Mental Health Association of Portland

By Jenny Westberg, Portland Mental Health Examiner, May 23, 2013

A rising controversy over the DSM-5, the new edition of the so-called Bible of psychiatry, heated up to flashpoint last weekend, when the book was launched at the 166th annual meeting of the American Psychiatric Association.

Criticism of the new psychiatric manual has issued from diverse sources, from the director of the National Institute of Mental Health to the activists of Occupy Psychiatry.

Occupy Psychiatry mounted a protest outside the Moscone Center in San Francisco, where the APA was meeting. Among the protesters was Portland mental health activist, coach and group facilitator Chaya Grossberg, who said Occupy Psychiatry drew some respectful attention from APA members.

“Some of the psychiatrists stopped and listened, some for almost the whole time!” Grossberg said yesterday.

In recent weeks, however, psychiatrists were likelier to be sniping at each other.

Shrink vs. Shrink

NIMH director Thomas Insel, MD, on April 29 criticized the manual’s “lack of validity,” calling it “at best, a dictionary” that defines the exact set of labels it creates. “Patients with mental disorders deserve better,” he wrote.

But David Kupfer, MD, chair of the DSM-5 task force, in a May 6 statement defended the diagnostic manual and struck back at Insel, saying the NIMH director’s proposed replacement for the DSM — a system basing diagnosis and treatment on biological and genetic markers — “cannot serve us in the here and now.”

Though he said he hopes such a system will exist someday, Kupfer called it “disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”

Word War

Fellow psychiatrists parried in the New York Times letters section after professor of psychiatry Ronald Pies, MD, scoffed at criticism of the DSM. “There is nothing inherently dehumanizing or ‘stigmatizing’ about a psychiatric diagnosis,” he wrote, followed by a self-contradictory reference to “society’s animus and prejudice toward those with mental illness.”

Victor Altshul, MD, a psychiatrist in New Haven, pointed out that “responsibility for the stigmatization of large groups of people can partly be laid at our door. Just ask gay people who were around before 1973, when homosexuality was finally removed from the DSM.”

And psychiatrist Leon Hoffman, MD, joined the dissent: “The problem with the DSM is that psychiatry over at least the last four decades has attempted to categorize mental and psychological manifestations as distinct illnesses, similar to the categorization of medical and surgical illnesses, instead of recognizing that the best way to understand psychological health is on a spectrum.

“All of us are a little depressed, a little obsessional, a little histrionic and a little borderline,” wrote Hoffman. “Some of us have a little more of one of these qualities and less of one of the others. We seek help when one of our traits causes us or those around us too much psychic pain.”

Overdiagnosis a Threat

Specific criticisms of the DSM’s fifth edition center around certain diagnostic criteria that threaten to make the categories so broad that overdiagnosis is a looming risk. For example:

• People with normal grief and sadness after the death of a loved one, previously excluded from a depression diagnosis, might now be diagnosed with major depression.
• Diagnosing a child’s temper tantrums as “disruptive mood dysregulation disorder” could saddle normal kids with a mental illness label.
• Older people who sometimes find it more difficult to do everyday tasks or have an occasional “senior moment” might now be diagnosed with “mild neurocognitive disorder.”
• Excessive thoughts or feelings about pain or other discomfort is now termed “somatic symptom disorder,” which could give cancer patients another, perhaps unwarranted, diagnosis.
• It will be easier to qualify for a diagnosis of ADHD, a condition many say is already overdiagnosed.

As of today, psychologists had collected 14,888 signatures on an online petition raising questions about the DSM-5 and asking for a collegial reconsideration.

Occupy Psychiatry and O.P.P.

For the 40 or so Occupy Psychiatry protesters outside the Moscone Center, and many of their supporters, the problem is broader — and deeper — than changes from the previous manual, the DSM-IV. The problem is psychiatry itself.

“The issue is not about this edition of the DSM,” said PJ Moynihan, who was not at the protest, busy instead with the Open Paradigm Project, a social media campaign giving voice to people who reject psychiatric labeling. “It is a broader, philosophical issue about how we respond to human emotion, or life challenges.”

