Homelessness and reinstitutionalization

The Observer has an "interesting" story on homelessness and housing — "interesting" that it minimizes to a fair degree GOVERNOR Ronald Reagan starting the deinstitutionalization of the seriously mentally ill and minimizes the degree to which reinstitutionalization might help. Much of the story is good, above all for rightly lambasting Monty Bennett, but that part is not. 

My rule of thumb has long been that approximately one-third of homeless are that way for problems outside their control, whether simply having too low of income (the Observer doesn't mention roommates, nor in today's world, a screening system for pairing people up with such) or things such as medical bankruptcy, one-third are due primarily to addiction, and one-third primarily due to mental illness. The second and third, of course, have some overlap.

This is not to deny that the world of "One Flew Over the Cuckoo's Nest" didn't have problems. It certainly did. But, both in, theoretically, the operation of inpatient long-term mental health care housing today, and the variety of medications available today vs 50-60 years ago, we're generally not in that world.

Also, interestingly, the Observer didn't even talk about "housing first" outside the US. For me, when I started the story, Vancouver, British Columbia came immediately to mind.

But, back to the main problem. Mentally ill on the streets will NOT be medication-compliant. And shelters aren't well-trained in this. Period. And, of course, "housing first," if it means non-shelter housing, means mentally ill remaining medication-noncompliant. 

Looking behind Luigi Mangione and armchair psychology

I don't know who this Bev Potter is, but, this piece by her claiming Mangione in the header that Mangione "Didn't Have 'Political Motivations,'" for whatever reason "Political Motivations" is in square quotes, is wrong unless read in the most narrow sense. In other words, Mangione didn't kill Brian Thompson because he heard Thompson had joined Trump's Cabinet.

In the broader sense? Oh, he did.  I've read his "manifesto" at Klippenstein, and he states his motivation, and to the degree neither political party has addressed this issue, it's political motivations. Not conspiracy-theory political motivations, but in a broad sense, political motivations.

Beyond that, it's grossly wrong for its author to say they're sure Mangione is a paranoid schizophrenic.

I’m not a doctor, but Luigi Mangione is clearly paranoid schizophrenic.

You admit you're not a doctor. You don't admit you've never seen him in person.

This is almost as irresponsible as the conspiracy theory chuds she calls out.

It is POSSIBLE, per the Baltimore Sun editorial you cited?

A gradual personality change, signs of delusional, disordered thinking, a recent withdrawal from family and friends, all raise the possibility that the man caught Monday morning at a McDonald’s in Altoona, Pennsylvania, was not entirely of sound mind. Mental health professionals tell us these are the common symptoms of schizophrenia and the mid-20s are the peak years for onset and diagnosis.

Yes. No more than that. Especially since Bev Potter cut off the last one third of that paragraph, which says:

Did Luigi Mangione suffer from it? That’s highly speculative but that possibility haunts the case — and at least offers some rational explanation of so much irrational behavior.

So, POSSIBLE. Not sure.

AND? IF he has a diagnosable mental illness, maybe it's not schizophrenia, whether of paranoid or non-paranoid type. As for him "dropping out," including from his family? Others have done similar. The just-reunited (we think?) Hannah Kobayashi is an immediate example. It's no proof of mental illness, and if it is seen as a hint of possible mental illness, that doesn't necessarily mean schizophrenia. In fact, the snarling anger at his first post-arrest hearing would contra-indicate schizophrenia. Flattened effect is one of the more common symptoms of schizophrenia.

The fact that he read and favorably reviewed Ted Kaczynski's manifesto also does not make him a paranoid schizophrenic.

Back to that manifesto. As many people have noted, it's nothing like Ted Kaczynski's. There's no conspiracy thinking there, for one thing.

And, it WAS wrong.

We in Merikkka aren't 42nd in life expectancy. We're 55th, behind fucking Albania.

Meanwhile, Nancy Pelosi got a hip replacement after her fall in Luxembourg. And, she got a medevac from there to Landstuhl Regional Medical Center in Germany for the procedure. Shit, United Healthcare wouldn't even give the average Joe a hip replacement rather than some sort of fusion surgery, and sure as hell wouldn't medevac you to the surgery. And, especially since Pelosi has no official Congressional leadership position, even if not technically, it smacks like an abuse of resources. No wonder people hate Congress about as much as health insurance companies.

Deconstructing Sarah Fay

Cliches become well-used before they get known as clichéd for good reason: They express near-universal truths, to venture into the land of clichés. And, the best of them never become hackneyed.

With that? 

