Introduction to the Special Issue: Treatment Considerations for Aggressive Adolescents in Secure Settings | Complex Trauma and Aggression in Secure Juvenile Justice Settings - Behavioral Forensics

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Introduction to the Special Issue: Treatment Considerations for Aggressive Adolescents in Secure Settings

via Criminal Justice and Behavior recent issues by Langton, C. M. on 5/10/12

 

Complex Trauma and Aggression in Secure Juvenile Justice Settings

via Criminal Justice and Behavior recent issues by Ford, J. D., Chapman, J., Connor, D. F., Cruise, K. R. on 5/10/12

Youth in secure juvenile justice settings (e.g., detention, incarceration) often have histories of complex trauma: exposure to traumatic stressors including polyvictimization, life-threatening accidents or disasters, and interpersonal losses. Complex trauma adversely affects early childhood biopsychosocial development and attachment bonding, placing the youth at risk for a range of serious problems (e.g., depression, anxiety, oppositional defiance, risk taking, substance abuse) that may lead to reactive aggression. Complex trauma is associated with an extremely problematic combination of persistently diminished adaptive arousal reactions, episodic maladaptive hyperarousal, impaired information processing and impulse control, self-critical and aggression-endorsing cognitive schemas, and peer relationships that model and reinforce disinhibited reactions, maladaptive ways of thinking, and aggressive, antisocial, and delinquent behaviors. This constellation of problems poses significant challenges for management, rehabilitation, and treatment of youth in secure justice settings. Epidemiological and clinical evidence of the prevalence, impact on development and functioning, comorbidity, and adverse outcomes in adolescence of exposure to complex trauma are reviewed. Implications for milieu management, screening, assessment, and treatment of youth who have complex trauma histories and problems with aggression in secure juvenile justice settings are discussed, with directions for future research and program development.

Adolescent Attention Deficit Hyperactivity Disorder in the Secure Treatment Setting

via Criminal Justice and Behavior recent issues by Connor, D. F., Ford, J. D., Chapman, J. F., Banga, A. on 5/10/12

This article examines issues related to adolescent and young adult attention deficit hyperactivity disorder (ADHD) in juvenile justice treatment settings. Characteristics of ADHD are first discussed including diagnostic criteria, gender, and prevalence in both community and secure settings. Next, the importance of adolescent ADHD to the juvenile justice system is examined, including risk for psychosocial impairments, antisocial problems, and aggressive behavior while in secure treatment settings and the issue of psychiatric comorbidity in ADHD youths. Recommendations for assessment of the ADHD adolescent are discussed. Evidence-based treatments are next reviewed and suggestions for modifying extant ADHD evaluation and treatment criteria for use with juvenile detainees are presented. Finally, we discuss issues pertaining to ethnicity in adolescent ADHD and how these issues are of importance to the evaluation and treatment of adolescent and young adult ADHD in the secure treatment setting.

Adolescent Substance Use and Aggression: A Review

via Criminal Justice and Behavior recent issues by Doran, N., Luczak, S. E., Bekman, N., Koutsenok, I., Brown, S. A. on 5/10/12

Substance use disorders (SUDs) in youth are strongly associated with aggression, delinquency, and involvement with the juvenile justice and mental health systems. This article reviews the relationship between aggression and SUDs and discusses evidence-based approaches to assessment and intervention, with a focus on youth in secure settings. While evidence indicates etiological overlap, SUDs also confer risk for aggression and delinquent behavior. SUDs and aggression are each influenced by executive functions that develop as youth transition toward adult roles. Additionally, the effects of substance use on the adolescent brain impair neurocognitive function and increase the risk for aggression and further substance use. In terms of assessment, it is important to identify function and form of aggression in order to understand motives and associations with substance use and to select appropriate interventions. Evidence-based screening and assessment of aggression, substance involvement, and related domains is also critical. In terms of treatment, youth with SUDs tend to be underserved, particularly when they are also involved with the juvenile justice system. Multiple modes of evidence-based treatment for substance use are available. Approaches that address risk factors common to SUDs and aggression across multiple domains (e.g., family therapies) have been found to be most effective but may be difficult to adapt for use in secure settings. Individual therapy approaches also have empirical support and may generally be more practical in secure settings.

