Archive for the 'US Psychology' Category

Sandy IDPs & some good mental health information for New York & New Jersey

If you have paid attention to any news from the Northeast U.S. in last couple weeks, you know that here in New York and across the river in New Jersey many people are hurting in the wake of the “superstorm” Sandy. According to the New York Times, there are an estimated 10,000-40,000 internally displaced persons (IDPs) in New York City alone. In response to the massive loss and devastation along the waterfront, there have been many heartwarming displays of care by neighbors, friends, and even complete strangers. And in contrast to the response to Hurricane Katrina in New Orleans, local government and even the Feds seem to have their act together in providing supplies and now housing to those displaced.

IDP issues may, however, become a long-term issue. The sudden loss of material goods and social connections that people have based on where and how they live can have long-term consequences for social capital, employment opportunities, and even just knowing how to complete everyday tasks (e.g., where to get healthy food for your kids). The outpouring of support needs to be transformed into long-term engagement with IDPs, along the lines of the better psychosocial programs undertaken in more severe IDP crises (e.g., in Medellín, Colombia).

In the meantime, there has been a little attention to mental health. The best I have seen so far has been a post by “The 2×2 Project,” a blog written by Dr. Lloyd Sederer out of Columbia University’s Mailman School of Public Health. (A thank you to my wife, who forwarded me the link.) Here’s the intro, which sums up and corrects the myths that are often hears in immediate post-disaster environments:

In the aftermath of Hurricane Sandy, opinions—some reliable, some misleading— about the storm’s potential mental health impact have proliferated. When media channels act responsibly they engage experienced experts as spokespeople; when that does not happen, wrong information adds to the public’s anxiety and can foster inappropriate clinical interventions and waste resources.

In the latter category, perhaps the greatest myths I have heard are:

Post-traumatic stress disorder (PTSD) can appear in the immediate wake of a disaster.

Watching television can cause PTSD.

The highly common psychic distress in the wake of a disaster is a mental illness.

Here are some facts:

Psychic distress after a disaster, which can be highly prevalent and last up to a month, generally is a normal reaction to an abnormal situation.

Read the rest of the post (and check out other informative posts) here.

“Canine PTSD” or “Army dogs suffer from Pavlovian conditioning”

McGill University’s Summer Program in Social and Cultural Psychiatry presents wonderful opportunities to share ideas with those who think a lot about culture and mental health, culture in mental health, and, perhaps most interesting, the culture of mental health. Allan Young, whose historical ethnography of posttraumatic stress disorder, The Harmony of Illusions, is a must-read for anyone interested in trauma studies, passed along the following example of PTSD’s exaggerated role in current US culture, from the Army Times:

Dogs bring home war’s stress, too

By Michelle Tan – Staff writer
Posted : Thursday Dec 30, 2010 9:41:04 EST

SAN ANTONIO — Dogs suffer from post-traumatic stress, too.

Years of war and frequent deployments have affected military working dogs just as they have humans, and Dr. Walter Burghardt is trying to do something about it.

Dr. Burghardt explains:

“The dogs that go overseas … we’re starting to see some distress-related issues,” he said. “It results in difficulty doing work. They’re distracted by loud noises. We’re not saying it’s the same as in people, but there are common things.”

That includes hypervigilance or showing interest in escaping or avoiding places in which they used to be comfortable. For example, a dog that used to work at a security checkpoint or gate may try to pull away on his leash when he sees he’s being led to that checkpoint or gate, Burghardt said.

Some of the dogs also become very clingy or more irritable or aggressive, the doctor said.

“Canine PTSD” is either the most extreme example of what Richard McNally calls PTSD’s “bracket creep” or some perhaps nonintentional Pavloivan insight into the nature of stress response. Or perhaps both. If we take the “symptoms” reported in the article as accurate, and I have no reason to doubt the staff writers at the Army Times, then yes, dogs get stressed and want to avoid the sources of their stressors — classical conditioning, a la Ivan Pavlov (1849-1936; Pavlov even demonstrated conditioning using dogs, until they drowned in their cages when the River Neva flooded the basement of his laboratory). But canine posttraumatic stress disorder?

