Sunday, March 24, 2013

Shrink Links: Guns & Suicide, DSM-V, and the Evolution of NAMI

Here are some links to some thought-provoking articles about psychiatry.

Our colleague and friend,
 Dr. Steven Sharfstein writes in the Baltimore Sun that keeping guns from the mentally ill will decease suicide rates.  I'll agree with him, and add that keeping guns from everyone will decrease suicide rates even more. See Mental Illness and Guns: Suicide is the Issue.

The Invitation to a Dialogue editorial in the New York Times once again features a psychiatrist who has been a guest blogger on Shrink Rap.  Dr. Ron Pies talks about the value of psychiatric diagnoses and the new DSM-V.  Among those who responded are Dr. Allen Frances, the chairman of the DSM-IV Task Force who has been railing against the DSM-V, a member of the DSM-V committee who quit, and a number of people with psychiatric diagnoses, including a recovery movement advocate.  I think you'll enjoy Sunday Dialogue: Defining Mental Illness.

And over on Pete Earley's blog, he takes us through the history of NAMI and how it's moved from being parent-focused to including a strong patient voice.  This year's convention will include speaker Robert Whitiker, author of several books which demonize psychotropic medications.  Do check out: The Changing Face of NAMI.   

As always, we'd love to hear your thoughts. 



Anonymous said...


Thanks for mentioning that Robert Whitaker is going to be a guest speaker at at NAMI convention. Wow, who would have thunk it?

But that is totally untrue that he has demonized psychiatric medication. He has repeatedly said that for a certain percentage of people, that it works beautifully. He just doesn't think it works a majority of the time and in his book, used alot of psychiatry's own studies to make that point.

Of course, reasonable people can disagree with his research but to essentially characterize him as anti psychiatry is totally off the mark. Maybe you should contact him as one of your colleagues, Sandra Steingard did, to get the true facts before you make incorrect statements like you did.


LM said...

Dinah only posts her opinion of the facts, didn't you know?

But yes, AA is correct here.

jesse said...

The letter from Leon Hoffman, a psychiatrist in NY regarding diagnoses is particularly to-the-point and worth reading. He stresses that the categories are too rigid and that most people have a blend of various attributes.

Yes, the drug companies advertise and create demand for medications, but quite important to are the multiple forces that lead diagnoses to be made. For instance, an insurance company may not pay for treatment, with or without medication, unless a diagnosis is made; the diagnosis may determine how frequently the patient can be seen; Boards and legal requirements may insist that diagnoses be accurate and reflect data in the chart.The very fact that a certain diagnosis is or is not included in the DSM may make it possible, perhaps even likely, that a certain medication will be prescribed.

A very complex situation.

Nathan said...

Whitaker doesn't demonize psych meds. He does put together a strong case with lots of evidence that at the population level our increasing use of psychiatric medication may be increasing psychiatric morbidity and disability, not decreasing it. It is a sobering argument, but no one has really been able to effectively argue otherwise.

catlover said...

I read the Baltimore Sun article about suicide, and as a rural person, I have some general comments, but not making a thesis here. Hey, the snow is thigh deep out there so there's nothing else to do but type on blogs or clean the kitchen. Therefore, I comment here, even though city folk won't get it, with their multitude of entertainment and social group options. "The state with the highest suicide rate in the U.S. is Wyoming, where the prevalence of guns in the home is the highest."

Wyoming is a predominantly rural state where I'd expect that almost everyone goes hunting or has close relatives who do. Targeting mental patients who are not thought to be a threat to others by removing their firearms permanently is a mistake. This is a sure fire way to isolate people with depression problems even more, when they can't go hunting with their families and everyone knows why they can't, too.

In the case of those rural people who don't live near a city, I'll bet you not many of those men in WY who killed themselves were driving 150 miles round trip once a week to see a therapist. I personally drive 90 miles round trip to see a therapist, and it is a challenge. I'm not in Wyoming, where the challenges to get medical care must be greater. But then, those men probably didn't have a psychiatric label and wouldn't have their guns taken away.

In a lot of rural areas, there is no other recreation for guys other than hunting and fishing. Most people live there because they prefer an outdoor lifestyle.

I can think of very few men that I know who don't hunt, fish or both. About half of the women I know do these things, too. Of course, ladies don't often kill themselves with firearms, do they, a point made on this blog before.

I strongly believe from my rural viewpoint that if large numbers of people with psychiatric labels have their guns taken away, society has also cut those men (and some women) off from their social groups. Some lives may be saved at the cost of deepening depression and isolation for many others. It's not like in the city where you can just do something else. If you are a guy and you don't hunt or fish, you have nothing in common with others. It's a lot worse than a guy who doesn't know his state's pro football team is in the playoffs. How many people is it acceptable to harm in order to save a life?