Conduct-Disordered Adolescents With Fetal Alcohol Spectrum Disorder: Intervention in Secure Treatment Settings

via Criminal Justice and Behavior recent issues by Novick Brown, N., Connor, P. D., Adler, R. S. on 5/10/12

Youth with fetal alcohol spectrum disorders (FASDs) are in a perilous circumstance. FASD is associated with a high rate of self-regulation problems and trouble with the law and is underdiagnosed. Standard juvenile corrections-based interventions often do not meet the needs of these vulnerable youth. This article describes what is known about conduct-disordered adolescents with FASD and the neurocognitive deficits that directly affect emotional and behavioral self-control. The authors propose guidelines for the assessment of FASD within residential treatment settings and analyze interventions that show promise for inpatient treatment of youth with FASD.

Callous-Unemotional Traits and Their Implication for Understanding and Treating Aggressive and Violent Youths

via Criminal Justice and Behavior recent issues by Munoz, L. C., Frick, P. J. on 5/10/12

This article reviews the current research literature on the development of aggression and callous-unemotional traits. Research suggests there are two functions to aggression, reactive and instrumental, and each has concomitant cognitive and emotional factors associated. Furthermore, callous-unemotional (CU) traits (i.e., an absence of empathy and guilt) have been shown to be associated with the instrumental type of aggression. Research on CU traits suggests that there are distinct developmental mechanisms operating in the development of aggressive and violent behavior for youths with and without these traits. These distinct developmental mechanisms have important implications for the assessment and treatment of aggressive and violent youths.

Assessment and Treatment of Adolescents Who Sexually Offend: Clinical Issues and Implications for Secure Settings

via Criminal Justice and Behavior recent issues by Worling, J. R., Langton, C. M. on 5/10/12

Some adolescents who have committed a sexual crime are placed by the courts in secure residential settings. Given the heterogeneity of this client group, it is important for clinicians in these settings to complete comprehensive assessments to determine the course and content of specialized treatment, if necessary. With a focus on residential care, suggestions are provided for the assessment of strengths, risks, and needs. Particular attention is paid to issues related to informed consent, interviewing, and risk assessment. Also reviewed are various treatment issues with implications in secure settings, including the delivery of therapeutic services, use of manuals, therapeutic relationships and context, and self-care for providers. The growing evidence base for cognitive-behavioral treatment for adolescents who have sexually offended is outlined, and common treatment goals for youth who have offended sexually are critically examined. With an emphasis on treatment tailored to the unique needs of each adolescent, suggestions are offered regarding goals such as increasing accountability, recovery from posttraumatic distress, developing offense-prevention strategies, and enhancing awareness of victim impact, prosocial sexual attitudes, and healthy sexual interests. Additional issues that are considered with implications for clinicians working in secure settings include sibling sexual abuse and offenses involving child abuse imagery.

Research and Practice in Adolescent Firesetting

via Criminal Justice and Behavior recent issues by MacKay, S., Feldberg, A., Ward, A. K., Marton, P. on 5/10/12

Firesetting by juveniles results in billions of dollars of property loss, thousands of burn injuries, and hundreds of deaths each year. A review that specifically focuses on adolescents’ role in this devastating and costly behavior is not available. To address this gap, the current article reviews the past 30+ years of literature on adolescent firesetters, examining topics such as models of firesetting behavior, risk factors and correlates of adolescent firesetting, diagnostic issues, assessment tools and approaches, and current interventions. The article concludes with a discussion of goals for the field, including the development of relevant criteria for pathological firesetting.

Prison minister Khatuna Kalmakhelidze orders Georgia's prisons to raise the limit on number of inmates, despite a warning from the country's ombudsman that overcrowding is causing serious problems - Prison Psychiatry News

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Kalmakhelidze orders more crowded *prisons* in Georgia | News *...*

via prisons - Google Blog Search by DFWatch staff on 5/13/12

Prison minister Khatuna Kalmakhelidze orders Georgia's prisons to raise the limit on number of inmates, despite a warning from the country's ombudsman that overcrowding is causing serious problems. TBILISI, DFWatch ...

Peru prison: from pot smoke to pottery class - GlobalPost | Tear gas at Venezuela prison after gunfire erupts - Las Vegas Sun - Prison Psychiatry News

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Peru prison: from pot smoke to pottery class - GlobalPost

via prisons - Google News on 5/14/12

GlobalPost

Peru prison: from pot smoke to pottery class GlobalPost There's nothing quite like Lurigancho, Peru's largest prison, reputedly one of the toughest in South America. GlobalPost gets inside, and finds some surprises. LIMA, Peru — Salsa blares from the cells and the pungent smell of cannabis smoke hangs in ...