"Trying to have one's cake and eat it too" is the best I can think of on Sarah Fay's attacks on the DSM, the Diagnostic and Statistical Manual of Mental Disorders, the "bible" of counseling psychology and psychiatry, in her books "Pathologized" and "Cured." Hers is not by any means the first such attack; indeed, as noted on my Goodreads review of "Pathologized," which expanded to cover both books when I noted, via her website, that "Cured" is being published for free reading (in part?) in Victorian-type serialization on Substack installments, (See near the end for specific takes on specific chapters.) I long ago wrote a long, detailed blog post about Asperger's being "schizold disorder of childhood" until DSM-IV.

Pathological: The True Story of Six Misdiagnoses by Sarah Fay
My rating: 2 of 5 stars

This is kind of a hard book to rate. Or, it was, until I hit Fay's website and became more agog at what I read.

I will spell out in more detail, wrapping up with heading back to selected portions of the review, how it earned that 2-star rating, including warnings to readers of this book or her in-progress sequel, "Cured."

Hers is also not the only attack on the pharmaceutical industry in general and its psychotropic wing in particular.

That said, despite some Overton window shifting in her referencing a "recovery model" of mental illness, she seems to not only accept the need for such medications for herself, but to accept such need willingly, not grudgingly.

Just one problem. Such medications are prescribed based on a mental illness diagnosis. Such diagnoses are based on mental illnesses mentioned in the DSM, however imperfect it may be. To want such medications without accepting an accompanying diagnosis? More specifically, to want a doctor to prescribe without offering an accompanying diagnosis? That is essentially asking a doctor to commit medical malpractice.

If this is not the impression you intended? You've got a Ph.D. in English, creative writing or similar. I suggest you contact yourself or your editor if that's not the impression you planned. But, you can't have your cake and eat it.

Fay's story has other issues, some about her story, and some about her understanding of psychological counseling. The calls of her, and other people, for patient centered counseling?

Has she, and have they, never heard of Carl Rogers and his client-centered approach? It's like she (and others whose shoulders she stands on) are reinventing the fucking wheel. "Pathologized" never mentions his name, nor do the parts of "Cured" already available for reading. I would have checked the anti-DSM website of hers listed on the dust cover, but? It's expired. (Also interesting.) She loses claims to credibility right there. It's not entirely her fault; the therapy world today seems to be "meds here, cognitive behavioral therapy there." Other counseling modalities (she does mention dialectical behavioral therapy once) get ignored. Group therapy, gestalt, etc? Not mentioned. The broader humanistic psychology (which does not generally include gestalt) also ignored. Not all elements of humanistic psychology work well with more serious mental illness, even when medications come first. Nonetheless, for neurotic-level depression, alone or with hypomania, neurotic-level anxiety and other issues? It can be very good. 

As for patient involvement in general? Did you really not get involved in dialogue about your medications for 20 years or whatever? That may be something symptomatic of women's treatment in mental health. If it is, you really didn't discuss it, even as a couple of Goodreads reviewers noted this, race, etc., have long been "problematic." On the other hand, you mention at least one female psych and other female counselors. If not asking questions for 20 years reflects other obsequiousness to authority? That's not a mental health problem but it may be a personal development one.

Otherwise, what the new "recovery model" focuses on in one way is also just like the old humanistic psychology, and can be summed up in one word, a word I nowhere see in Fay's writing: "acceptance." It's that simple.

Then, there was her reply to me on Substack. She said "Cured" "isn't an advice book, it's a memoir." The two aren't mutually exclusive. "Pathologized" is a memoir, but it has an epilogue, which most memoirs do not, and that epilogue is very much an advice book.

I also found interesting that the circle wasn't closed in "Pathologized." Fay, if not full-on anorexic, had some sort of eating disorder as an adolescent, during the run-up and through her parents' divorce. Relations as an adult seem somewhat strained with her mom at times and more so with her dad before in the end of the book, she seems to indicate all is hunky-dory with both. But, she never talks, even in generalities, about how that happened, given that the relationship was clearly "distanced" per later parts of the book. And, at the same time, after her parents split, during high school, she bounced back and forth between them. Color me skeptical. She also talks about the "murky pit" already in the first chapter. That may not quite be Churchill's "black dog," but it sure sounds similar. So, two of the six misdiagnoses she alleges don't seem to be misdiagnoses.

That's even more true when one reads her essay "On Suicidal Ideation". "Interestingly" (that's scare quotes, Sarah) much of its material did NOT make it into "Pathologized." That includes not only details of the frequency of her ideation, but that she had a less hateful take on the DSM. And, that's not ancient history. It's 2019, and "Pathologized" went to press in 2022 and was surely in writing a full year or more before that.

And, while not a counselor myself, she strikes me as a "highly sensitive person," not just in the sense of the book of that name, but more. She seems to have a highly developed sense of interoception, which in turn then would influence her high emotional sensitivity. None of that is either good or bad; it simply is. That said, it should be noted that interoception that is off the norm is associated with many mental illnesses.

