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.

By Sharon Ko, KDRV.com, May 17, 2013

Officers in the Rogue Valley are working to better understand and help the mentally ill.

This week, members from every law enforcement agency in southern Oregon are doing what’s called a ‘Crisis Intervention Training’ or CIT. Back in February, several officers and the Jackson County Mental Health department went to Salt Lake City, Utah to train in a nationally known program called “The Memphis Model.” After months of preparation, they’re bringing back what they learned to teach others.

On Friday, officers did some scenario based training. Situations ranged from an intoxicated Vietnam veteran to a child who did not take his medication.

“In this class, there are officers with less than 6 years of experience to 20 years,” said Medford Police Lt. Curtis Whipple.

Along with the officers, the Medford police chief volunteered to be in the first class.

“I believe in this program and I want to have some skin in the game. I want to be here, I want to see what we teach,” said Medford Police Chief Tim George.

Since Monday, officers heard from doctors, mental health workers and even put themselves in a mentally ill person’s shoes. They listened to voices for a few hours to simulate someone suffering from schizophrenia. They were told a story and had to remember it.

“Honestly, it was disturbing. It really is. I think some of these people have to deal with and go through, if you don’t feel empathy, there’s  something wrong with you,” said Medford Police Sgt. Brent Mak.

The Jackson County Mental Health Department is hoping to change how officers respond to a mental illness call. Officials are working to start up a mobile response team, which is consisted of an officer and a health care worker.

In the next 12 months, every person from the Medford Police Department will be CIT certified and in the next few years, every other law enforcement agency in southern Oregon will be trained.

By Maxine Bernstein, The Oregonian, May 16, 2013

Crisis Assessment and Treatment Center

Portland Mayor Charlie Hales announced Thursday that the city will not cut its share of funding for the Crisis Assessment and Treatment Center, as he had set out to do in his proposed budget.

“We are gratified that people having serious mental health issues will continue to have this vital resource,” Hales said, in a joint statement with Multnomah County Chair Jeff Cogen. “In the two years since the county and city jointly opened the CATC, the center has helped to stabilize about 1,300 people in a mental health crisis.”

Hales’ proposed cut was harshly criticized by Cogen as a short-sighted mistake.

The 16-bed secure center opened in June 2011 off Northeast Grand Avenue to considerable fanfare by city, county and state officials. They touted it as a much-needed alternative to jail and hospital emergency rooms for people suffering a mental health crisis. Portland’s City Council resolution called the investment “a very high priority.”

But nearly two years later, Hales had recommended cutting the city’s annual $634,000 share of funding for the center, based on reports from Portland police that they haven’t found it useful.

Some veteran patrol officers dedicated to crisis intervention work say they didn’t know the center existed. The Police Bureau hasn’t encouraged officers to bring people they encounter there, largely because it doesn’t allow for drop-offs.

Center managers, though, earlier this month pointed to statistics that showed while Portland police haven’t been taking people directly to the center, many of the people they encountered were ending up there for treatment anyway.

Of the 1,300 people treated since the center opened, 942 patients came from emergency departments, where police likely took them initially, county officials said. Another 358 came from community referrals through social service agencies and the county jail. Of those referrals, 82 came from Project Respond staffers, who police regularly call out to mental health emergencies.

Under an agreement signed in 2010, the city and Multnomah County each agreed to 20 percent, or $634,000, of the center’s $3.5 million operating costs. The state picks up the rest.

The mayor’s about-face came after further discussions with Cogen about the crisis center, as well talks about finding ways to fund other services, such as the needle exchange program, a one-stop domestic violence center, local senior centers and SUN schools.

“Because Multnomah County is in a stable budget position this year” Hales and Cogen said in their statement, “we agreed that the county will pick up the city’s share for the needle exchange program and one-stop domestic violence center. And the county will provide one-time-only money to maintain the current level of funding for our community’s senior centers and split the cost of three SUN schools for one year, giving both the city and county time to work on a longer-term solution for both of those vital services.”