Tear gas at Venezuela prison after gunfire erupts - Las Vegas Sun

via prisons - Google News on 5/14/12

Tear gas at Venezuela prison after gunfire erupts Las Vegas Sun AP Gunfire erupted at a Venezuelan prison on Tuesday, prompting National Guard troops to use tear gas as they sought to take back control from armed inmates. Venezuela's government is trying to close La Planta prison following two escape attempts and ...

In Venezuela's prisons, inmates are the wardens - GlobalPost - Forensic Psychiatry News

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In Venezuela’s prisons, inmates are the wardens

Prison riots in Venezuela. Jailbreaks in Mexico. Prison fires in Honduras. Latin America is displaying violent cases of the ails of its prison systems. Overcrowded and rundown, many of the region’s jails are out of control and ready to burst. In this in-depth series, GlobalPost gets inside some of the most violent jailhouses of the Americas to figure out what’s gone horribly wrong.

 

There’s always a party, everyone is armed, and prisoners sometimes engage in gladiatorial fights to the death.

Girish GuptaMay 14, 2012 06:22

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CARACAS, Venezuela — A cloud of marijuana bounces along with the bass line from a stack of six-foot high speakers in the corner of this large hall, its smell infused with that of urine.
Through the darkness, noise and the bustling crowd, it takes a moment before you notice that everyone here is carrying a machine gun, a rifle or pistol — not slung over their backs or tucked into their pants, but menacingly prone. Others toss grenades up and down or sharpen knives while enjoying the cocktail of drugs and music.
Outside the makeshift club, the Venezuelan sun bathes a small soccer field. Supporters are armed and one player even goes in for tackles with a pistol in hand. Corridors in the building are lined with gunmen, smiling and joking, seemingly unaware of their own terror.
Prison guards are nowhere to be seen here at La Planta, a typical Venezuelan jail that often sees gunfights and riots.
“If the guards mess with us, we shoot them,” says one prisoner, asking not to be identified. “I've seen a man have his head cut off and people play football with it.” Others who have spent time inside, as well as videos that appear online, corroborate his stories.
Last year, about 500 people were killed in Venezuela’s prisons, according to the Venezuelan Prisons Observatory. Inmates frequently clash with each other, prison guards and soldiers who are sent in to maintain control during riots.
And now the guns inside La Planta are going off. The government is now trying to shut down the prison, though a group of inmates refusing to leave have kept authorities at bay for nearly two weeks. Troops are gathered outside along with hundreds of worried relatives.
Read more: In-depth series on Latin America's prison problems
An identical situation took place last June when more than 5,000 troops spent a month trying to quell an uprising at El Rodeo jail, just outside Caracas.
“We face a truly serious prison crisis in which the state has not shown up with solutions and this has led to chaos,” said Carlos Nieto, a lawyer and university professor who runs Window to Freedom, a local prison watchdog.
“There are huge problems with the prisons here in Venezuela,” he said. “The inmates do absolutely nothing; they don’t study, work or anything. On top of this is the access to weapons, drugs and alcohol.”
A deficient and corrupt staff as well as severe overcrowding, Nieto added, contribute to an “explosive cocktail,” which detonates frequently. Indeed, the day GlobalPost visited the human rights specialist, the front page of the country's national newspaper, El Nacional, published a story about 18 deaths that took place the previous weekend inside several jails.
The country’s 30 prisons are designed to hold 12,500 inmates. But in reality, they house just under 50,000, according to Window to Freedom. In La Planta — built to house 350 in 1964 but now housing about 2,500 — many inmates sleep in the corridors, with rats scurrying in between them.
“The conditions are deplorable, inhumane,” Nieto said.
There are reports of gladiatorial contests in the country’s other complexes, fights organized by gang leaders in which contenders battle to the bloody end for the entertainment of inmates. It was one of these bouts that left two dead and 128 injured in February at a jail in Uribana, western Venezuela.
La Planta itself saw a fire break out in 1996 after authorities fired tear gas inside. Local newspapers reported that 25 prisoners burned to death, their bones glued to the prison furniture. Two years earlier, 130 inmates were burned or hacked to death at a prison in the country’s western state of Zulia.
More from GlobalPost: Peru prison — from pot smoke to pottery class
It is not only weapons that are easy to obtain within prison walls. Mobile phones and computers, hooked up to the internet, are commonplace. With such access to the outside, inmates can control and partake in gang activities that no doubt exacerbate Caracas’ already troubled streets — with one of the highest murder rates in the world.
Gangsters, who have worked their way up the prison hierarchy, control the sites and therefore the flow of weapons. Nieto blames “functionaries of the state” for the weapons inside, adding that it is a “big business run by an internal mafia.” The type of weaponry, Nieto said, indicates a high level of corruption. “They have the types of weapons that can only be obtained by the country’s armed forces. ... No one else has these.”
Last year, after President Hugo Chavez went silent before announcing that he was suffering from cancer, the El Rodeo riots became a major political issue for the country. On the president’s return to action, Iris Varela was appointed as new prisons minister and she quickly came up with a quick-fix solution.
Some 20,000 inmates would be released onto the streets of Caracas, which already has a murder rate comparable to that of Baghdad during the Iraq War.
“In prison, there are people that do not pose a danger to society,” she said. “They can be handled outside prison.”
The murder rate in Venezuela last year averaged 67 per 100,000 people, according to the Venezuelan Violence Observatory, which labelled it “the most violent year in the nation's history.”
Nieto blames the country's prison problems on Chavez, who has not succeeded in his pledge to revamp the system.
More from GlobalPost: The Argentine economy’s fuzzy math problem
Chavez himself was locked up after the 1992 coup attempt that launched his career. Despite failing, the coup turned Chavez into a national icon, standing up against what many saw as the corrupt rule of then-President Carlos Andres Perez.
In his biography of Venezuela’s president, author Bart Jones writes that Chavez was horrified as guards failed to intervene when a man was raped and murdered in a cell above him.
“Today, the prisons are much worse than before Chavez arrived,” Nieto said.
In the long line to leave La Planta, visitors are numbed to the horror of what they have witnessed inside. They see it every weekend.
Going the other way are two young men, carrying duffel bags and — no matter what their crime — an innocence they will almost certainly lose in order to survive inside.

