Celebrities Take on Roles as Mental Health Advocates

Actor Jared Padalecki, known for his roles in “Supernatural” and “Gilmore Girls,” has become the latest in a long list of celebrities who are speaking out about mental illness. These famous people are talking about their personal experiences and using their popularity to help raise awareness, fight stigma, and encourage people who are struggling to reach out and get help. Padelecki has talked about his struggles with depression and initiated the #AlwaysKeepFighting campaign to raise awareness and support.

Musician Demi Lovato has been outspoken and public about her experience with bipolar disorder and has become an outspoken advocate for mental health.  She recently joined with several organizations, including the Depression and Bipolar Support Alliance, the Jed Foundation, and others, as part of the  Be Vocal: Speak Up for Mental Health initiative. The campaign encourages individuals to speak up for themselves in asking for help and to learn how to speak out for others in the community.

Actress Glenn Close has been outspoken and active in bringing national attention to the issue of mental illness. After seeing her sister cope with a mental illness and the stigma associated with it, Close founded the nonprofit advocacy organization of Bring Change 2 Mind.  

Actor Joey Pantoliano, has also been active in talking about his personal struggles with depression and substance use. He is raising awareness and fighting stigma through his No Kidding, Me Too! foundation.  Among its many activities, NKM2 promotes messages of empowerments and acceptance through an award-winning documentary of the same name and a series of public service announcements.

Brooke Shields has publicly shared her experience with postpartum depression and written her story of despair and recovery in a memoir, “Down Came the Rain: My Journey Through Postpartum Depression.” Carrie Fisher (Princess Leia of “Star Wars” fame) has taken her advocacy to the stage with her autobiographical one-woman play “Wishful Drinking,” where she tells her story of bipolar disorder and substance use with openness and humor.

As Jeffrey Borenstein, M.D., president and CEO of the Brain and Behavior Research Foundation, noted in a recent interview with CNN, "When celebrities speak publicly about their own experiences with depression or other psychiatric conditions, it's very helpful. It opens up a conversation about these issues. If someone you admire is going through the same thing you might be going through, it makes a difference with people, it causes people to seek help."

Borenstein is also host of a PBS series on mental health issues called Healthy Minds.  You can view past episodes on topics such as bipolar disorder, autism, schizophrenia, and more online at WLIW – Healthy Minds.

By Deborah Cohen, senior writer, American Psychiatric Association

Mental Illness Alone is Not a Risk for Gun Violence

While media coverage of gun violence often leaves us with the perception of close link between violence and mental illness, extensive research tells us that many other factors are associated with a greater risk of gun violence. Most people with mental illness are not violent, and most violent acts are committed by people without mental illness.

New research adds to the wealth of evidence that mental illness is not a risk for gun violence. Research published in June in Psychiatric Services in Advance  found that prior violence, substance abuse, and early trauma are more likely to contribute to future violence than mental illness. The study authors conclude that public safety will not be improved by policies “shaped by highly publicized but infrequent instances of gun violence toward strangers.”

A 2006 report from the Institute of Medicine concludes that "… the contribution of people with mental illnesses to overall rates of violence is small, and further, the magnitude of the relationship is greatly exaggerated in the minds of the general population."

People with mental illness are far more likely to be victims of violence—people with serious mental illness are more than 10 times more likely to be
victims of violence than the general public.

And while mental illness is not a major risk factor for gun violence, mental illness is a significant risk factor for suicide.  Some 39,000 people die by suicide in the United States each year—more than 50 percent by firearm (56 percent of men and 31 percent of women), according to the Centers for Disease Control and Prevention.  Among the major risk factors for suicide are a prior suicide attempt, substance misuse, mood disorders (depression or bipolar disorder), and access to lethal means.  However, research has also identified key protective factors—factors that make it less likely that a person will attempt or die by suicide.  Protective factors include effective mental health care and connection to family, friends and community.

By Deborah Cohen, senior writer, American Psychiatric Association

Diversity, Culture, and Mental Health

Diverse Populations and Mental Health

July is the American Psychiatric Association’s Diversity Mental Health Month, a time to appreciate the diversity among us and to focus on the unique mental health issues of diverse populations and efforts to reduce mental health disparities.  It’s clear we live in an increasingly diverse society, but how does that diversity relate to mental health and receiving quality mental health services?