Sunday, May 19, 2013 – 7:30-9:30 PM
This event is FREE
Powell’s Bookstore Burnside – 1005 W Burnside Portland

Download event flier here: http://bit.ly/104suVF

Join Portland Hearing Voices in a co-sponsored event at Powell’s Books welcoming author Gary Greenberg in discussion with Will Hall, host of Madness Radio.

Gary will be talking about and signing copies of his new book, “The Book Of Woe: Making of the DSM and the Unmaking of Psychiatry,” an exposé of the psychiatric profession’s bible from a leading psychotherapist.

The Book of Woe reveals the deeply flawed process by which mental disorders are invented and uninvented—and why increasing numbers of therapy patients are being declared mentally ill.

“In this gripping, devastating account of psychiatric hubris, Gary Greenberg shows that the process of revising the DSM remains as haphazard and chaotic as ever. His meticulous research into the many failures of DSM-5 will spark concern, even alarm, but in doing so will rule out complacency. The Book of Woe deserves a very wide readership.”
—Christopher Lane, author of Shyness: How Normal Behavior Became a Sickness

Gary Greenberg is a practicing psychotherapist and author of Manufacturing Depression and The Noble Lie. He has written about the intersection of science, politics, and ethics for many publications, including Harper’s, The New Yorker, Wired, Discover, Rolling Stone, and Mother Jones, where he is a contributor. Dr. Greenberg lives with his family in Connecticut. http://www.garygreenbergonline .com

Will Hall, MA, DiplPW, is a therapist who has himself recovered from a diagnosis of schizophrenia and now teaches internationally. Director of Portland Hearing Voices and host of KBOO’s Madness Radio, Will has written in the Journal of Best Practices in Mental Health and in the upcoming Oxford University Press Modern Community Mental Health Work. He is author of the Harm Reduction Guide to Coming Off Psychiatric Drugs, used widely in the peer recovery movement. http://www.willhall.net.

Co-sponsored by Portland Hearing Voices and Powell’s Books.

More info: http://www.madnessradio.net/madness-radio-2007-08-08-manufacturing- depression-gary-greenberg,
More info: http://www.garygreenbergonline .com
More info: www.portlandhearingvoices. net

Portland Police Bureau news release, May 15, 2013

In crisis? Call 503-988-4888.

The Portland Police Bureau investigated four incidents of suicide from May 11 to May 13, 2013, and wants to remind the community that suicide is preventable and help is available.

On Saturday May 11, 2013, at approximately 11:30 a.m., Central Precinct officers responded to Northwest Broadway, between Hoyt and Irving Streets, on the report of a male that jumped from the eighth floor of the Bud Clark Commons, located at 655 Northwest Hoyt Street.

Portland Police and Portland Fire & Rescue personnel arrived and determined that the 42-year-old man was deceased. Witnesses confirmed that he man jumped from the eighth floor of the Bud Clark Commons.

Officers learned that the man was from Aberdeen, Washington and had recently left a long-term drug treatment program.

On Sunday May 12, 2013, at approximately 9:00 a.m., East Precinct officers responded to a residence in the 4700 block of Southeast 71st Avenue on the report of a suicide by hanging.

Portland Police and Portland Fire & Rescue personnel arrived and determined that the 39-year-old man was deceased.

Officers learned that the man and his partner both lived at the home with their six-year-old son. The deceased’s partner told police that they had an argument the night before so she went to bed and he went to the basement. She told police that she discovered him deceased this morning in the basement. Officers also learned that the man struggled with mental health issues throughout his life.

Also on Sunday May 12, 2013, at approximately 9:00 a.m., East Precinct officers responded to a residence in the 1500 block of Southeast 150th Avenue on the report of a suicide by hanging.

Portland Police and Portland Fire & Rescue personnel responded and determined that the 24-year-old male was deceased.

Officers learned that the man was out with his mother the night before but both returned home and nothing seemed to be bothering the deceased. Officers located a suicide note in the man’s bedroom, which was turned over to the Oregon State Medical Examiner.