In case you were concerned that the Army veterinarians were not being careful about differential diagnosis, or perhaps even that some dogs might be faking in order to cash in on the generous disability benefits for veterans with PTSD:

[Dr. Burghardt] cautioned, “canine [post-traumatic stress disorder] is only diagnosed if the dog has combat exposure or repeated, prolonged deployments.”

The article continues with a description of the treatment given the dogs to get them right back “in the service”… which is, of course, the goal of treating human PTSD in the military as well.

Response style, and the differences between Swedish and Irish Americans

Whenever I teach response style — the tendency people have to express themselves using a consistent and limited range of expressive behavior — I talk about my grandmother. Lavern Rasmussen was a small-town Minnesotan with deep roots in Swedish and Danish communities. When my family would call her to check in, she would let us know that things were great by saying things were “not bad” and that things were not going so well by saying, “Oh, well, you know…” In teaching my students in New York, I ask them to translate Grandma’s responses into those of a randomly selected individual from the 8 million in our fair city, and when they do this (usually both positive and negative responses involve language unsuitable for printing in these pages), it becomes obvious that there are cultural differences within the U.S. as to how people respond to questions.

Why do psychologists care about this? Many of us use responses to questionnaires as our representation of people’s emotions, and if a certain group of people are responding on the low end of the scale and another group on the high end and we want to compare them, we need to know the characteristics of each group’s response style in order to tell if they are in fact having different reactions or not. And now I have a study to help me explain Grandma’s response style.

First, credit where credit is due: it was Andrew Ryder of Concordia University that passed this study along, in a class on statistical models in emotion research. The class is part of McGill University’s Summer Program in Social and Cultural Psychiatry, which I am attending through the month of May. (In my humble opinion McGill has the best collection of thinkers on how culture shapes emotions, cognitions, and perhaps most importantly the practice of mental health.) Professor Ryder was discussing his own work on differences in behavior between depressed European-origin Canadians and depressed Chinese, and noted that each group had particular norms for emotional expression of happiness — for example, when to smile, what to smile at, even how to smile. Note here that emotion researchers make a distinction between emotions — the actual feelings — and emotion behaviors — the things you do to show the feelings.

When emotion researchers talk about happiness behavior, they almost always mention that U.S. Americans are really into expressing their happiness, as did Prof. Ryder. But, he added, there is significant variability in the expression of happiness in U.S. that is connected to cultural identity, even cultural identity four- or five-generations removed. And this brings us to Scandanavian Americans — those U.S. residents with ancestors from Sweden, Denmark, Norway and Finland. It turns out that they are different.

In Variation among European Americans in emotional facial expression, Jeanne Tsai and Yulia Chenstova-Dutton compared facial expressions among “Scandinavian Americans” and “Irish Americans” after inducing six emotions (happiness, pride, love, anger, disgust, and sadness) through a somewhat convoluted (if ethical) “relived emotion task.” And what did they find? What any Swedish grandmother will tell you: the Irish are more emotional. Or, to look at the other side, as Prof. Ryder did, “You have to control for Scandinavian Americans’ ‘Scandinavianness’ to get them to look like the rest of Americans.”

I don’t want to get too emotional here, but I kind of think my Scandinavianness is not too bad — although I don’t want to make a big deal about it.