Cultural background, including race/ethnicity and other aspects, can greatly influence how we think and feel about mental health and illness, how we experience symptoms, how we communicate about mental illness, and how and where we seek help.  Some people may be reluctant to talk about mental health concerns out of fear or shame, some people may seek help from faith leaders, while others may turn to a family doctor or a mental health professional.  (See the infographic from APA:  Mental Health and Diverse Populations.)

Extensive research tells us that ethnic and racial disparities in mental health care exist. A new report from Substance Abuse and Mental Health Services Administration (SAMHSA) notes that among adults with mental illness, whites, American Indian/Alaska Natives, and adults reporting two or more races reported higher mental health service use than black, Asian, and Hispanic adults. (See chart.)
Being aware of differences in the use of mental health services among different ethnic/racial population groups is critical for mental health professionals. That is part of what Diversity Mental Health Month is about – increasing understanding among psychiatrists about the influences of cultural diversity in their practices.

The SAMHSA report also looked at why people don’t use mental health services.  Adults across all racial/ethnic groups cited the same reason most frequently for not using mental health services:  the cost of services cost or lack of insurance.  Other reasons included:  low perceived need; stigma; and structural barriers. Concern about whether mental health services would help was the least cited reason by all racial/ethnic groups.

The top barrier to care, cost, may at least be partly addressed as more people gain access to mental health care with the Affordable Care Act and the Mental Health Parity Act. Many organizations, including the APA, are working to improve cultural sensitivity and to reduce the stigma of mental health, particularly among racial and ethnic minority populations.

By Ranna Parekh, M.D., M.P.H., Director
APA Division of Diversity and Health Equity

This post is part of an ongoing series spotlighting diversity from APA’s Division of Diversity and Health Equity.

Marijuana: Legal Doesn’t Mean Safe

Twenty-three states and the District of Columbia have laws legalizing some form of marijuana use, and recreational use of marijuana is legal in four states and D.C.

Does this growing trend to legalize marijuana mean we don’t need to worry about it?  About one in 10 people who try marijuana will become addicted to it which means that they most likely will use it in increasing quantities, develop tolerance (less effect from it as time goes on), will have withdrawal symptoms if they try to stop, and will find that the marijuana use is causing them to neglect other important areas of their life like work, relationships and leisure activities. 

Even occasional use of marijuana can have negative effects.  hen someone has marijuana in his/her system, short term memory is impaired, reflexes are impaired and judgment is impaired.  These impairments can last 24 hours or longer after the use of the marijuana so it is certainly not safe to drive after using marijuana. Most people will not be able to perform other demanding tasks (work-related activities, childcare) at the level they are accustomed to after using marijuana. 

All the evidence that we now have indicates that marijuana is possibly permanently damaging to the developing adolescent brain. All children should be strongly discouraged from using it at all until they are at least 21 years of age. If marijuana is smoked there are also potential physical health risks, such as damage to the lungs or cardiovascular system.

For more information, see American Psychiatric Association’s  Resource Document on Marijuana as Medicine.

By Andrew Saxon, MD

Professor and Director, Addiction Psychiatry Residency Program

University of Washington

Director, Center of Excellence in Substance Abuse Treatment and Education

VA Puget Sound Health Care System

Seattle, WA

Reducing the Stigma of Addiction

Nora Volkow, MD, Director, NIDA

Addiction is common – an estimated 1 in 11 people in the United States experiences a substance use disorder in a given year. Despite significant advances in understanding and treatment, stigma still prevents many people from seeking help.

Nora Volkow, M.D., director of the National Institute on Drug Abuse, speaking recently at the APA’s Annual Meeting in Toronto, talked about some of the recent advances in the understanding of addiction and called on psychiatrists to help reduce the stigma of addiction and “help to eliminate the shame and suffering that accompany the addict who experiences relapse after relapse after relapse.”

Volkow opened her speech with a moving and emotional story of how she learned of her grandfather’s alcoholism and suicide. He had died when she was a girl of 6 in Mexico, but Volkow’s mother did not reveal the truth of her grandfather’s addiction and death until many years later, when her mother was dying and after Volkow had already achieved distinction as an addiction expert.