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In Venezuela's prisons, inmates are the wardens - GlobalPost

via prisons - Google News on 5/14/12

In Venezuela's prisons, inmates are the wardens GlobalPost There's always a party, everyone is armed, and prisoners sometimes engage in gladiatorial fights to the death. CARACAS, Venezuela — A cloud of marijuana bounces along with the bass line from a stack of six-foot high speakers in the corner of this ... Tear gas at Venezuela prison after gunfire eruptsLas Vegas Sun all 2 news articles » Read More In Venezuela’s prisons, inmates are the wardens There’s always a party, everyone is armed, and prisoners sometimes engage in gladiatorial fights to the death. Peru prison: from pot smoke to pottery class There's nothing quite like Lurigancho, Peru’s largest prison. GlobalPost gets inside, and finds some surprises. Brazil: Rio shuts makeshift police-run jails With prisons overloaded, police turned anything from old buses to horse stables into detention centers. Rio de Janeiro is cracking down. Caging in Central America The region’s overcrowded prisons are deadly and churn out the real hardened criminals. Mexican hot potato over who controls prisons Some of Mexico's prisons are out of control and ill-equipped to handle the glut of inmates. While politicos fiddle, prisoners break out. How packed are the Americas' prisons? Prison overcrowding is a big concern throughout much of the Americas. GlobalPost maps out prison populations and capacity by country. Prison riots in Venezuela. Jailbreaks in Mexico. Prison fires in Honduras. Latin America is displaying violent cases of the ails of its prison systems. Overcrowded and rundown, many of the region’s jails are out of control and ready to burst. In this in-depth series, GlobalPost gets inside some of the most violent jailhouses of the Americas to figure out what’s gone horribly wrong. In Venezuela’s prisons, inmates are the wardens There’s always a party, everyone is armed, and prisoners sometimes engage in gladiatorial fights to the death. CARACAS, Venezuela — Through the darkness, noise and the bustling crowd, it takes a moment before you notice that everyone here is carrying a machine gun, a rifle or pistol — not slung over their backs or tucked into their pants, but menacingly prone. Others toss grenades up and down or sharpen knives while enjoying the cocktail of drugs and music. - Girish Gupta Peru prison: from pot smoke to pottery class There's nothing quite like Lurigancho, Peru’s largest prison. GlobalPost gets inside, and finds some surprises. - Simeon Tegel Caging in Central America The region’s overcrowded prisons are deadly and churn out the real hardened criminals. - Mike McDonald Brazil: Rio shuts makeshift police-run jails With prisons overloaded, police turned anything from old buses to horse stables into detention centers. Rio de Janeiro is cracking down. - Taylor Barnes Mexican hot potato over who controls prisons Some of Mexico's prisons are out of control and ill-equipped to handle the glut of inmates. While politicos fiddle, prisoners break out. - David Agren Home » Regions » Americas Occupancy levels of prisons by country in 2011 (All data was provided by the International Center for Prison Studies) Comparing 1992 and 2010 incarceration rates by country Comparing 1992 and 2010 prison population growth by country > PrisonJoin the conversation   Colombia's FARC 'to release' journalist Romeo Langlois The rebels told the ICRC directly of their intention to hand Langlois, 35, over to ICRC officials, Colombian senator and mediator Piedad Cordoba, and an envoy of Francois Hollande, the