Brain-mind or heart-mind; TMS or MST; DSM-5 or DSM-V? The American Psychiatric Association in New Orleans

This weekend and the first part of this week the American Psychiatric Association held its annual meeting in New Orleans, LA. In addition to staying out of the way of drifting gulf oil and seeing a lot of great music, I sat in on a few sessions in the monstrous Morial Convention Center to hear the latest from my psychiatric cousins. Psychiatrists in general fascinate me. On the one hand they rely heavily on the biomedical model to explain psychological phenomena (they are, after all, doctors), on the other they talk even more impressionistically than my psychologist compatriots (one of the presentations this year is on Chopin). As doctors, they know so much stuff (doctors have to memorize an amazing number of facts about the body), yet as researchers they can hardly handle more than two-by-two tables in their analyses (to be honest, most psychologists don’t do a whole lot better — they just don’t get published). I get asked all the time whether I’m a psychologist or a psychiatrist, and then, regardless of the answer, if I can prescribe; for those of you wondering: psychologist, and no.

On Saturday, I attended a session run by Devon Hinton (of Mass General) on cultural assessment of non-Western patients. In addition to Devon, his brother Ladson, Roberto Lewis-Fernandez, and myself, Brandon Kohrt of Emory University presented a paper on culture and symptoms. Brandon’s done a lot of work with child soldiers in Nepal, and presented on “child-led indicators” of distress among this population. Lots of good things in there, but my favorite was a distinction made among Nepalis between problems of the “brain-mind” and problems of the “heart-mind.” Your heart-mind is where your emotions are, your brain-mind where your thinking and cognition happen. Heart-mind problems are normal, brain-mind problems stigmatized. Although heart-mind problems can lead to brain-mind problems, they usually can be addressed successfully with appropriate social support. Critically, Brandon reported that Western psychosocial NGOs working with Nepalis affected by the civil war (which ended in 2006) had translated posttraumatic stress disorder into a term associated with brain-mind problems, and thus found it very hard to get people to participate in their interventions. It was only when they started using a heart-mind term that they got more people to participate.

TMS stands for transcranial magnetic stimulation. MST stands for magnetic seizure therapy. I’ll admit here that I am way out of my league here, but I’ll give you the synopsis. Both are new treatments for depression, and both involve magnets applied to your skull (falling under the somewhat euphemistic category of “brain stimulation”). In TMS you are awake, in MST you are under anesthesia. Okay, why do you want to do either of these things? Well, the treatment with the strongest therapeutic effects on people who have suffered multiple bouts of severe depression is well known to be electroconvulsive therapy, ECT. Yes, that means administering electric shocks to people’s brains. The problem with ECT is that associated with shocking people’s brains is some retrograde amnesia. So, electrotherapists have searched for more focal treatments at lower doses, and have found some success by putting strong magnets on the surface of people’s heads. I’m being a bit glib here, but really, this is pretty exciting stuff — particularly for those suffering from depression that is resistant to medication. For more on TMS, see the work of William McDonald; for MST, see Sarah Lisanby (she’s also done TMS work as well).

The development of DSM-5 was a big topic at APA 2010. The publication of the DSM-5 in May of 2013 (at APA San Francisco) is already a much-heralded event, and those on the various subcommittees have been doing due diligence throughout the various mental health conference circuits. I heard a lot about DSM-5 at APA 2010, but perhaps the most interesting proposed conceptual change I heard was the decoupling of disability from the notion of mental disorder. Since DSM-III (1980), criteria for diagnosing most disorders has included a functional criterion; i.e., you can’t just have some symptoms, the symptoms have to keep you from doing the things you want or need to do. So, someone with depression who is really sad but gets everything done cannot really have clinical depression. Decoupling symptom criteria from functional disability would put DSM-5 in line with the World Health Organization’s ICD-10/ICF system (ICD-10 is the WHO’s classification disorders manual; ICF is their functional disability manual). It would also clearly expand the number of people with disorders, as the functional criterion limits the application of a given disorder. Over-diagnosis will likely result. However, leaving things as they are means that the functional criteria limits prevention efforts: if you have to wait to diagnose a disorder before it becomes disabling, how can you administer (or more to the point, how can you pay for the administration of) prevention efforts? Stay tuned… or just check out the DSM-5 website. (By the way, it’s settled: DSM-5, not DSM-V.)


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