It was a dramatic illustration of the despair experienced by people who have an addiction and continue to engage in a behavior that they may know is destroying them. She described how it was once believed that addiction was a disorder of hyperactive reward centers in the brain—that people with addiction s sought out drugs or alcohol because they were especially sensitive to the pleasure-inducing effects of dopamine.

But Volkow explained that in recent years research has revealed just the opposite: that those with addiction are actually less sensitive to the effects of dopamine. They seek out drugs because of the very potency with which they can increase dopamine in the brain, often at the expense of other pleasurable natural stimulants that do not increase dopamine so dramatically

Moreover, she emphasized that addiction to drugs disrupts multiple systems in the brain that govern the ability to plan, anticipate, and change behavior in response to changing circumstances. Volkow said it is this phenomenon that accounts for the “craving” experienced by addicts and alcoholics in response to environmental triggers—often leading to what she characterized in the account of her grandfather’s death as that “one last moment of self-hatred.”

Adapted from Psychiatric News

Giving Kids a "Sip" of Alcohol Can Send the Wrong Message About Drinking

That little sip of wine or beer that some parents offer their kids at a wedding or on New Year’s Eve may muddle messages about alcohol, according to a new study by researchers at the Center for Alcohol and Addiction Studies at Brown University. The scientists surveyed middle school students for three years to learn whether even a taste in early childhood was a predictor of risky behavior in high school.

The Internet-based study, published in the April 1^st issue of the Journal of Studies on Alcohol and Drugs, included more than 500 Rhode Island school students. More than one-third of the kids surveyed reported trying their first sip of alcohol by the sixth grade, and most said that their first taste took place at home. Wine and beer were the most commonly tried beverages, usually at a special occasion, such as a wedding or a holiday, and adults were the primary source of the alcohol. Nearly three-quarters of the children were offered sips by their own mom or dad.

The study also showed that kids who sipped alcohol by the sixth grade were five times more likely to down a full alcoholic beverage by the time they reached 9^th grade—26% of sippers consumed a full drink versus 5.5% of non-sippers. The earlier sippers were also four times more likely to get drunk or binge drink by early high school, and trying alcoholic beverages earlier in life also raised a child’s risk for trying other substances.

Even when the researchers controlled for other factors, such as risk-taking behavior, the drinking habits of parents, and a history of alcoholism in a parent, kids who’d sipped before sixth grade had higher odds of alcohol use by their freshman year of high school.

The take-home message: Offering a child a sip of your beverage may send the wrong message, says study author Kristina Jackson, Ph.D., associate professor in the Department of Behavioral and Social Sciences at Brown School of Public Health.

"Parents should provide clear, consistent messages about the unacceptability of alcohol consumption for youth,” Jackson advises. “Younger teens and tweens may be unable to understand the difference between drinking a sip and drinking one or more drinks. Certainly there are exceptions, such as religious occasions, so the most important thing is to make sure that children know when drinking alcohol is acceptable and when it is not.”

The context of alcohol use is important, says Oscar G. Bukstein, M.D., M.P.H., medical director at DePelchin Children’s Center and a clinical professor of psychiatry at Baylor College of Medicine and the University of Texas Health Science Center-Houston, who was not involved in the research. “Often, by allowing children to sip or try alcohol on ‘special occasions’, the message delivered may be one of ‘this is how we celebrate’, we drink,” Buckstein says.

He says that sipping may be associated with increased access to alcohol, too, or more lax parent attitudes and that undermines any anti-drinking messages kids hear.

April 21^st is the national day to talk with your kids about alcohol. Visit Mothers Against Drunk Driving’s (MADD) Power of Parents page to learn more.

by Mary Brophy Marcus, health writer, APA

Williams’ death reminds us that a patient’s relief might be a warning sign

By H. Steven Moffic, MD

One of my favorite movie moments is when Robin Williams signs on as an edgy D.J. by exclaiming "Good Morning, Vietnam" from the 1987 movie of the same name. Sometimes, I played the audio over and over, as if it could promise a good day. As he did so often, he found a way to not only lighten the sadness, but to do it in such a way that might be constructively critical.

Surely, the real life mornings were not often happy ones, as so many of our troops died or ended up with post-traumatic stress disorder (PTSD) from that war. It is a lesson we are still learning, so that movie and his role is worth seeing again soon.

Now, after his reported suicide, that good morning seems more like a final good night.