WATCH – Video Testimonial by Cicely Spencer (Open Paradigm Project)

Moynihan added, “My experience in listening to countless stories from individuals whose lives have been severely damaged by psychiatric diagnosis, and consequently psychiatric medication, is that the point of intervention by psychiatry, due to whatever the circumstances may be, is more harm than good.”

“Telling someone who is going through a period of overwhelm, or emotional difficulty, as well as their support system of family and friends, that they have a biological brain disease that is most effectively treated with long term medication, is devastating to the individual, informs how their support network responds or views them, and not founded in any real science or proven biological markers.”

“In short,” said Moynihan, “we need a paradigm shift in mental healthcare, not variations on the prevailing model.”

Speaking Out

Chaya Grossberg

Speakers at the protest, most of whom identified as psychiatric survivors, included:

• Attorney Ted Chabasinski: “The increased labeling and drugging of children, and the way the new DSM puts everyone at risk for being called ‘mentally ill’ must be stopped. Everyone must realize that they too can be called crazy, not just those who have already been dragged into and trapped by the system.”
• Licensed therapist and human rights activist Michael Cornwall, Ph.D.: “The profession of psychiatry lives in a collective state of denial. Psychiatrists are true believers with a religious fundamentalist type of fervor that allows them to routinely injure, and frequently hasten the death of those they are sworn to heal. But the reckoning is upon them. Their blatant human rights violations will not stand the light of day.”
• Attorney James B. (Jim) Gottstein, Esq.: “Hundreds of thousands of people are locked up and drugged or electroshocked against their will every day under the auspices of the American Psychiatric Association. These are human rights abuses on a massive scale in violation of United States and International Law. The American Psychiatric Association must be held accountable for its role in these horrors.”

Chaya Grossberg, the Portland activist, said the protest was effective and important. “Hundreds of people watched on Livestream,” she said. “People came to the protest for community and solidarity, from Alaska, Portland, Los Angeles, and even Alberta, Canada.”

For many, the protest had a personal impact. Said Grossberg, “Some people who came have been isolated, trying to come off of, or recover from, psych drugs for many years. This protest helped them to know they are not alone, and their voice matters and can be heard.”

By The Associated Press, in The Oregonian, May 21, 2013

Nine people have been affected by a three-strikes-and-you’re-out policy that prohibits repeat troublemakers from venturing into downtown Ashland.

The City Council created the exclusion zone in August. People who commit three offenses within a six-month period can be banned from the downtown for three months. Opponents of the zone say it targets homeless people and doesn’t address underlying problems such as mental illness and addiction.

The Ashland Daily Tidings made a public records request to obtain the names of people who have been banned.

The nine have amassed citations for offenses such as theft, urinating in public, trespassing, disorderly conduct, having an open container of alcohol in public, drinking alcohol in public, furnishing alcohol to a minor and failing to appear in court, the newspaper reported.

For the most part, the people banned from downtown have stayed away.

Chief Terry Holderness of the Ashland Police Department said five of the nine left town before police could notify them that they qualified for exclusion.

“We had people causing problems on a daily basis who just left,” he said.

Two of the four served with notices left the area, Holderness said.

One of the remaining two is an alcoholic and the other has mental health problems. Each has been arrested multiple times downtown since receiving exclusion notices, Holderness said.

Those who violate the ban are taken to the Jackson County Jail in Medford where they are processed for a few hours before being released back out on the streets because of space limitations.

Offenders who want to return to Ashland must their own transportation back.

“We’re saying, ‘If you’re doing this too many times, we’ll at least inconvenience you,’” Holderness said.

More time is needed to determine whether the exclusion zone is cutting down on bad behavior, he said.

The department has received 214 calls about downtown disorder in the eight months since the zone was created, a slight decline from the 227 calls received during the same eight-month period before its creation.

