See here for a recent study by ISEPP’s Joanne Cacciatore on the effects of poverty and parental education on the experience of bereaved mothers. Her study is the first to investigate poverty, education, and parental bereavement while examining the relative risk of other variables as informed by the literature. The findings reveal that poverty was the strongest predictor of psychological distress when compared to others factors which have traditionally been considered significant in parental bereavement. Bereaved parents living in poverty may be less likely to seek support and have fewer available resources.
ISEPP In Action
Toby Watson, Psy.D., recently submitted an ISEPP challenge to an FDA proposed rule to reclassify ECT so it can be used in "treating severe major depressive episode in patients 18 years of age and older who are treatment resistant or require a rapid response." You can read his challenge here.
ISEPP's Jim Gottstein won another Alaska Supreme Court case on January 29th. Appellant H.R.was subjected to an involuntary psychiatric evaluation based solely on the testimony presented by her condominium association, which she had accused of financial improprieties. The statute authorizing the court to grant an ex parté (no notice) order to have someone picked up by the police and taken to a psych hospital for evaluation requires a screening investigation that included interviewing the person if possible. The Alaska Supreme Court reversed the order of involuntary psychiatric evaluation because the court did not try to interview H.R. See, the Opinion. Three cheers for Jim!
ISEPP's Jonathan Leo pulls the curtain back and allows us to see what's really happening. In his article The Search for Schizophrenia Genes, he provides an excellent explanation of why genetic research into mental disorders is a failed project.
The Fear In My Doctor's Eyes
I have seen the fear in their eyes
When they first realize
What I did during the war
And my issues we have yet to explore
One of my docs even backed away
I'm over my head, as if to say
So he referred me to another doc
I'm tossed around like a dirty old sock
I was referred to an in-patient facility
Do I really have that much instability
I wasn't admitted in though
They said I needed more time to grow
I was actually rejected
For the reason I should have been selected
That's like going to the doctor for a vaccine
And he says you're too sick to be seen
I wish I knew what my docs are thinking
When they stare at me without blinking
My PTSD must be rather severe
When they look at me with such fear
During the last two weeks of October, Al Galves and Joe Tarantolo (the former ISEPP Executive Director and Chairperson of the Board, respectively) visited several Congressional offices on Capitol Hill, to express ISEPP’s grave concern about HR 2646. This bill was reintroduced in June by Representative Tim Murphy (R-Pennsylvania) in the Energy and Commerce Committee. It is ostensibly a reaction to the spate of violent incidents that have caught the public’s eye over the past few years. A 2014 Energy and Commerce Committee investigation concluded, “…those with untreated severe (or, used interchangeably, “serious”) mental illness (SMI) are at an elevated risk of exhibiting violent behavior….” The Committee referenced only one, quite dated, study to support this contention. In addition to being 25 years old, the study also conflates labels of “mental illness” with the actual factors that increase risk of violence (Swanson, J., Holzer, C., Ganju, V., & Jono, R. (1990). Violence and Psychiatric Disorder in the Community: Evidence from the Epidemiologic Catchment Area Surveys, Hospital and Community Psychiatry, 41(7), 761 -770).
Nevertheless, Al and Joe were very impressed with the members of the Energy and Commerce Committee staff. Both the Republican and Democratic staffers had spent enough time with people who oppose the bill to have a deep and comprehensive understanding of its problems. They suggested Al and Joe meet with Representative Murphy's staff and to write a letter to the Chairman and Ranking Member of the Committee. While they were unable to meet with Murphy's staff, they did draft a letter in record time (as is typically needed for Congressional action) and sent it to the Committee. The letter was signed by Al, Joe, Dominick Riccio (current Board Chair) and Chuck Ruby (current Executive Director).
During the Committee hearing, Ranking Member Pallone twice mentioned ISEPP by name as one of several organization, including the ACLU, who have concerns about the bill. That makes us think Al and Joe’s visit to the Hill made a difference. Let's hope we made enough of a impact to keep this bill from being passed by Congress.
A better bill to replace HR 2646 should have provisions that support and expand non-medical model approaches such as Vermont’s Soteria house, which has been recently opened in Burlington. Also, New York could expand the open dialogue approach that is now being used by the Parachute Project in New York City. The bill could even fund private non-profits like Melwood in the greater metropolitan DC area. For over a year now, Melwood (with the help of ISEPP’s Mary Vieten) has been running a unique, non-medical model, program that helps military and veterans suffering from war trauma.