Although he is probably best known for his manic comedy, he also played many serious roles. Most ironically now, he won an academy award in 1997 for playing an empathic therapist in the film “Good Will Hunting.”
Indeed, beloved entertainers like Robin Williams have a therapeutic role of sorts for society in the sense that they provide some relief—even if briefly—for the grief and stress of everyday life. For playing that societal role, such people become a repository for our hopes, dreams and demons. As we know for so many famous entertainers, it is not easy for them to have a successful private life—a private life that the public also tries to invade, as if they were related to us.

What we do know publicly is that Williams suffered from chronic depression and intermittent substance abuse. It is reported that he received treatment, including entering rehab just last month. Obviously, money to get the best treatment was not an issue, though how good the treatment was will remain unknown. We do know, however, that wealthy VIPs often receive treatment just as poor as low-income folks without resources. We also know that occasionally depression is a terminal illness, though that ending is not predictable.

Beyond the public information, and despite the understandable curiosity, this is not the time, nor should it ever be the time, to speculate about his diagnosis and reasons for committing suicide. In fact, the so-called "Goldwater Rule," called that for the inappropriate professional speculation about presidential candidate Barry Goldwater, ethically prohibits such speculations on the part of psychiatrists like myself.

Given this professional ethical principle, as well as the family's request for privacy, is there anything we can still learn from this apparent tragedy? The most intriguing detail that caught my attention was his last tweet and Instagram on July 31. Reportedly, he had wished his daughter a happy 25th birthday.

Why might this positive communication be of importance to us?

It reminded me of the only patient I ever had who committed suicide, long ago, when I was a resident in training. In the second session, the depression of this elderly man seemed to be less severe, but after that session he walked into Lake Michigan and drown. In the psychological autopsy, I never forgot the warning that when a depressed patient starts to seem better, they actually can be at higher risk for suicide.

Risky time

Why is that time of apparent improvement a risky time? The person can have more energy, then plan and complete a suicide. They may also feel relief at their decision, causing others to paradoxically feel relief. That is one of the reasons why it is so common to hear of the genuine surprise that the suicide occurred, as the person seemed to be happier.

What this means, not only for professionals, but for the public, is not to take at face value if a depressed person seems better. Be sure there is a sound explanation for the apparent improvement. 

Our only consolation must be that entertainers like Robin Williams keep on living in the form of their life’s work, like the movie “Good Morning, Vietnam,” that is so ubiquitously available nowadays. Even so, it would not be surprising if at the times we laugh once again at Robin William's humor, that the laughter will also be accompanied by some tears of grief.

Bio

H. Steven Moffic, MD, is a Life Fellow of the APA. Currently, he blogs regularly for Psychiatric Times, Behavioral Healthcare, and The Hastings Center's Over 65.

This blog was originally published in Behavioral Healthcare. Tweet

Effective Addiction Treatments are Available

By John Renner, MD and Frances Levin, MD

We are all saddened by the death of Philip Seymour Hoffman and the many other individuals who have died because of overdoses of heroin or pain medications.  For all of those individuals who struggle with opioid use problems, it is important to realize that help is available and that effective treatment can restore them to productive lives.  Some 4.7 million people in the U.S. have used heroin at least once in their lives.  It is estimated that nearly a quarter of people that use heroin become dependent on it.

Whether it be through mutual support programs such as NA, long-term residential treatment, or addiction pharmacotherapy with buprenorphine, methadone or ER naltrexone, no individual need fear that their condition cannot be treated.  Friends and family members also need to be educated in the use of intra-nasal naloxone for the reversal of opioid overdoses.  

APA has long fostered the development of addiction focused training programs for psychiatrists.  Many psychiatrists have been specifically trained to provide office-based addiction pharmacotherapy and to manage the co-occurring psychiatric disorders that often complicate recovery from substance use disorders.  