Just seems like more punishment for seeking treatment and getting a lovely psychiatric label in return, and your social group stolen away. I don't think I'm overstating the case for people who live in rural areas. Other opinions: I do think it is fine for a doctor to discuss guns in the home & storing them elsewhere.

jesse said...

@Catlover: you have changed my mind on this subject by your well thought out and expressed post. Thank you.

mctps said...

I don't see much talk anywhere about the idea that there are people who want to die, because they are suffering or in despair, and have been for a long time, yet people who can't manage to kill themselves due to the instinctual difficulty of pulling it off especially in places where their access to guns has been critically they end up killing OTHER PEOPLE INSTEAD, with a knife or by any number of other deadly means that don't require a gun, and yes, sometimes with a gun as well. Killing yourself is so difficult, so risky (partial paralysis, serious brain damage, broken limbs, what have you), and often so painful, that it's easy to push it further and further into the future until KILLING OTHERS begins to seem like a reasonable thing to do instead. You can easily avoid killing yourself in this present atmosphere and culture where it's a hard thing to do -- you can avoid it until you're so f*cked up that you become dangerous to others rather than yourself. One of the most dangerous things about alienation is that it can gnaw at your soul and completely make you despise humanity if it lasts long enough. If killing yourself were easy, you'd have done it a million times before you reach the point of no return, before you notice you have turned into a monster. You don't hear about this mechanism much in the news, but its occurrence is a rather obvious inference to make from what you do hear if you have insight into the minds of such people.

So that's an argument for suicide to those of you who don't care about the suffering of people who want to kill themselves. I mention it because I've never seen anyone express it in public.

I've been watching Futurama lately, and if there's one indication of progress in it that makes sense it's the suicide booth and the implied easy availability of easy suicide for everyone. While I think a waiting period of a couple of days or even weeks should be required in most cases, the suicide booth as such is a solid idea, although it would unfortunately require a more rational culture than the idiocracy thing we have today, and that's the only reason it can pass off as a comical detail in a popular TV show instead of the best idea since sliced bread.

Joel Hassman, MD said...

From the NY Times article you linked to in this post:

"Surprising though it may seem, psychiatric diagnosis is not scientifically grounded, does not reduce human suffering and carries risks of a wide array of serious kinds of harm. Even more disturbingly, it is totally unregulated, making it even less regulated than the financial institutions in this country.

I served for two years on two committees that wrote the current DSM but had to resign on ethical and professional grounds when I saw the way they ignored or distorted what high-quality research showed but presented junk science as though it were good when it suited their purposes.

The potential damage caused by a diagnosis is virtually limitless, including loss of custody of a child, loss of employment, skyrocketing insurance premiums, and loss of the right to make decisions about one’s medical and legal affairs."

Palm Desert, Calif., March 20, 2013

The writer is a clinical and research psychologist and the author of “They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal.”

Just curious, how do people maintain their membership to an organization that has such a damning indictment said in a major media publication?

oh yeah, she's just a psychologist, her opinion doesn't count, right?

Careful, remember the adage, "you are judged by the company you keep", I don't know if having a membership to the APA is a real positive mark on one's CV these days!

Oh, and just a reminder to people who have been practicing for more than 20 years and remember the damage that managed care caused to our profession, who ran under the "behind the scenes" campaign in 1995 saying 'managed care is here to stay, deal with it!',that lead to a loss by just 4% to an opponent who ran voraciously to reject managed care? That is right, Dr Sharfstein, lost to Harold Eist.

The fact that 48% voted for managed care is here to stay, well, a major reason why I dumped the APA renewal paperwork in the trashcan that year.

Disturbing how a profession sabotages itself and is so oblivious to the consequences. But, being insulated from the realities of life is the hierarchy that the APA leadership is about.

Care to dispute that position?

Anonymous said...

"keeping guns from everyone will decrease suicide rates even more."

Is that why Japan, where guns are kept from everyone, has such a lower suicide rate than the USA? So if we take Americans' guns away, our suicide rate will plummet to that of Japan? Oh, wait:

Japan: 21.7 suicides per 100,000 people
USA: 12.0 suicides per 100,000 people

"Crikey", even gun-free Australia has a higher suicide rate than we do. It's almost like people who want to kill themselves will do so no matter what, gun or no gun, and that the super-high rate of gun ownership in America does NOT equate with a super-high suicide rate, on a global scale.

Anonymous said...

I have read Robert Whitaker's books, and I didn't feel that he demonizes psychotropic medications. I am intrigued by what he writes as his arguments are well thought out and well supported. I also see a psychiatrist and take psychiatric medications. I don't think psychiatrists should feel threatened by him. I think he's interesting, and good for NAMI for allowing someone to speak who doesn't support the party line. There's room for everyone.

