Great Articles, Part 1

In no particular order, these are some of the best articles on mental illness I have read recently.

Behind the Yellow Door; A Man’s Mental Illness Worsens by Stephanie McCrummen (Washington Post)

The man behind the yellow door hadn’t come out of his house more than a few minutes in two years. A former Capitol Hill staffer gripped by schizoaffective disorder, he didn’t think of himself as sick, but rather that God was speaking to him through his two young sons. In the past, his frightened family would have been able to have him committed to a psychiatric hospital, but with the passing of laws expanding the rights of those who are mentally ill, their only choice is to wait for him to become a danger to himself or others before he can be forced into treatment. “With no other treatable illness do we wait for someone to hit bottom before providing treatment even though acute signs and symptoms are apparent. Why do we, the families of people living with serious mental illnesses, have to continue waiting and weeping?”

The Rise of the Neuronovel by Marco Roth (n+1)

“The last dozen years or so have seen the emergence of a new strain within the Anglo-American novel. What has been variously referred to as the novel of consciousness or the psychological or confessional novel—the novel, at any rate, about the workings of the mind—has transformed itself into a neurological novel, wherein the mind becomes the brain.” Roth argues that the recent interest in contemporary novels in the disordered wetware of their characters represents a defeat for fiction. “…the new genre of the neuronovel, which looks on the face of it to expand the writ of literature, appears as another sign of the novel’s diminishing purview.” This is a nicely written and thought provoking essay, but ultimately I disagree with Roth. Novels are not about the same things as they were during Dickens’ time. Get off my lawn.

When My Crazy Father Actually Lost His Mind by Jeneen Interlandi (New York Times Magazine)

Interlandi follows a sobering episode in the debilitating bipolar history of her father, revealing flaws in the nation’s mental health and criminal justice system, specifically with laws requiring that the acutely psychotic meet the imminent danger standard—that they pose an immediate threat to themselves or someone else—in order to be involuntarily committed to a psychiatric facility. Interlandi describes her family’s experience of being trapped in a broken system: “During the three months in which my father cycled through the system, he racked up five emergency room visits, four arrests, four court appearances…and too many police confrontations to remember. He spent 25 (nonconsecutive) days in a psychiatric hospital and 40 in a county jail.” I like this piece because it effectively uses the deeply personal to illustrate a national crisis, and because it doesn’t flinch in the face of uncomfortable truths.

God Only Knows Where I Am by Rachel Aviv (New Yorker)

Aviv’s article is a poetic ode to a struggling woman. Like so many with delusional disorders, Linda Bishop does not believe she has a psychiatric illness. Because of her deteriorating mental condition, Linda is incarcerated for a crime, spends a year and a half in jail before she is found incompetent to stand trial and then goes to a psychiatric hospital where she remains until she is discharged with no plans for housing, money, follow-up care, or notification of family. After her release, she takes shelter in a little-used New Hampshire home, surviving on only apples and rainwater until she succumbs to starvation. This article raises the important question of what should happen when patients reject their diagnosis.

Intake: Locked on the Psych Ward by Rosalind Adams (Buzzfeed)

This Pulitzer worthy year-long investigation raises several concerns about how America’s biggest psychiatric chain—Universal Health Providers (UHS)—made its earnings, suggesting that UHS “turns patients into profits.” The report, for which 175 current and former UHS staff were interviewed, raises serious concerns about the extent to which the company’s large profits were achieved at the expense of patients, some of whom shouldn’t have been hospitalized at all.

What Michael Did by Amy Dempsey (Toronto Star)

A powerful feature story about a schizophrenic man named Michael Stewart who killed his mother during a psychotic episode. Michael was found not criminally responsible and now lives in a forensic health institute in Canada. The article documents how Michael and his family have tried to piece their lives back together after such a horrific event and, in the process, develop both forgiveness and understanding for one another. This is an exceptional piece that humanizes Michael and his illness in a way that I rarely see. He is not a criminal. He is someone who is trying to climb out of a dark pit and fix himself.