More information:

·         Information on addiction
·         Opioid Overdose Prevention Toolkit (SAMHSA)
·         Substance use treatment locator (SAMHSA)
·         Buprenorphine Physician and Treatment locator (SAMHSA)
·         For psychiatrists:  Providers Clinical Support System for Medication Assisted Treatment

Blog contributors:

John Renner, MD

Member, APA Council on Addicition Psychiatry (Past Chair)
Director of Addiction Fellowship Program,
Professor of Psychiatry,  Boston University School of Medicine
Associate Chief of Psychiatry, VA Boston Healthcare System

Frances Levin, MD

Chair, APA Council on Addiction Psychiatry
Kennedy-Leavy Professor of Psychiatry, Columbia University Medical Center
Director, Addiction Psychiatry Fellowship,
New York Presbyterian Hospital
New York State Psychiatric Institute

Tweet

Addiction: A Real Disease with Effective Treatments

By Amanda von Horn, Medical Student

Reviewed by Claudia L. Reardon, M.D.

For September's National Recovery Month, let's discuss recovery from alcohol / drug addiction. Odds are that you or someone you know has struggled with addiction, whether it be alcohol, street drugs, or prescription medications. Unfortunately, many believe that those who struggle with addiction are simply weak, lacking morals, or don’t have the desire or will-power to stop using. The fact is that addiction is a chronic brain disease with real physical and psychological symptoms. People may voluntarily use drugs or alcohol initially, but the drugs themselves can change the brain and make it extremely difficult to stop using, even if they have a strong desire to quit. 

This post answers some commonly asked questions about the disease of addiction. Hopefully you will share the information so others understand that with treatment and support, people do recover.

What actually is addiction?

Addiction is a long-term, often relapsing brain disease that results in repetitive and compulsive substance use despite harmful effects or consequences. 

 

Why is it so hard to stop using drugs/alcohol?

With long-term drug/alcohol use, there are significant changes in the “reward” pathways of the brain. These changes can result in needing more and more drugs just to feel normal. Stopping the drug often causes withdrawal, with symptoms such as intense nausea/vomiting, fevers and chills, horrible depression and/or anxiety, and in some cases even life-threatening seizures. 

Why does addiction affect some people more than others?

Addiction can be caused by many factors, and it is hard to predict individuals who are more vulnerable to the disease. A person’s biology and genetics can play a big role; for example, if a parent abuses drugs/alcohol, the child has a higher chance of having the same problem than does a child of parents who don’t use. 

I am struggling with addiction. What kind of treatment is available?

No one treatment is appropriate for everyone. Effective treatment often involves a combination of medication, counseling, behavioral therapy, and 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous. In many cases, a person may need hospitalization to treat the physical symptoms of withdrawal in the early stages of recovery. 

The recovery plan must address not only the patient’s addiction but all aspects of his or her life in order for treatment to be effective long-term. Since relapse is often a part of the recovery process, it is important to identify “triggers” (people, places, or things that set off an alcohol or drug craving for someone in recovery) and how to cope with these triggers without the use of alcohol or drugs. 

If you or someone you know is struggling with addiction, please consult a physician for evaluation. Recovery is possible, and there is no better time to ask for help than now.

For more information on addiction, visit http://psychiatry.org/addiction. 

Tweet

Fight for Your Right to Behavioral Health Benefits

By Carol McDaid, Co-Chair of the Parity Implementation Coalition

In 2008, Congress passed a law that requires health plans to provide benefits for addiction and mental illness that's equal to other medical benefits. Unfortunately, many people still don't know about this law called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (named after two bipartisan senators who experienced addiction/mental illness in their families).

Parity is personal to me. Did you know that 23 million people have a diagnosed substance use disorder but fewer than 10% receive any help for that condition? I am one of the lucky ones who got the treatment I needed to recover. When my insurance failed twice to provide the coverage promised in my employer-provided health benefit package, I got support from family and employers to help pay for the care I deserved.

When my insurance company refused to pay for any of my last residential treatment (after years of failed attempts at outpatient programs), I fought back. I used all of my internal and external appeals rights. It took me three years and a blizzard of paperwork, but one day a check for half of my treatment appeared in the mail.

Sadly, the average American family with a loved one suffering from addiction or mental illness lacks the resources to fight a three year battle with their insurer to get benefits they are entitled to - by law. Often afraid to discuss their illness with employers, they suffer in silence rather than using their behavioral health benefits promised by insurers. These victims become sicker and even unemployable – causing the burden of paying for their treatment to be shifted to the public sector, where taxpayers like you and me are forced to pick up the bill for health plans that simply will not pay their fair share.