French President-elect. - Amanda Morrow Panama fisherman sues cruise liner over rescue failure The teenager filed a lawsuit for negligence in a Florida state court against Princess Cruises, which has expressed regret for the incident. - Amanda Morrow How packed are the Americas' prisons? - Kyle Kim Flesh-eating bacteria victim may lose fingers Necrotizing fasciitis, the rare flesh-eating disorder that has already claimed the leg of 24-year-old Georgia grad student Aimee Copeland, now looks likely to claim her fingers. - News Desk Archive » Macro chatter: "You're fired," love JPMorgan and Yahoo Need to know: Euro zone central bankers' are thinking of a post-Greece world. The European Commission won't ease up on the rules of Greece's bailout, and the country's still fledgling government doesn't want to play along. That's increasing the likelihood that Greece will have to leave the euro zone. European officials are trying figure out how the handle the fallout, Bloomberg reported. Euro zone finance ministers are scheduled to meet today in Brussels. Want to know: The casualties are piling up at JPMorgan and Yahoo. The hedge fund that’s been trying to win power by getting Scott Thompson booted from Yahoo has finally succeeded. Thompson stepped down Sunday, just a few months after he started the job. Patti Hart, the board member who helped recruit Thompson, is also gone. Daniel Loeb's Third Point is getting three board spots. At JPMorgan, one of the most powerful women on Wall Street is out. Ina Drew has resigned over the bank’s $2 billion-and-counting trading loss. Two other traders also are gone. Meanwhile Bruno Iksil, the London Whale whose bad bets led to the losses, appears to have joined Twitter. He tweets that he'll be hanging around awhile longer. Hey Jamie, Ina, before I clear my desk I'm assuming you want me to unwind this thing right? — London Whale (@TheLondonWhale) May 13, 2012 Dull but important: China, Japan and South Korea want to do more business together. The countries are planning to set up a three-way free trade area, but it won’t be easy. Each of the countries has a at least one powerful business sector that will likely have a problem with the increased competition they'll face. China, Japan and South Korea already trade a combined nearly $700 billion among them. Combined, the countries are home to 1.5 billion people. Just because: Facebook co-founder Eduardo Saverin is renouncing the US citizenship his parents emigrated to get him. Saverin, who was born in Brazil and lives in Singapore, will likely save about $600 million by giving up his US passport, Pando Daily’s Farhad Manjoo calculated. Saverin owns about 4 percent of Facebook’s shares. While he may be among the wealthier Americans renouncing their citzenship, he definitely is not alone. Nearly 1,800 people gave up their citizenship next year to avoid the IRS. Strange but true: You too can be in charge of the Fed, at least on the Internet. - Meena Thiruvengadam NBC says new lineup is "heavy on comedy" The struggling TV network announced its fall schedule will include 10 sitcoms, twice the number of dramas. - Jennifer Mattson Sandwich celebrates 250th birthday - Hélène Hofman Naked gunman shot twice by Indiana police - Jill Langlois Tanned mom action figure retails below $30 Krentcil first made headlines when her then 5-year-old daughter arrived at school with a sunburn bad enough the school nurse called police. - David Trifunov Man convicted in murder of Jennifer Hudson's family - Talia Ralph

How do controversial revisions in psychiatry's guidebook make you feel? - Philadelphia Inquirer - General Psychiatry News