On Monday May 13, 2013, at approximately 2:30 a.m., Central Precinct officers responded to the report of a deceased male on Southwest Jefferson Street below the Vista Bridge.

Portland Police and Portland Fire & Rescue personnel arrived and determined that the 40-year-old man was deceased and that his injuries were consistent with a jump from the Vista Bridge.

Officers located personal effects belonging to the man on a bench near the Vista Bridge on Southwest Vista Avenue.

Suicide is preventable.

Help is available for community members struggling from a mental health crisis and/or suicidal thoughts.

Cascadia Behavioral Healthcare has an urgent walk-in clinic, open from 7:00 a.m. to 10:30 p.m.
7 days a week. Payment is not necessary.  Walk in or call 503-963-2575.

 The Multnomah County Crisis Line is available 24 hours a day, seven days a week.  Call 503-988-4888.

By Harry Esteve, The Oregonian, May 14, 2013

A group of unionized mental health workers in the Oregon state prison system wants a pay raise that even they acknowledge is big enough to cause a public relations problem.

About 50 mental health specialists who handle inmates with addictions and other mental health problems want to be reclassified because their job descriptions have changed, including a requirement of a master’s degree. Under their current proposal, they’re seeking raises between 25 percent and 26 percent, which would result in a maximum salary of more than $80,000, according to a memo obtained by The Oregonian.

Like most correction workers, the mental health specialists are represented by the American Federation of State County and Municipal Employees. The memo, written by Brad Holt, one of the prison mental health specialists, urges his colleagues to keep quiet about the proposal.

“Again, my gut feeling only is that with the budget having been so bad over the last 5-6 years, with step-freezes, layoffs, furloughs and increased costs of our health insurance, we are the only positions that are looking to be reclassified with a very substantial increase in pay,” Holt wrote in an email dated April 30. “I am afraid that if enough staff outside of BHS (behavioral health services) were aware, it could become a huge issue for the state and AFSCME to deal with if it became public knowledge or hit the local news media.”

Public employee unions are in the middle of bargaining over new labor contracts with state government agencies. To date, the negotiations have been kept largely under wraps.

The Department of Corrections is under a brighter spotlight this year because Gov. John Kitzhaber has singled it out as one of the reasons the state doesn’t have enough money to spend on education. Kitzhaber has asked for policy changes that ensure the prison population doesn’t continue to grow, as a way to hold down costs.

About a month ago, the state offered to reclassify the prison mental health specialists because of the new requirements, said Matt Shelby, spokesman for the Department of Administrative Services. Under the new classifications, they would become psychiatric social workers, and the state offered an undisclosed wage increase. The union made a counter offer of a bigger increase.

“It’s unresolved at this point,” Shelby said.

The reclassificiation is necessary, Shelby said because of a 2011 law that splits mental health duties. Some of the duties are more complex and require a license and more education, while others don’t, he said. Most of the prison mental health specialists fall under the higher classification, Shelby said.

According to the email, mental health specialists in the Corrections Department earn a starting wage of $3,859 a month, which tops out at $5,328, or $63,936 a year. Under the new classification proposed by the union, the starting wage would be $4,853 and a top scale of $6,747, or $80,964 per year.

Those at the top end would see an annual pay increase of $17,028, or 26.6 percent.

By way of comparison, a similar position of psychiatric social worker at the Oregon Youth Authority, which supervises juveniles and some young adults convicted of crimes, pays $66,288 a year.

Tim Woolery, who is negotiating the contract for AFSCME, defended the proposed wage increases.

“We’ve asked for more, but that doesn’t mean the state’s going to give it to us,” Woolery said. “Those people have been underpaid for a number of years.”

He said they should be paid what other psychiatric social workers make, plus some extra because of the risky nature of their work. He said he isn’t worried about public response to the request for higher pay.

“Of course the state budget and the state revenue picture are factors that come into play in this,” Woolery said. “But my job is to advocate for the members, and to be reasonable about it. And I think we are.”