The text of ISEPP’s letter reads:
Dear Chairman Upton and Ranking Member Pallone:
We write to you as practitioners in mental health, and advocates for safe, humane, and life-enhancing treatment for people diagnosed with mental disorders. Our organization, the International Society for Ethical Psychology and Psychiatry (ISEPP), is made up of professional mental health clinicians, scholars, educators, peer-advocates, and “psychiatric survivors.” This is the term we use to designate those who have been hurt by the current, broken, mental health system. We applaud Congress’ intense interest in addressing this brokenness, and we thank Representative Tim Murphy’s efforts to bring this issue to the forefront of Congress’ attention.
We have serious problems, however, with many of the H.R. 2646 provisions:
(1) We oppose, both as mental health practitioners and citizens vested in civil liberties, provisions that restrict civil rights. It is mandatory that criminal behavior be distinguished from eccentric behavior and bizarre speech. In a word, it is not against the law to be “crazy.” It is against the law to behave illegally. We realize, of course, that the two often are mixed, that criminals can also be mentally ill. The alleged criminal is entitled to due process. The mentally ill person, criminal or not, needs treatment.
(2) We realize as practitioners that it is very often necessary to engage family members, friends, and associates of the identified patient. As good clinicians we should always be open to listening to what they have to tell us about the patient. But it is also crucial that we respect any of the patient’s expressed instructions not to divulge very private matters. It remains clinical judgment when to seek out help or give counsel if a patient is incapacitated or in a dangerous predicament. HIPAA regulations do not need revision. There is adequate leeway now allowing appropriate interchange between therapists and family. There need be no significant change in HIPAA’s regulations. Therefore, we oppose Section 401 of H.R. 2646.
Section 401 sets a dangerous precedent by making diagnosis-specific exception to the privacy rule. In one fell swoop, the mentally ill no longer have the same privileges of any other sick person being treated by professional caregivers. Do not make treatment odious to the mental patient by depriving him of legitimate privacy.
(3) Assisted Outpatient Treatment (AOT) laws as prescribed by H.R. 2646 are a very slippery slope. These laws are heavily geared toward forcing psychotropic medication, usually the neuroleptic (also called anti-psychotic) drugs. Although as practitioners we realize there is a place for offering these drugs to distressed individuals, they should only be prescribed with adequate informed consent. Given their profound adverse reaction profile (severe neurological damage, brain shrinkage, cognitive decline, metabolic abnormalities, decreased life expectancy, deadening of emotionality) it cannot be considered an irrational decision to reject their use. The argument that the mentally ill cannot make that decision is vastly overstated. As clinicians we have rarely had patients who can’t say, “yes, that helps” or “no, that feels terrible.” For these reasons we oppose rescinding funding from states that have not passed AOT laws.
(4) As practitioners and advocates for the mentally ill we have grave concerns about H.R. 2646 weakening standards that justify in-patient commitment.
(5) AOT programs are heavily invested in the use of drugging patients as a first line of treatment. Although drugging may be indicated in selected patients, the weight of the evidence is that drugs are at best short-term solutions. In a penetrating study published in 2007 by Martin Harrow and Thomas Jobe, they found in their 15-year follow-up “A larger percent of schizophrenic patients not on anti-psychotics showed periods of recovery and better global functioning (p< .001).” (“Factors Involved in Outcome and Recovery in Schizophrenic Patients Not on Anti-psychotic Medications: A 15-Year Follow-Up Study,” Journal of Nervous and Mental Disease, Volume 195, page 406, 2007).
A landmark study in Michigan demonstrated that skilled therapists had substantially better long-term results using no drugs. Notably, drugs had better results only in the first few months. (see Karon, B and VandenBos, GR (1994) Psychotherapy of Schizophrenia ,Treatment of Choice. Northvale, NJ: Jason Aronson).
A recent study featured on the front page of the New York Times (“New Approach Advised to Treat Schizophrenia” October 20, 2015) reported an approach used in Finland and imported to the US called “Open Dialogue” which uses intensive family therapy and social interventions with minimal anti-psychotic medication. The Open Dialogue approach fared significantly better than the usual high dose drug approach. A pilot program in New York called the “Parachute Mental Health Program” offers both respite centers for the mentally ill and mobile treatment teams that go to the home of the identified patient. Preliminary data suggest these programs prevent hospitalization and therefore potentially give more bang for the mental health system buck. Hospitalizations are extremely expensive and disruptive. Investment in these alternative approaches merits Congressional support.
(6)We oppose the provisions of H.R. 2646 which constrict the work of the patient protection and advocacy agencies which protect the rights of disabled persons.