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How do controversial revisions in psychiatry's guidebook make you feel? - Philadelphia Inquirer

via psychiatry - Google News on 5/4/12

Scientific American (blog)

How do controversial revisions in psychiatry's guidebook make you feel? Philadelphia Inquirer By Stacey Burling When upward of 10000 members of the American Psychiatric Association meet here this weekend, they'll be met by protesters - there are always protesters - and tough questions about where their profession is headed and how it will ... A Major Transformation in Psychiatry?Medscape APA Announces New Changes to Drafts of the DSM-5, Psychiatry's New “Bible”Scientific American (blog) Last chance to comment on psychiatry's controversial diagnostic 'bible'MinnPost.com (blog) TIME -Age of Autism all 27 news articles »

Althouse: "D.S.M.-5 promises to be a disaster... it will introduce many new and unproven diagnoses that will medicalize normality...."

Althouse: "D.S.M.-5 promises to be a disaster... it will introduce many new and unproven diagnoses that will medicalize normality...."

May 13, 2012

"D.S.M.-5 promises to be a disaster... it will introduce many new and unproven diagnoses that will medicalize normality...."

Despite some last-minute changes, there are big problems, says Allen Frances, who led the task force that produced D.S.M.-4.

[T]he D.S.M. is the victim of its own success and is accorded the authority of a bible in areas well beyond its competence. It has become the arbiter of who is ill and who is not — and often the primary determinant of treatment decisions, insurance eligibility, disability payments and who gets special school services. D.S.M. drives the direction of research and the approval of new drugs. It is widely used (and misused) in the courts....

Frances rejects the accusation that the D.S.M. is "shilling for drug companies":

The mistakes are rather the result of an intellectual conflict of interest; experts always overvalue their pet area and want to expand its purview, until the point that everyday problems come to be mislabeled as mental disorders. Arrogance, secretiveness, passive governance and administrative disorganization have also played a role....

Psychiatric diagnosis is simply too important to be left exclusively in the hands of psychiatrists....

Experts in Philly describe mysteries of polyamory: When one lover isn't enough - Philadelphia Inquirer - General Psychiatry News

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Experts in Philly describe mysteries of polyamory: When one lover isn't enough - Philadelphia Inquirer

via psychiatry research - Google News on 5/14/12

Experts in Philly describe mysteries of polyamory: When one lover isn't enough Philadelphia Inquirer A panel of experts at the American Psychiatric Association meeting in Philadelphia last week said that open relationships between more than two people can work, but it requires a lot of talk about rules, boundaries, and time spent with various lovers.

A Letter From Clancy McKenzie, M.D. « ISEPP Blog

A Letter From Clancy McKenzie, M.D. « ISEPP Blog

A Letter From Clancy McKenzie, M.D.

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Three of the APA’s Clinical Treatment Guidelines were developed by 20 physicians, 18 of whom received incentives from the drug companies — which they failed to disclose, and 100% of those 18 recommended the drug from the company that paid them! Each probably rationalized that the money did not influence their decision. The influence is subtle, but 20 billions are devoted to clever ways of influencing decisions, recommendations, thinking. This affects every facet of the medical community and the lay population as well.

Journals print ads that extol the virtues of medications; the Psychiatric Times and the APA Newspaper print articles that are pleasing to the drug companies, the FDA considers the pharmaceutical companies their best customers and would eradicate all their competition; TV, radio and newspaper ads influence the general public, organizations such as NAMI and Schizophrenia Research Forum have been bought by Big Pharma. I was banned from that latter group because I asked if they were funded by drug companies. These and other seemingly helpful groups are funded either directly or indirectly by Big Pharma — and these influence still more professionals, patients and family members.

Eighteen combat veterans commit suicide every day, and most are given medication instead of treatment. Some of these medications triple or quadruple the suicide rate!

Prisoners, veterans, nursing home residents, welfare recipients and their children, foster children and even foster babies are given drugs, free of charge — and in ever-increasing numbers!

This has resulted in a massive increase in mental illness in this country. Understanding has been replaced with pills — which can cause more harm than good.