Madness by Eyal Press (New Yorker)

A shocking exposé that documents how prison guards at the Dade Correctional Institution in Florida have subjected mentally ill prisoners to vicious beatings, scalding showers, and severe food deprivation. Many prisoners have been driven to suicide. These guards have acted with near impunity since prison staff, including mental health workers, often fear reprisals for speaking out. Through on the record interviews of former employees, Press paints a portrait of a deeply dysfunctional institution where violence, retaliation, and retribution against prisoners by prison staff is commonplace.

Trouble in Mind by Brandi Grissom (Texas Monthly)

This is part five of a six-part series that explores the intersections of the mental health and criminal justice systems in Texas through the case of Andre Thomas, a death row inmate who began exhibiting signs of mental illness as a boy and committed a brutal triple murder in 2004. While incarcerated, he clawed out both of his eyes and ate one of them. Yet the state of Texas remains unconvinced that he is too mentally ill to be executed.

The toughest questions that Andres’ case presents, however, are not political in nature but moral. As a society, we want justice for the victims of his horrific crime. But what if Andre is not capable of understanding right from wrong or of comprehending why he is facing execution? Conversely, if the death penalty is not intended for someone who cuts out the hearts of two children, then for whom is it meant? At the center of this dilemma is Andre himself, who, now almost thirty, is presently too mentally ill to be housed on death row. For the past four years, he has been confined to a special psychiatric prison facility, where he remains indefinitely. All of which raises perhaps the most difficult question of all: What should be done with Andre Thomas?

His case offers a lens through which to examine the effects of a long underfunded mental health system and raises important questions about how Texas punishes the mentally ill. In my opinion, if Andre Thomas is not insane then the insanity defense law certainly is.

The Death Treatment by Rachel Aviv (New Yorker)

This poignant and troubling essay is about assisted suicide for people with non-terminal illnesses. Aviv writes about Godelieva De Troyer, a Belgium woman with a severe psychiatric disorder who was euthanized by Wim Distelmans, an oncologist and professor of palliative medicine at the Free University of Brussels. He was one of the leading proponents of a 2002 law in Belgium that permits euthanasia for patients who have an incurable illness that causes them unbearable physical or mental suffering, including psychiatric disorders. In seeking to understand his mother’s death, her son exposes a darker side of this law which includes minimal and poorly funded outpatient care. He also finds out that prior to being approved for euthanasia, Godelieva was not required to undergo more invasive procedures such as electroconvulsive therapy even though it is effective in about half of patients with depression. I used to unequivocally support the right to euthanasia, but as I learn more about how it works in Belgium and the Netherlands and as I learn more about the nature of psychiatric disease, I realize what a complex issue this is with no simple black and white answers.

Patient Observation by Skip Hollandsworth (Texas Monthly)

I am happy to read anything that Skip Hollandsworth writes. In this article, he recalls his early fascination with North Texas State Hospital, an in-patient psychiatric facility located in Wichita Falls. He describes riding past the state hospital in his adolescence in the back of a pickup truck with his friends, looking for madmen. “For us, the state hospital, which nearly everyone referred to as LSU, or Lakeside University, because it was located across from Lake Wichita, was our real-life haunted house. The fact that two thousand adults were being treated for “insanity” out in those buildings, just past the city limits sign, simply tortured our imaginations.” Later he found himself returning to the hospital, volunteering in different departments and even playing his cello for patients. He writes that he was drawn “for reasons I couldn’t then explain” to what he described as this “community of odd souls who had never been able to make it on the outside.” His fascination with the state hospital is what ultimately led him to a career in journalism.