Though the drop is small, it reverses an upward trend, Holderness said. And, he added, had the repeat scofflaws not been banned from the downtown, the number would certainly have been higher than 214.

By Maxine Bernstein, The Oregonian, May 22, 2013

Portland Police Chief Mike Reese has been known to fill patrol shifts for officers  named employees of the month as a way to reward them with a day off.

But this week, Reese has left his office on the 15th floor of the Justice Center to ride around downtown, filling three consecutive day-shift patrols to reduce overtime costs. Each time this week, he’s taken a lieutenant with him.

On Tuesday, the chief tweeted a message from his police car: “Working patrol today in downtown with Lt. (Jim) Dakin.”

Just before 3 p.m. on Wednesday, the chief, riding with Lt. Mike Marshman, tweeted his latest assignment: “Received a call at 10th and Yamhill on an overdose. Assisted medical.”

And Thursday, he’s scheduled to fill another day shift downtown.

Bureau spokesman Sgt. Pete Simpson said the chief is on patrol this week “to reduce backfill overtime,” meaning he’s working patrol shifts to avoid bringing an off-duty officer in on overtime pay to fill vacant shifts.

There have been shifts left open this week because officers have been sent for additional training as part of the bureau’s new Enhanced Crisis Intervention Team. Under pressure from federal investigators to improve officers’ response to calls involving people with mental illness, the bureau has returned to having a specialized team of officers to be the go-to cops called out to such crisis calls.

About 50 officers were selected for the team and are receiving an additional 40 hours of training this month.

The police bureau budgeted $7.8 million for overtime this fiscal year. As of February, the bureau spent $5. 8 million and is projected to spend $8.6 million by June 30. The mayor and two commissioners who studied the bureau’s overtime spending have recommended the Police Bureau, among other bureaus, take immediate steps to reduce its overtime costs.

The commissioners suggested the Portland police place tighter controls on overtime; move officers from specialty units to fill gaps in patrol; appoint command staff who don’t earn overtime to take on public information duties on nights and weekends; limit the number of officers that prosecutors subpoena to appear in court on pending cases and assign someone to manage overtime.

Looks like Chief Reese has taken the message to heart.

“The mayor appreciates that the chief is stepping in,” said Dana Haynes, the mayor’s spokesman.

Asked if Reese is continuing to technically serve as chief or has appointed one of his assistant chiefs as acting chief while he’s handling emergency calls, Simpson simply said: “Still the Chief.”

By Capi Lynn, the Statesman Journal, May 23, 2013

The Oregon State Hospital Museum of Mental Health welcomes author Jane Kirkpatrick for a presentation and book signing from 2 to 3:15 p.m. Saturday.

Kirkpatrick will discuss her latest novel, “One Glorious Ambition,” which tells the story of Dorothea Dix, an early advocate for mental health care reform in the United States.

The event is free and open to the public. Books will be available for purchase during the event, with a portion of sales going to support the museum, 2600 Center St. NE, Salem.

For more information, visit the OSH Museum website.

News release, Portland Police Bureau, May 22, 2013

The Portland Police Bureau’s Service Coordination Team (SCT) has scheduled a graduation for Thursday May 23, 2013, from 10:00 to 11:00 a.m., in City Council Chambers at Portland’s City Hall.

City Hall is located at 1220 Southwest 4th Avenue.

Coffee and cake will be served immediately afterwards in the foyer on the first floor.

The Service Coordination Team is a Portland Police Bureau program that provides drug treatment to chronic offenders as an alternative to incarceration, working to address the root cause of their criminal activity.

Thursday, the SCT will be honoring 14 graduates from the Central City Concern Housing Rapid Response Program and the Volunteers of America Day Treatment and Residential Support Programs.

This will bring the total number of SCT graduates to 116 people.

Darryll White, Class of 2009, will be Master of Ceremonies, Commissioners Amanda Fritz and Steve Novick will be making welcoming remarks and Portland Police Chief Mike Reese will be presenting the certificates.