And, with that, on to extracts from my Goodreads review.

Near the end of the book, Fay does slightly nuance her diatribe against the DSM, and against mental health diagnoses.

I give you the last two sentences of the Epilogue:

Before you accept a DSM diagnosis, pause. That doesn't mean you don't seek treatment or take medication or ultimately decide that having a diagnosis, no matter how tenuous (at least for now), serves you, but you do so knowing the truth.

Sadly, especially given my further digging around, it's too bad those words weren't in the first two sentences of the Prologue or Introduction.

That said, she's more close to right on the DSM, and the DSM's evolution, than many 3-star reviewers give her credit for. On the other hand, that has to be seen in light of her suicidal ideation essay, which frankly raises questions of "why the shift."

Beyond the DSM, although she doesn't go into it a lot, she's right as rain, including her own experience, of too many doctors still peddling too many benzos for anxiety. Or antipsychotics. Anti-depressants are another option (especially if used in low doses with talk therapy).

She doesn't square the circle with her opening chapter. Whether she had full-blown anorexia or not, she had some sort of eating disorder that appears to have been in part a reaction to her parents' divorce. And, while she says she's got a good relationship with her dad at the end of the book, she never talks, even in generalities, about how that happened, given that the relationship was clearly "distanced" per later parts of the book. And, at the same time, after her parents split, during high school, she bounced back and forth between them. She also refers to the "murky pit" in the opening chapter, which sounds like depression to me. And, wanting to stay on an SSRI, plus the suicidal ideation, would certainly point to that.

So, that would mean that a minimum of two of her six diagnoses weren't wrong. They may have been partial, or incomplete, but they weren't wrong. That's even more true when one reads her essay "On Suicidal Ideation." "Interestingly" (that's scare quotes, Sarah) much of its material did NOT make it into "Pathologized," though the essay is referenced.

Now, more of a review of "Cured."

And, guess what, Sarah? Your diatribe against group therapy lost you another star, and gets a "recommend against further reading" as part of this review. (In a reply to me, she claimed she wasn't "dissing" group therapy; I differ, without begging.) In the words of scientific skepticism, you've now clearly ventured into "n=1" territory. And, you could be contributing to someone else's mental harm, not cure. Also, her chapter on recovery models of therapy comes off as glib:

Psychiatric “symptoms” like depression and lack of interest and anxiety and ruminations are part of the human condition—even psychosis. (I used to think psychosis was different but as someone I know who hears voices explained, “Ever had a song stuck in your head? That’s not the same, but it gives you an idea.”)

The chapter after the one dissing group therapy has two issues. First, "Staying on the Course" is largely a recycle plus some expansion from this book. And, she talks about Patricia Deegan being "healed" from schizophrenia. Deegan talks about "recovered," but I'm not sure she would use the word "healed." She uses the word "heal" for herself in Chapter 9, and it again seems clear that this is NOT "cure" as in the Latin root meaning "care," as she says in this book, but ... "cure."

And, Fay undercuts herself on this:

As she healed from schizophrenia, Deegan developed her own personal medicine: “Medications were just one tool in an entire set of recovery tools I slowly pulled together for myself. I built my recovery toolkit over time, intuitively, and without even having heard the word ‘recovery.’”

Time after time, it's shape-shifting from her on the issue of medications. Or? Whether better or worse, the political phrase: Overton window shifting. She'll imply or insinuate that recovery models of mental illness somehow move beyond medications .... until there they are! And, why are they there? Because of a diagnosis.

What does Fay want from her movement, anyway? If it's to be "more than a label," I think she's tilting at windmills. I don't think the majority of mental health patients, and certainly not the majority of less severe ones, identify themselves as a label. And, if she really accepted much of her psychs' advice passively for years? See above, about humanistic and client-centered therapy. I am halfway dumbfounded at this.

As for labels, and "healing"? In both schizophrenia, and in chronic depression, and in both sides of bipolar, etc., symptoms can flare up and die down. That doesn't mean the underlying condition has gone away. Happens in some physical ailments, too, like multiple sclerosis, and nobody but a sicko or a self-delusional person would talk about being "healed" from MS.

If a mix of relabeling and refocusing helps Sarah Fay, more power to her. But, this isn't magic. Nor, as I risk moving from skepticism to cynicism, is this about being a "brand." Stopping short of cynicism, there's intellectual dishonesty toward the public, and maybe toward herself, in not describing the "shift" between her state of mind at the time of the suicidal ideation essay and the start of writing "Pathologized" two years later. 