Today, I use my skills as an advocate and former employee benefits analyst to fight for the rights of those coping with addictions and mental illnesses. I'm driven by the passion of my personal parity experience with insurance discrimination and my sense of justice and equality. Help for these conditions should not be limited to those who can afford to pay out-of-pocket or have the fortitude to fight long battles with insurers.

If you or a loved one have been unable to get your insurance to pay for addiction or mental health treatment, please share your story. 

I've been in the halls of Congress fighting this fight since 1993. I realize that laws and regulations are complex and often take many years to be fully implemented. I intend to fight this fight as long as it takes to end insurance discrimination against people suffering from addiction and mental illness. But, to be successful, we need your stories and a collective sense of outrage.

Join me. Share your personal parity story by sending an email to hsf@psych.org. Fight for your rights. Every 15 minutes in the U.S., someone dies from suicide. The clock is ticking.

Petitions by iPetitions.com

Tweet

Should your Doctor be your Friend?

By Jeffrey Borenstein, M.D.

Last Friday, October 14th, I was asked to be a guest on the Dr. Drew show to address the important issue of the doctor-patient relationship. Our discussion centered on the friendship between Dr. Conrad Murray and Michael Jackson and the inappropriate crossing of boundaries.

First and foremost, the doctor-patient relationship is special, centered on trust, caring, and helping. But it is not a friendship – friendships are two way streets. The therapeutic alliance in the doctor-patient relationship is a one-way street – the doctor’s role is to help the patient. 

Another issue we discussed was “doctor shopping." When a person who has a diagnosis of chemical dependency gets prescriptions from various doctors in order to misuse medications, typically pain meds or anti-anxiety meds (benzodiazepines), it's called "doctor shopping." When a physician is aware of this behavior or even suspects "doctor shopping," it's the doctor's duty to take action and stop filling prescriptions rather than enable such destructive behavior.

If you have a friend or family member misusing medication in this way, don’t sit by quietly. Taking appropriate action could save a life. Encourage your loved one to seek appropriate treatment. On the Healthy Minds Public Television series, we have two episodes which focus on chemical dependency, episodes #111 and #112 which can be seen at www.wliw.org/healthyminds. 

Tweet

Live Longer by Making Mental Wellness Your Mission

By Felicia Wong, M.D.

September is National Recovery Month and SAMHSA's National Wellness Week (Sept. 17-23), a time to remind us why "wellness" is so important to our overall health. Did you know, people with mental and substance use disorders die decades earlier than the general population, mostly due to preventable medical conditions?

Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues. In a past blog post, I identified coping tools for dealing with stress and boosting your overall well-being. Here are "Top 8 Tips for Mental Wellness." I hope you will take another look and share with your loved ones this week. 

1) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.

2) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.

3) Stay Positive. Positive emotions can boost your ability to bounce back from stress.

4) Get Physically Active. Exercise can help relieve insomnia and reduce depression.

5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.

6) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.

7) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.

8) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.

Which tips on this list are missing in your life? Today is the perfect time to take action! Your wellness matters. 

Tweet

Mental Illness or Muse? Amy Winehouse and Historic Artists with Bipolar Disorder

By Mohammad Alsuwaidan, MD 

We have no doubt lost a profound musical talent in the tragic death of Amy Winehouse this week.  Her public struggle with substance abuse and bipolar disorder (commonly known as manic depression) has reignited curiosity about possible links between creativity and mental illness. In such unfortunate circumstances, it serves well to draw upon the lessons of history in making meaning out of sorrow.

A little more than 120 years ago, a misfortune befell another budding talent. A young painter entered a psychiatric hospital in Saint-Rémy-de-Provence, Southern France. Known by his neighbors in town as “fou roux" (the crazy redhead), he had been troubled with mental illness throughout his life. A few months prior, he had reached a crisis point and during his breakdown, he rushed to a brothel to see his friend - a prostitute named Rachel. He handed her a small wrapping of newspaper - telling her to “keep this object carefully” and ran off. Unwrapping it, she was shocked to find the freshly cut and still bloody lower portion of his left ear!

Vincent van Gogh holds legendary status in Art and his influence has crossed cultures and eras. To gaze onto the vivid colors and hypnotic swirls in his work is to be transported into another world - a morphed view of reality that can only be seen through his eyes. There is a tendency to romanticize van Gogh’s mental illness – which most respected psycho-biographers believe to have been bipolar disorder.