The question is what can we do to change the tide? Fads catch on. There are hit tunes that everyone hums or sings. One day when I was walking to the John, I noticed I was singing a song. It was psychopharmacomania. Over the next week I awakened with 18 more verses — but cut it down to the five best. If you have a good speaker system on your computer you can appreciate the production by the vocalist who was proclaimed by Pavarotti to have a voice that comes around once in 100 years, and accompanied by the lead guitarist for the grammy-winning group The Tramps. It is a catchy tune and well produced — with an incredibly creative story board to go along with it. This can make a difference. I would hope that each of you might help by sending it to your email list and encouraging everyone to do the same. If it goes viral then we might make a substantial impact. People must be awakened to how they are being influenced and deceived.

 

 

We also have a 31 minute production of the song for those who wish to use it in a protest march. It is very musical and enjoyable.

Click here to view on Youtube.

Thank you for your help.

Clancy

Dr. Clancy McKenzie is one of the world’s foremost experts on Schizophrenia and mental health. As a youth and young adult, Dr. McKenzie was always regarded as a very compassionate person and an explorer. While in college he often shared his stories of counseling homesick campers when he was ten years old – and exploring the world, hitchhiking throughout Europe, into Asia and across North Africa, sometimes alone on the Sahara Desert. So it came as no surprise to friends and family when, early in his career, he embarked upon an unknown path in his quest to help others.

After graduating from the University of Michigan Medical School in 1962, McKenzie’s life work focused squarely on the study of the human mind in pursuit of helping those afflicted with mental disorders. Following internship, he studied adult and child psychiatry and psychoanalysis with top experts in the field at some of the best institutions – to gain overview of what was known in the field at the time. He trained at the Menninger School of Psychiatry, the Philadelphia Psychiatric Center and the Philadelphia Psychoanalytic Institute.

 

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By isepp, on May 14, 2012 at 2:15 am, under Dr. Clancy McKenzie, Schizophrenia. Tags: advocacy, Clancy McKenzie, dsm 5, M.D, MindFreedom, psychiatry, psychoanalysis, SCHIZOPHRENIA. No Comments

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DSM-5 and the Prisons - YouTube#at=11#!

DSM-5 and the Prisons - YouTube#at=11#!

Published on May 6, 2012 by WebsEdgeHealth

Marcia Goin, M.D. and Ken Rosenberg, M.D. talk to APA TV about the huge challenges faced by the criminalization of people with mental health and the problems faced with so many people with mental illness facing custodial sentences.

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Real Psychiatry: Why Allen Frances has it wrong

Real Psychiatry: Why Allen Frances has it wrong

Sunday, May 13, 2012

Why Allen Frances has it wrong

Allen Frances has been a public critic of the DSM process and as an expert he frequently get his opinions out in the media. Today he has an op-ed piece on the New York Times that is a more general version of a more detailed post on the Health Care blog. His main contention is the stakeholder argument and that is that there are too many stakeholders both public and professional to allow the American Psychiatric Association to maintain its "monopoly" on psychiatric diagnosis. I will attempt to deconstruct his argument.

He discusses the earlier DSM versions as revolutionizing the field and the associated neuroscience but then suggests that diagnostic proliferation has become a central problem and the only solution is political arbitration. What about the issue of diagnostic proliferation? The number of diagnostic entities per DSM entity are listed below:

DSM-I, 268 entities

DSM-II, 339 entities

DSM-III, 322 entities

DSM IIIR, 312 entities

DSM-IV, 374 entities

DSM-V, 370 - 400 entities (depending on final form)

In terms of the total diagnostic entities, I have not seen any stories in the media pointing out that the total number of diagnoses may be less than DSM-IV. I have also not seen any discussion of major diagnoses where that is clearly true, such as the elimination of schizophrenia subtypes. I have also not seen any discussion of the role of psychiatrists in making a psychiatric diagnosis. Psychiatric diagnosis does not depend on looking up a diagnosis in a catalog of symptoms. It involves being trained in psychopathology and knowing the patterns of these illnesses. The patterns of psychotic disorders have basically been unchanged across DSMs.


The "medicalization of normality" is another argument. The media routinely runs stories about the percentage of the population that is "mentally ill" based on DSM diagnoses. One of the common stories is the estimate that as many as 50% of the population has a DSM diagnosis over the course of the year. There is never any critical look at that statistic. The first dimension is whether any percentage should be too high or too low. For example, would anyone be surprised to learn that 100% of the population has a medical diagnosis in the previous year? With a high prevalence of gastroenteritis and respiratory infections - probably not. The second dimension speaks directly to the issue of threshold for an illness. One of the key papers in this area shows that although the one year prevalence using DSM criteria may be high limiting the diagnoses to severe disorders reduces the prevalence to 8%.