Expected to attend are the 14 new graduates, including several of whom are referrals from the Drug Impact Area (DIA) Program. Additionally, 13 previous graduates will be honored as they have achieved a year or more of sobriety.

The graduation program is a moving opportunity to see the power of change at work and the success of the Service Coordination Team’s partnerships.

The Service Coordination Team is a partnership between the Portland Police Bureau, the Multnomah County Sheriff’s Office, the Multnomah County District Attorney’s Office, the Multnomah County Department of Community Justice, Portland Patrol Inc., Project Respond, JOIN, Transition Projects Inc., Volunteers of America, Central City Concern and the Portland Business Alliance Clean and Safe program.

For additional information about the Service Coordination Team, contact Program Manager Austin Raglione at Austin.Raglione@PortlandOregon.gov

By Dr. Pamela Wible, The Lund Report, May 21, 2013

A psychiatrist in Seattle had picked out the bridge. At 3 a.m. he would swerve across his lane and plunge into the water. Everyone would assume he fell asleep.

A surgeon in Oregon was lying on the floor of her office with a scalpel. Nobody would find her until it was too late.

An internal medicine resident in Atlanta heard an anesthesiologist joking about the lethal dose of sodium thiopental. Alone in the call room, she would overdose that night.

Three planned suicides. All three physicians survived. Why?

While preparing to overdose, the internist was interrupted by an endocrinologist calling to check on her. Before grabbing her scalpel, the surgeon called several physicians pleading for help—I responded immediately. Two days before he was to drive off the bridge, the psychiatrist spotted my ad for a physician retreat. He called me begging to attend.

One week later, I’m hiking through the Oregon Cascades. The scent of cedar envelops me as I approach the lodge where I’m welcoming physicians who have arrived from all over the United States and Canada, all of us on a pilgrimage for answers.

Tonight we begin a retreat for doctors who yearn to love medicine again. Studies confirm most doctors are overworked, exhausted, or depressed. The tragedy: few seek help.

I ask the group, “How many physicians have lost a colleague to suicide?” All hands are raised. “How many have considered suicide?” Except for one woman, all hands remain up—including mine.

“Physicians have the highest suicide rate of any profession,” I explain. “In the United States we lose over 400 physicians per year to suicide. That’s the equivalent of an entire medical school. Even that’s an underestimate because many physician suicides are incorrectly identified as accidents.”

I tell them, “Both men I dated in med school are dead. Brilliant physicians. Loved by their families and patients. Both died young—by ‘accidental overdose.’ Really? How many physicians accidentally overdose?”

The room is quiet.

It’s easier to say accident than suicide. Doctors can say gonorrhea and carcinoma. Why not suicide? Maybe we can’t face our own wounds.

“I’m a family doc in Eugene, Oregon, where we’ve lost three physicians in eighteen months to suicide. I was suicidal once. Assembly-line medicine was killing me. Too many patients and not enough time sets us up for failure. Rather than kill myself, I invited my patients to help me design an ‘ideal clinic.’ It is possible to love medicine again.”

The Canadian doctor to my right wipes her eyes. “I’m feeling so discouraged. I want to give up and work at Starbucks. My head is exploding from banging it against the system.”

A bright-eyed, blonde woman reveals, “I just took a leave of absence from med school because it was killing my soul. Three classmates attempted suicide.”

A newlywed couple join in. “I’m a nurse. My husband is an internist. He’s suffering, but I don’t know how to help him. Doctors don’t seek psychiatric care because mental illness is reportable to the medical board. He fears he’ll lose his license.” Her husband adds, “I was suicidal three months ago. On the edge. My wife and I are hoping to find answers here.”

Here, physicians, nurses, and medical students share their wounds and their wisdom—in community. We share new practice models, communication techniques, and strategies to care for ourselves—so we can care for our patients.

In four days, I witness more healing than in four years of med school. Once strangers, we’ve become family. Parting ways, the psychiatrist from Seattle thanks me again.

I didn’t know these doctors, but I know their despair. By speaking about my own pain, I validated their pain. By being vulnerable, I gave them the strength to be vulnerable too.