(7)As practitioners and patient advocates we oppose provisions of H.R.2646 which defund and weaken the recovery oriented approaches that have been promoted by the Substance Abuse and Mental Health Systems Administration (SAMHSA). There is ample evidence that these non medical approaches are not only effective but also less costly than the typical AOT’s. We believe it is important to maximize the voices of mental health consumers. And that is what SAMHSA programs provide.
(8) Any legislation must approach the arena of mental health treatment with great humility. There are myriad theories and ideologies. Resources supplied to the States by the Federal government must be given with strings attached, viz., “show us the evidence” that your approach(es) is/are effective, safe, humane, and life-enhancing.
Joanne Cacciatore has what many would find to be an unbearable calling: to help counsel parents through their grief after the death of a child. As a professor of social work at Arizona State University, the Sedona resident and mother of four grown kids — and one stillborn — is a top expert in the field of child loss and traumatic grief; her vast body of research ranges from maternal depression after stillbirth to fathers’ grief after infant loss and parental bereavement in Native American cultures. She’s founder of the support-giving MISS Foundation, as well as the Center for Loss and Trauma. But as a therapist, Cacciatore, 50, has a more basic if hard-to-fathom focus — to support and guide moms and dads through their darkest days. Recently, ahead of National Pregnancy and Infant Loss Awareness Month, she sat down with Yahoo Parenting to discuss the importance of facing a topic that pretty much everyone wants to avoid.
Over the past decade, there have been numerous allegations of inappropriate collusion between the American Psychological Association (APA), CIA, and the Department of Defense (DoD) with the intent of molding APA ethics guidelines to allow psychologists’ continued involvement in enhanced interrogations, considered torture under international law. Still, APA leadership stood firm in the face of the mounting evidence against them.
The ISEPP Board of Directors has followed this issue, releasing two public statements (here and here) and joining with Physicians for Human Rights, Psychologists for Social Responsibility, and the Coalition for an Ethical Psychology in public petition to the APA. Last November, the APA finally commissioned David Hoffman of Sidley Austin, LLP, to conduct an independent investigation.This past July, Hoffman’s report was released. It was a bombshell, revealing many deceptive deeds committed by senior representatives of APA, to include the Ethics Director, in order to curry favor with the DoD and the Bush administration. Since its release, some of the senior APA representatives involved have been fired, resigned, or retired early.
With the Hoffman report in hand, the APA Council of Representatives surprised many in August at the annual APA Convention in Toronto when it overwhelmingly passed a resolution that finally banned all psychologists’ participation in any national security interrogations that violate international law regarding cruel, inhuman, and degrading treatment. The only dissenting vote came from the Society of Military Psychology Division representative and former military psychologist at Guantanamo who was one of the DoD representatives colluding with the APA. We wait with cautious optimism for this resolution to be implemented (the caution is because a member-driven referendum with the same ban in 2008 was never enforced by the APA).
In addition to our public statements and petitions to the APA, ISEPP has also been involved in the development of new ethical guidelines intended to supplement APA’s Ethical Principles of Psychologists and Code of Conduct, and to prevent the kind of nightmare revealed by the Hoffman report. In particular, the Coalition for an Ethical Psychology invited ISEPP’s Chairman of the Board of Directors, Chuck Ruby, Ph.D., to represent ISEPP at a workshop on the ethics of operational psychology in Brookline, MA, that took place September 18-20. As a retired military counterintelligence officer and psychologist, Dr. Ruby had been consulted earlier by the Coalition in the development of ideas about the ethics of operational psychology (see Arrigo, J.; Eidelson, R; & Bennett, R (2012). Psychology Under Fire: Adversarial Operational Psychology and Psychological Ethics. Peace and Conflict: Journal of Peace Psychology. 18:4, 384-400.). At the workshop, Dr. Ruby joined with experts from several professions to develop principles and guidelines for operational psychologists. The formal report entitled “The Brookline Principles on the Ethical Practice of Operational Psychology”, was released today to the press, professional organizations, and distributed widely within the APA.
ISEPP remains committed to continue this fight of bringing psychology back in line with the basic values of do no harm and respect for human dignity.
ISEPP's Mary Vieten, Ph.D., ABPP, is expanding her attempts to change the landscape of PTSD treatment. She recently was asked to talk at the Massena, NY Operation Grateful Nation where veterans attended the Greater Massena Ministerial Association. See here for the details.
Mary has been leading the effort of ISEPP's Operation Speak Up in turning the tide toward a humane response to military and veterans who have witnessed the horrors of war. One of her projects is TOHIDU, which is an America Indian word that means peace, mind, body, and spirit. TOHIDU is a week-long retreat that offers non-medical support to our country's warriors. See what's happening at TOHIDU here.