The Prozac, Paxil, Zoloft, Wellbutrin, Celexa, Effexor, Valium, Klonopin, Ativan, Restoril, Xanax, Adderall, Ritalin, Haldol, Risperdal, Seroquel, Ambien, Lunesta, Elavil, Trazodone War by Jennifer Senior (New York Magazine)

The contours of former Army medic and surgeon’s assistant David Booth’s life have been drastically redrawn. After suffering and eventually recovering from a severe injury (which included breaking his neck) during a combat mission, he was left with severe chronic pain, sleeplessness, and PTSD for which he now takes a glut of powerful psychiatric medications to quell. And he is not a unique case. It is reported that of 20,000 soldiers, up to a quarter have received some kind of mental health treatment in the last year.

Defense Department spending on Ambien, a popular sleep aid, and Seroquel, an antipsychotic, has doubled since 2007, according to the Army Times, while spending on Topamax, an anti-convulsant medication often used for migraines, quadrupled; amphetamine prescriptions have doubled, too, according to the Army’s own data. Meanwhile, a study by the Rand Corporation has found that 20 percent of the soldiers who’ve deployed in this war report symptoms of post-traumatic stress and major depression. The number climbs to almost 30 percent if the soldiers have been deployed more than twice.

While substance abuse and criminal activity are increasing among active-duty service members, even more ominously, the suicide rate for military members has surpassed that of the civilian population’s. And there is a direct correlation between military suicides and psychiatric drugs. Many soldiers are taking more than one kind of medication and are mixing several pills into daily cocktails.

Schizophrenia in America by Jonathan Cohn (Huffington Post)

Cohn’s deep dive into our lacking treatment of schizophrenia is worth your time. The article begins in 1974 with Glenn, a smart high school student with a knack for building robots, who began experiencing episodes of psychosis. He was diagnosed with schizophrenia and given the standard grim prognosis, being basically told by everyone that his life was over. Yet four decades later, there is a breakthrough treatment approach being used in places like Australia with the hopes that people with schizophrenia can actually lead normal lives.

In America, not much has changed from the way Glenn was treated in the mid-1970s to today. In the US, those who have schizophrenia are usually diagnosed only after they have reached an advanced state of the disease. The treatment du jour includes massive dosages of psychotropic medications combined with therapy. Not much else is done. This lack of progress in schizophrenia research is troubling considering the pressing impact it has on our society.

Not many people would include schizophrenia on a list of major diseases that burden American society, but that is what it is. Schizophrenia affects about 1 percent of the population, roughly three times the number of Americans who suffer from Parkinson’s. Because the disease typically appears in adolescence or early adulthood, it claims many more years of healthy life than conditions like leukemia and HIV. Its suffers also die earlier, about 12 years before the typical American. Economists say that schizophrenia costs the U.S. at least $60 billion a year, and probably a good deal more.

In contrast, Australian researchers have begun to focus on treating patients when they first develop symptoms and what they discovered was that there were less pronounced changes in prefrontal cortex and gray matter and greater sensitivity to medication which allowed for lower doses and less debilitating side effects. Researchers carefully developed detailed questionnaires and other intervention methods in order to target the early stages of the disease in patients. We may not be able to cure schizophrenia, but we can make life so much better for those who have it. So why don’t we?

Brain Attack by Erin Digitale (Stanford Magazine)

When he was only 7 years old, Paul Michael Nelson suddenly flew into a violent psychotic rage. His terrified parents rushed him to their local emergency room where the medical staff seemed incredulous and even suggested to the parents that Paul Michael must have had a bad temper tantrum. He was released, but the rages got worse. Over many months, Paul Michael cycled through psychiatric hospitals as his doctors struggled to find what was wrong with him. One team of physicians eventually came to a surprising conclusion: Paul Michael was suffering from an autoimmune disease that was making him crazy. “When the immune system gets derailed from its usual infection-fighting role and attacks the brain, it can trigger obsessive-compulsive actions, anorexia-like refusal to eat, severe anxiety, violent outbursts and other symptoms of mental illness, as well as a host of neurological problems.” Paul Michael was the first of more than 70 children who have been evaluated at a new clinic at Lucile Packard Children’s Hospital at Stanford for pediatric acute-onset neuropsychiatric syndrome (PANS), a disease that doctors are still working to define.