Anonymous said...

Anonymous #n said:

"Crikey", even gun-free Australia has a higher suicide rate than we do. It's almost like people who want to kill themselves will do so no matter what, gun or no gun, and that the super-high rate of gun ownership in America does NOT equate with a super-high suicide rate, on a global scale.

Suicide is a complex phenomenon, and rates vary enormously throughout the world -- with cultures of shame and despair, with the extent to which it is seen as an honorable or rational exit, and, yes, with access to lethal means. Yes, rates in many countries with restrictive gun policies, like Japan and South Korea, are much higher than in the US.

Anyone who wants to reduce suicide rates in their own country has to look at the culture of suicide in that country. I believe that a significant number of suicide attempts in the US are impulsive decisions made by drunk people. Killing yourself is not an easy task, believe it or not, but beer and a gun make it a lot easier.

So yes I believe that fewer guns in American homes would reduce our suicide rate. But it's not going to happen by government fiat. It's a cultural shift as people come to believe that whatever sense of safety they get from owning a firearm isn't worth the chance that the weapon will cause a tragedy. We don't leave drain cleaner out where children will get it because we know they don't make good decisions -- they might try to eat it even if we patiently tell them not to. Why do you think no one, including yourself, will try to use your gun to commit suicide? Is your thinking always blameless? Does mental illness not exist? I wonder if people who are very pro-gun-rights think, deep down, that they have a goddamn right to commit suicide with their own goddamn gun if that's what they want to.

btw, I'm having trouble finding support for your point about Australia; my internet searches are finding rates similar to, but slightly lower, than in the US.

Anonymous said...

My experience is very similar to Catlover's. I grew up in a rural area, my dad and brother went hunting and fishing, friends of the family went hunting and fishing. We had guns in the house (my parents still have several), most of the people I knew growing up also had guns in their homes, mental illness existed with some of these families, yet I have never known a single person who committed suicide or murder with a firearm, which doesn't surprise me since most gun owners don't commit homicide or suicide.

Anon, I will answer your question. I can't think of a gun owner I know who owns a gun because it is their expletive right to commit suicide by firearm, although I don't doubt there are people who have purchased a gun solely for that purpose, just as others have purchased medications to overdose, or whatever else.

The people I know who own guns do so for sport or they collect them. I would also imagine most mothers with a bathtub in their house don't think they have the right to drown their children, yet it happened. If we start noticing a trend in child drownings by depressed moms, according to your argument we would need to make sure moms live in homes with showers only, after all mental illness exists.

Dinah said...

Suicide rates, as mentioned above, are related to cultural views of suicide. You can't compare Japan to America, you can only look at before and after rates. The concern is not people who buy guns for the purpose of killing themselves, those people go through a complex set of actions, they will commit suicide by another means. The concern is the people who already own guns, purchased for another, valid reason, who then have easy access in an impulsive and vulnerable moment, who if they lived through it, might not die. Not every gun death would be prevented: where there's a will, there's a way. But as in the coal stove story above, some people who die would not. Some people would replace their sure-fire death with a non-fatal attempt and would then be happy to have lived.

The bathtub story is a thoughtful one, but the thinking is skewed. I do know someone who drowned their child in a bathtub, and I don't know anyone who's killed themselves with a gun, so by your logic, we should outlaw bathtubs. But the truth is, it's pretty rare to drown a child in a bathtub and 20,000 people/year kill themselves with firearms. 20,000.

I don't think there is a great answer to this problem.

Anonymous said...

No, I get that more people die from firearms than bathtubs. I was addressing the point (and not very well) that the previous anon made about looking at trends. I was trying to say, speaking very hypothetically, if there suddenly became a trend that depressed moms who kill their children drown them in their bathtubs and you are addressing trends, then it would seem to help depressed moms who kill you would need to remove the bathtub.

I should have used a better example. Let's use a real example. Women who commit suicide are more likely to kill themselves through poisoning, (assuming I am reading the most recent suicide data), So, back to the previous anon's argument:

"Anyone who wants to reduce suicide rates in their own country has to look at the culture of suicide in that country."

For women, then, since they are more likely to commit suicide with poisons it appears we should be looking more at poisons than firearms. Surely we care about women, too? Anon argued that after all we wouldn't leave drano around children, implying that we therefore shouldn't let folks have access to guns. Why not make the same argument about poisons (regarding women)? If we care about lowering the female suicide rate, then the first place we need to look are at the U.S. trends which would be suicide by poisoning. Should we limit female access to poisons, since we never know when they might suicide?