field have evaluated the  effect of such drugs as an adjunct to his treatment program but if they have not, it certainly should be done.

Ido frequently mentions that he knows that he has an illness that places many limitations on him but he prefers to focus on what he can do and what he hopes to be able to do in the future. He also is dedicated to teaching the public as well as families of children with autism and experts about the potential of people like himself.   Ido would probably say “ so called experts” since he has a sense of humor and he is keenly aware of how so many experts have misinterpreted his abilities). Not only is he becoming an advocate but he must be also considered to be a hero for so many people who are locked in the land of autism.

For a view of brief video clip of Ido at a meeting as one of his speeches is read go to:  http://www.youtube.com/watch?v=V4VR1KYRX8s

2 comments » | AM - Autobiography or Memoir, M - Medical, MHP - Mental Health/Psychiatry, T - Recommended for Teenagers

Hidden Impact: What You Need to Know For The Next Disaster

July 4th, 2011 — 3:09am

Hidden Impact: What You Need to Know for the Next Disaster: a Practical Mental Health Guide for Clinicians: A Practical Mental Health Guide for Clinicians, by Frederick J. Stoddard, Jr., Craig L. Katz and Joseph P. Merlino,  Published by Jones and Bartlett Publishers, Boston, 2010, 249 pages

Review originally published in the Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry

Most clinicians who have expertise in mental health aspects of disaster developed their skills in this area after they found themselves seeing patients following some tragic event. It is true that well trained clinicians know about acute stress, loss, grief and PTSD since these conditions come up in many forms with many patients. However, the application of their clinical skills in the midst and in the aftermath of disaster is a whole different ballgame. Having co-taught a course in disaster psychiatry for several years at the annual meeting of the  American Psychiatric Association, I heard this story many times as colleagues joined us for the course after experiencing a disaster in their area.

There are many courses seminars, journal articles and books which will inform you in great depth about the essential topics in disaster mental health, many of them written and edited by the editors and contributors of Hidden Impact. The book is originated from the Group for the Advancement of Psychiatry (GAP) where the authors ore members of the Committee on Disasters and Terrorism . GAP has a tradition of identifying important areas of mental health and supporting publications in these areas. In my opinion this book fits the bill as the first book on this subject you should read or if you were only reading one book this is the one to read. It is the book that you will throw in your suitcase if you find yourself traveling to a site to render care in the aftermath of a disaster

In 250 pages this is  as comprehensive a course of study on this subject as I have ever seen in a book this size. It is well written, interesting and quite practical. Each chapter starts with a vignette, which either centers on victims of a disaster or on the caretakers faced with the dilemma of dealing with the aftermath of such an event.  The book is filled with practical information such as a comprehensive check list (and I do mean comprehensive) of  what to take with you if you go into an area to render care.( ie, pack your own power, take local maps, support socks, brimmed hat, iodine for water decontamination etc. There are clinical tables and charts to be sure you don’t miss the basics such as what to expect during the impact phase (first 48 hours) acute phase (1-8 weeks), post acute phase (2 months and beyond). There are many clinical screening tables such as the one for PTSD in children. There is a discussion and review of pharmacology in disaster situations. There are chapters on the use of telepsychiatry, liability, ethics, staff support as well as some of the latest thinking on resiliency. There is also a list of useful resources including websites

You should not be surprised to  find that if you are working in a  disaster situation, you will be interacting with the media as well with community leaders who have the responsibility to make reports to the media . In this regard the topic of risk communication and “how to do it“ is well covered in a succinct chapter. By the way, your clinical skills can also be useful to members of the working press who are often traumatized by working in a disaster environment. This latter clinical issue is discussed in the chapter about  understanding and helping first  responders. It is clear that the we need to apply our knowledge of the psychological impact of disasters not only to the primary victims  but also to the secondary victims who come to the aid of others. That of course includes ourselves. Perhaps one of the most valuable tables offered in the book is a table from SAMHSA (Substance Abuse and Mental Health Services Administration) about  managing and preventing stress, which includes the signs that you may need stress management assistance and ways to help manage your own stress.

As an added bonus the book is approved for AMA PRA Category 1 CME credits with instructions for getting Continuing Medical Education Credits from the Medical Society of The State of New York.

Addendum:  This review would not be complete without mentioning a recent book which should be a companion piece to this one. It is edited also by two of the same authors Fredderick J Stoddard and Craig Katz along with Anand Pandya and includes chapters by Merlino and many others on similar and related topics. It is titled Disaster Psychiatry: Readiness, Evaluation and Treatment. Published by the American Psychiatric Press, 2011.

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