But mostly we healed each other by not being afraid to say the word suicide out loud.

Dr. Pamela Wible is a family physician, author, and expert in physician suicide prevention. She offers biannual retreats for physicians struggling with burnout and depression. Contact her at idealmedicalcare.org.

By The Associated Press, in The Oregonian, May 15, 2013

In the new psychiatric manual of mental disorders, grief soon after a loved one’s death can be considered major depression. Extreme childhood temper tantrums get a fancy name. And certain “senior moments” are called “mild neurocognitive disorder.”

Those changes are just some of the reasons prominent critics say the American Psychiatric Association is out of control, turning common human problems into mental illnesses in a trend they say will just make the “pop-a-pill” culture worse.

Says a former leader of the group: “Normal needs to be saved from powerful forces trying to convince us that we are all sick.”

At issue is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, widely known as the DSM-5. The DSM has long been considered the authoritative source for diagnosing mental problems.

The psychiatric association formally introduces the nearly 1,000-page revised version this weekend in San Francisco. It’s the manual’s first major update in nearly 20 years, and a backlash has taken shape in recent weeks:

• Two new books by mental health experts, “Saving Normal” and “The Book of Woe,” say the world’s most widely used psychiatric guide has lost credibility.
• A British psychologists’ group is criticizing the DSM-5, calling for a “paradigm shift” away from viewing mental problems as a disease. An organization of German therapists also attacked the new guide.
• Even the head of the U.S. National Institute of Mental Health complained that the book lacks scientific validity.

This week, the NIMH director, Dr. Thomas Insel, tried to patch things up as he and the psychiatrists group issued a joint statement saying they have similar goals for improving the diagnosis and treatment of mental illness.

The manual’s release comes at a time of increased scrutiny of health care costs and concern about drug company influence over doctors. Critics point to a landscape in which TV ads describe symptoms for mental disorders and promote certain drugs to treat them.

“Way too much treatment is given to the normal ‘worried well’ who are harmed by it; far too little help is available for those who are really ill and desperately need it,” Dr. Allen Frances writes in “Saving Normal.” He is a retired Duke University professor who headed the psychiatry group’s task force that worked on the previous handbook.

He says the new version adds new diagnoses “that would turn everyday anxiety, eccentricity, forgetting and bad eating habits into mental disorders.”

Previous revisions were also loudly criticized, but the latest one comes at a time of soaring diagnoses of illnesses listed in the manual — including autism, attention deficit disorder and bipolar disorder — and billions of dollars spent each year on psychiatric drugs.

The group’s 34,000 members are psychiatrists — medical doctors who specialize in treating mental illness. Unlike psychologists and other therapists without medical degrees, they can prescribe medication. While there has long been rivalry between the two groups, the DSM-5 revisions have stoked the tensions.

The most contentious changes include:

• Diagnosing as major depression the extreme sadness, weight loss, fatigue and trouble sleeping some people experience after a loved one’s death. Major depression is typically treated with antidepressants.
• Calling frequent, extreme temper tantrums “disruptive mood dysregulation disorder,” a new diagnosis. The psychiatric association says the label is meant to apply to youngsters who in the past might have been misdiagnosed as having bipolar disorder. Critics say it turns normal tantrums into mental illness.
• Diagnosing mental decline that goes a bit beyond normal aging as “mild neurocognitive disorder.” Affected people may find it takes more effort to pay bills or manage their medications. Critics of the term say it will stigmatize “senior moments.”
• Calling excessive thoughts or feelings about pain or other discomfort “somatic symptom disorder,” something that could affect the healthy as well as cancer patients. Critics say the term turns normal reactions to a disease into mental illness.
• Adding binge eating as a new category for overeating that occurs at least once a week for at least three months. It could apply to people who sometimes gulp down a pint of ice cream when they’re alone and then feel guilty about it.

Removing Asperger’s syndrome as a separate diagnosis and putting it under the umbrella term “autism spectrum disorder.”