The notion that there is a fine line between creative genius and “craziness” is not new and has existed since ancient times. Most of this interest has focused on bipolar disorder; many famous figures have been speculated to have suffered from this mental illness: Beethoven, Edgar Allan Poe, Emily Dickinson, Victor Hugo, Charles Dickens, Edvard Munch, and many more. We continue to see this pattern in the modern day among celebrated actors, poets, painters, and musicians like Ms. Winehouse. Yet, despite our modern methods, illuminating the “line” or “link” between mental illness and creativity remains elusive.  Studies show that a certain level of melancholy or mixed emotions may be needed to access the creative spring. Unfortunately this negative emotion may also underlie some of the symptoms seen in bipolar disorder. 

Herein lies the eternal dilemma in the field of medicine – balancing benefits of treatments against their risks. Could some bipolar treatments dampen the creative drive? The evidence, both anecdotal and empirical, says yes.

Yet research also reveals that when individuals with bipolar disorder receive treatment, their overall productivity, focus, and organization improve. We know that the poet Robert Lowell produced the largest portion of his work after receiving lithium treatment for his bipolar disorder. And though some critics argue that his “pre-lithium” work is more striking in its poetic beauty, they admit that had it not been for the stabilizing effects of his treatment leading to many more – still beautiful – poems, we may have never known Lowell and his artistic mastery at all.

The message to mental health professionals is clear in my mind; we should attempt to treat highly-creative individuals with mood disorders with all the latest advancements including medications. BUT we should listen carefully and work with our patients to understand what effect treatment is having on their creative drive. Perhaps some individuals need some degree of discontent to “kindle the creative fire,” and we should step up to the challenge of helping them achieve a tolerable and productive balance.

At the young age of 37, after a manic episode of creating many paintings, Vincent van Gogh walked into an empty field outside his home, aimed a loaded revolver into his chest, and pulled the trigger. His famous last words, as he lay dying in his brother Theo’s arms, were "La tristesse durera toujours" (the sadness will last forever).

Perhaps had he not suffered some degree of sadness, you and I would have never heard of van Gogh. Perhaps had he lived longer, his influence would have been even greater. Perhaps the next van Gogh or Poe or Winehouse will walk into a mental health clinic next week suffocated by their sadness, yet possessed by creative inspiration. The questions are complex scientifically, ethically, and philosophically. But I believe that a balance can and should be reached (or at least approached) and that tragic endings can be re-written. 

Dr. Mohammad Alsuwaidan is a psychiatrist with expertise in Mood Disorders at the University of Toronto and a Master of Public Health candidate at Johns Hopkins University. Learn more: http://www.mohammadalsuwaidan.com/


References:
KR Jamison, Touched with Fire: Manic Depressive Illness and the Artistic Temparment, Free Press Paperbacks (New York 1993). p.85
AW Flaherty, Frontotemporal and Dopaminergic Control of Idea Generation and Creative Drive. Journal of Comp. Neurology 493:147-153 (2005).
Santosa C.M. et al. Enhanced creativity in bipolar disorder patients: A controlled study. J. Affect. Disord. (2006), doi:10.1016/j.jad.2006.10.013
Flaherty, A. (2011). Brain illness and creativity: mechanisms and treatment risks. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 56(3), 132.


Tweet

Yes, Food Addiction is Real. Do You Know Someone Suffering?

By Sarah Johnson, M.D.
The obesity epidemic is a huge problem (no pun intended) due to associated medical problems and their burden on the healthcare system. In 2009, an estimated 25% of Americans met criteria for obesity. This figure has steadily increased since the 1970’s.

Obesity leads to heart disease, strokes, high blood pressure, diabetes, and may be associated with increased risk for depression. It has been suggested that over-eating and other eating behaviors associated with obesity may share features with drug and alcohol addiction. This would certainly explain why this epidemic is so difficult to combat.  

The DSM IV-TR defines substance dependence as three or more of the following symptoms occurring within one year: tolerance, withdrawal symptoms, substance taken in larger amounts or for a longer duration than intended, attempts to cut back, excessive time spent pursuing, using, or recovering from use, reduction or discontinuation of important activities because of use, and continued use despite adverse consequences. 

Food cravings associated with binge eating can trigger the same area of the brain that is activated in drug craving. Although research is preliminary and limited at this time, specific foods such as carbohydrates may actually have a direct effect on mood in those who crave them.