The use of high prevalence numbers for mental illness based on DSM diagnoses also ignores the extensive Epidemiological Catchment Area (ECA) work that estimated lifetime prevalence. Readers are generally not told that the methods used include addictive disorders and neurological disorders that cause cognitive impairment. Would anyone doubt that 32% of adults would report a psychiatric disorder that included an addiction or cognitive impairment at any point in their lifetime?


Dr. Frances correctly points out that the other common media theory that DSM diagnoses are driven by the pharmaceutical industry is a myth. He continues on to suggest that the public and other mental health professionals somehow have a stake in the DSM and that organized psychiatry has frozen them out. He concludes: “Psychiatric diagnosis is too important to be left exclusively in the hands of psychiatrists.” I don’t understand how the specialty who invented the technology, who is trained and tested on it, and who is focused on a comprehensive view of psychopathology that extends beyond it should somehow give way to political considerations. As he points out – there are always political considerations – even in science. I would suggest that there is no such thing as “independent scientific review” of anything that psychiatry does. There are many ways to address issues of professional bias in terms of including a diagnosis or not.


The arguments against the DSM and psychiatric influence vary across the usual spectrum of there being no such thing as a psychiatric diagnosis to there are too many to they are nonspecific. There is no practical way to incorporate that spectrum into a diagnostic manual that is designed for psychiatrists to make clinical diagnoses and do research. The single most important fact that is left out of these debates is that psychiatrists are effective in treating serious mental illness and they are undoubtedly more effective now than they have been in the past. That is the only reason we need a DSM and that is why it stays squarely in psychiatry.


George Dawson, MD, DFAPA

Frances A. Diagnosing the DSM. New York Times May 11, 2012.

Frances A. DSM5 begins its belated and necessary retreat. Health Care Blog May 10, 2012.

Kessler RC, Avenevoli S, Costello J, Green JG, Gruber MJ, McLaughlin KA,

Petukhova M, Sampson NA, Zaslavsky AM, Merikangas KR. Severity of 12-month DSM-IV disorders in the national comorbidity survey replication adolescent supplement

Arch Gen Psychiatry. 2012 Apr;69(4):381-9.

Regier D, Kaelber CT. The Epidemiological Catchment Area Program: Studying the Prevalence and Incidence of Psychopathology. in Textbook in Psychiatric Epidemiology eds. Ming T Tsuang, Mauricio Tohen, and Gwnedolyn EP Zahner. John Wiley and Sons, 1995. p141.

Mike Nova: I support Dr. Frances' idea about founding some new... interdisciplinary body for establishing current scientific criteria, principles, parameters and most adequate working models for clinical mental health (psychiatric) diagnosis

Last Update: 9:20 AM 5/13/2012

Mike Nova: I support Dr. Frances' idea about founding some new, superpsychiatric (possibly under combined umbrella of all the appropriate agencies that he mentioned) interdisciplinary body for

Establishing current scientific criteria, principles, parameters and most adequate working models for clinical mental health (psychiatric) diagnosis,

which should include efficient participation of philosophers, neuroscientists, geneticists, biologists, psychologists, sociologists, specialists in forensic behavioral sciences and lawyers.

Maybe, with a little help from our friends the "heavenly gate" to a new, broader scientific paradigm in psychiatry will crack open; a little.

And this might lead to true and real (not imaginary, as a product of the wishful thinking), scientifically revolutionary "paradigm shift".  Any new paradigm in psychiatry (just like in any other [scientifically oriented] ideational activity, according to Kuhn) has to be significantly broader than the previous one, incorporating the new body of knowledge, disciplines and theories in a new conceptual framework, resolving the "anomalous contradictions" of the old paradigm which becomes conceptually inadequate to contain them.

This new paradigm must also fit into the larger current paradigmatic systems of  scientific and cultural beliefs, and the present lively debate about the meanings and the essence of psychiatric diagnosis is one, and maybe the best indication that the old paradigm "does not fit", that it is scientifically (which is not synonymous with medical practice) - inadequate.

It is also interesting to observe that the battle for this new paradigm is waged in a mainstream media, which might also indicate "the revolutionary situation" expressed as a heightened public awareness and concerns; absolutely justified, legitimate and significant.

Diagnosing the DSM - New York Times - Forensic Psychiatry News

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Diagnosing the DSM - New York Times

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