Dr. David Kupfer, chairman of the task force that oversaw the DSM-5, said the changes are based on solid research and will help make sure people get accurate diagnoses and treatment.

Dr. Jeffrey Lieberman, the psychiatry association’s incoming president, said challenging the handbook’s credibility “is completely unwarranted.” The book establishes diagnoses “so patients can receive the best care,” he said, adding that it takes into account the most up-to-date scientific knowledge.

But Insel, the government mental health agency chief, wrote in a recent blog posting that the guidebook is no better than a dictionary-like list of labels and definitions.

He told The Associated Press he favors a very different approach to diagnosis that is based more on biological information, similar to how doctors diagnose heart disease or problems with other organs.

Yet there’s scant hard evidence pinpointing what goes wrong in the brain when someone develops mental illness. Insel’s agency two years ago began a research project to create a new way to diagnose mental illness, using brain imaging, genetics and other evolving scientific evidence. That project will take years.

The revisions in the new guide were suggested by work groups the psychiatric association assigned to evaluate different mental illnesses and recent research advances. The association’s board of trustees decided in December which recommendations to include.

Advocacy groups have threatened Occupy-style protests and boycotts at this week’s meeting.

“The psychiatric industry, allied with Big Pharma, have massively misled the public,” the Occupy Psychiatry group contends. Organizers include Alaska lawyer Jim Gottstein, who has long fought against overuse of psychiatric drugs.

The new manual “will drastically expand psychiatric diagnosis, mislabel millions of people as mentally ill, and cause unnecessary treatment with medication,” says the website for the Committee to Boycott the DSM-5, organized by New York social worker Jack Carney.

Committee member Courtney Fitzpatrick, whose 9-year-old son died seven years ago while hospitalized for a blood vessel disease, said she has joined support groups for grieving parents “and by no means are we mentally ill because we are sad about our kids that have died.”

Gary Greenberg, a Connecticut psychotherapist and author of “The Book of Woe,” says pharmaceutical industry influence in psychiatry has contributed to turning normal conditions into diseases so that drugs can be prescribed to treat them.

Many of the 31 task force members involved in developing the revised guidebook have had financial ties to makers of psychiatric drugs, including consulting fees, research grants or stock.

Group leaders dismiss that criticism and emphasize they agreed not to collect more than $10,000 in industry money in the calendar year preceding publication of the manual.

By Maxine Bernstein, The Oregonian, May 17, 2013

The City of Portland would pay $35,000 to settle a lawsuit brought by a man who was injured during a March 2010 anti-police protest, under an ordinance that will go before city commissioners Wednesday.

The encounter, captured on television footage, resulted in injuries to Clifford Richardson. He was treated at OHSU Hospital after his head and face struck the pavement during a scuffle with an officer, according to city records.

During the 2010 protest, Portland police formed a line with their bikes to keep protestors from moving into the street. Richardson, according to city documents, pushed at an officer and officers moved in to take him into custody.

“During the struggle that ensued, Richardson’s upper body was struck by a police officer’s knee and as a result, his head and face struck the pavement,” according to city documents distributed to commissioners.

READ – Settlement documents (PDF, 291KB)

Richardson, then 24, was charged with disorderly conduct, resisting arrest, interfering with police and harassment. He was later acquitted of all charges at trial.

Richardson then filed a civil lawsuit against the city in Multnomah County Circuit Court, alleging false arrest, battery and malicious prosecution. He was seeking $15,000 for past and future medical bills, plus $500,000 in general damages.

The settlement figure was reached after significant negotiations, according to the city.

“Approval of this settlement will avoid the cost and expense of a trial and a jury award that could potentially be significantly larger,” according to Randy Stenquist, of the city’s risk management office.

The protest was one in a series that followed two officer-involved fatal shootings that year: the Jan. 29, 2010 fatal shooting of Aaron Campbell by Officer Ronald Frashour, and the March 22 fatal shooting of Jack Dale Collins near a Hoyt Arboretum restroom by Officer Jason Walters.