Certain eating behaviors, such as restriction combined with overeating or binge-purge cycles may emulate addictive behaviors. Personality traits such as impulsivity have been found in samples of addicts and obese individuals. Children with behavior disorders such as ADHD and Conduct Disorder may be at increased risk for both addictions and obesity.  

Prevention is the best way to reduce the impact of behaviors associated with obesity. While eating may have similarities with addiction, we live in a toxic food environment, and awareness is key in prevention. Family members can seek help from medical professionals for loved ones who may be exhibiting pathological eating behaviors. 

For more information: Corsica JA, Pelchat ML. Food addiction: true or false? Curr Opin Gastroenterol. 2010 Mar;26(2):165-9.
Wilson GT. Eating disorders, obesity, and addiction. Eur Eat Disord Rev. 2010 Sep-Oct; 18(5):341-51.

Tweet

Caring for the Mental Health of Your College Student

By Roberto A. Blanco, M.D.

A recently released national survey on the state of mental health for entering college students revealed that this year's freshmen class has the highest stress levels in the history of the 25 year survey.  There are several reasons.  According to study authors, students face increased competitiveness and demands in high school as well as more financial challenges due to today's economy.

Although it's an exciting time, your child's transition to college can be a difficult one - especially if he or she suffers from a mental illness.  Here are some things that you and your prospective college student should be thinking about prior to choosing a university and heading off to school:

1.    What can I do to ease the college transition? 

Some schools offer an orientation program over the summer to help students become comfortable with the campus and surroundings, learn organizational and study skills and socialize with fellow freshmen.  

Apart from these organized programs, it is important that, as a parent, you work on transition issues and independence.  Make sure that your child has all materials needed for school including an organizer and a computer.  If your child is getting psychiatric treatment, teach your son or daughter the importance of their medicines, therapy and attending their appointments regularly.  If they haven’t yet been self-administering their medications, before going to college, it is important that they learn and start taking their medicines without supervision.

If you have serious concerns about how your child will do with the college transition, you may want to consider schools close to home.  Depending on the amount of concern, it may be best to choose a school which would allow your child to drive home for the weekend if needed.

2.   What’s the quality of the college's mental health program?

Some colleges and universities do not have mental health services available through the school.  If they don’t, you need to understand how a student can go about getting help.  If the school is not in a major city, you need to make sure that there are enough providers close by so that your child can get the services that he or she needs in a timely manner.

Some universities have therapists but no psychiatric providers on staff.  Others offer both counseling and psychiatric services but put a cap on the number of appointments at the university mental health center prior to referring students out to the community.  All of this information should be provided by each individual school.  And you should know all of this information prior to committing to a particular school, especially if your child is likely to use mental health services.

3.    What is the educational environment of the university?

Some universities are known to be high-pressure, unforgiving environments.  This could be due to the rigor, expectations or challenges of courses.  Sometimes, this can be eased by a strong academic support team or advising system.  Often, peers can make the university culture overly competitive in unhealthy ways.  Some places are notorious for students stealing other students’ lecture materials and notes or not helping out when needed.  If your child is particularly sensitive to stress, it may be best to go to a school where the environment is more collegial and supportive.

Other schools are notorious for having easy access to drugs or alcohol on campus.  While drugs and alcohol are available at most schools, they are easier to get at some schools which are located in major cities or areas of high accessibility.  If your child has a history of drug or alcohol abuse, you should be extra considerate of these location factors.

4.    Will the financing of this school put my child in overwhelming debt?

While a good college education is one of the most important investments, your child should not mortgage his or her future by creating large amounts of unnecessary debt.  In addition, universities with higher tuition may necessitate your child working during school to avoid excessive debt.  This can also add stress.  If schools are relatively equivalent in meeting your child’s long-term career goals, choose the college which will put your child in a better financial position after he or she graduates.

Of course, after your children go to college, you will want to monitor how they are doing intermittently.  Particularly stressful times are usually at the beginning of school, around exam time (midterms and finals) and anytime a romantic relationship ends.  Checking in around these times may be the most beneficial.  If it turns out that they need more help than some parental TLC, make sure that they see a professional.

I hope that these suggestions have been helpful.  Feel free to leave comments or questions for further discussion.

Tweet