My guess on that, again at the risk of moving beyond skepticism to cynicism, or at least as being perceived as doing such? I think that some time in that two-year gap she became converted to the "recovery model" of mental illness and mental health and then became an evangelist. And, I use "converted" and "evangelist" quite deliberately. (Sidebar: I don't like the descriptor "recovery model" as it sounds too much like addiction and sobriety, where recovery generally means something quite different. It may be riffing on AA's "daily reprieve" statement, but still, beyond that, there's not a lot of parallels in the details. Sidebar 2: I could have riffed further on conversion into conversion disorder ...)

And, given that both her books are advice books as well as memoirs, and knowing there are better, more scientifically grounded, yet still personally focused, critiques of the DSM, I write this in fear that she could, with some of what she says, be a danger to others as well as being some degree of hypocrite, as I see it. On the danger part? I, along with a couple of reviewers who specifically mentioned this, wonder if some readers didn't get halfway through "Pathologized" and think they could just toss their pills. Or, per "Cured," pills or no, people thinking that schizophrenia can be cured.

==

Side note: The punctuation part of the book, trying to riff that into the different diagnoses, seemed forced. That said, it perhaps emphasizes that the rest of the book is split, per the "splitting" that Fay talks about in herself but never describes in detail (lest she get a dissociative identity disorder diagnosis?) between memoir that could have been better yet if more fleshed out, and the lurking anti-DSM screed.

View all my reviews

Needed: Texas lawsuit for the mentally ill

As the state plans to cut its mental health services budget, we're getting more and more mentally ill "warehoused" in city and county jails. Harris County Jail is now the state's largest mental health institution.

“We’ve done everything we can do to make it therapeutic,” said Sgt. Bernard Kelly, a supervisor in the jail’s mental health unit. Some inmates say it’s the best mental health care available to them in Houston. It all costs the county about $27 million a year.

Harris County officials have seen the number of mentally ill inmates explode since 2003, the last time Texas had a budget crisis and made major cuts. Then, there were fewer than three full-time psychiatrists on duty at the jail. Now, there are more than 15. Often they see the same mentally ill inmates repeatedly.

It will probably only get worse.

Sheriffs know that, but, especially in smaller counties, they don't have the resources to do much about it. I wrote about this three-and-a-half years ago, when the state was already 50th in per-capital mental health spending, and yes, it's only gotten worse since then.

Of course, we could have something even worse - Tricky Ricky Perry could beat the drums for faith-based mental health services. And, I'm not being 100 percent facetious about the possibility of that happening.

Various initial thoughts on Jared Loughner

First, Ross Douthat is right. Actual and attempted political assassins come from all angles of political opinion — or occasionally from none. (He cites George Wallace's would-be assassin, Arthur Bremer.)

That said, while he doesn't claim both sides are alike, by not discussing tea partier/Palinista language of the last year or so, he does allow one to infer he's making an equivalence argument.

Paul Krugman DOES get that right, including quoting Pima County, Ariz. Sheriff Clarence Dupnik, who said:

(I)t’s “the vitriolic rhetoric that we hear day in and day out from people in the radio business and some people in the TV business.” The vast majority of those who listen to that toxic rhetoric stop short of actual violence, but some, inevitably, cross that line.

And, since Douthat pulls out Oswald as counterintuitive to shoot JFK in wingnut Dallas circa 1963, let's go to Krugman again, to refute the "equivalence":

And there’s a huge contrast in the media. Listen to Rachel Maddow or Keith Olbermann, and you’ll hear a lot of caustic remarks and mockery aimed at Republicans. But you won’t hear jokes about shooting government officials or beheading a journalist at The Washington Post. Listen to Glenn Beck or Bill O’Reilly, and you will.

Speaking of Oswald et al — Gail Collins is right that gun control is an issue — Lee Harvey Oswald had had Loughner's 30-shot clip Glock, probably Speaker of the House John McCormack would have been succeeding JFK and Texas would be needing a new governor. Collins, though, doesn't delve into the "irony" of Rep. Giffords being anti-gun control, and that as a natural stance, apparently, not a political tactic.

Whehter Loughner had a political angle or not, many people wonder if he is mentally ill, in a clinical sense. Josh Rosenau points out in detail of how this "mentally ill = violent" is a horrible, horribly wrong, stereotype.

So, what will happen?

Palin won't draw in her horns. In fact, she'll bristle at the suggestion of doing so.

Gun control? Obama has no taste for it, we have a GOP House, and a gun-friendly Supreme Court. The only way to possibly get anything done is to tell Arizonans guns just like the one Loughner bought are also being bought in Arizona by Mexican drug gangs.

Mental health? Mentally ill, at least those of psychotic levels, will still be stigmatized and stereotyped.

Update, Jan. 11: The mental illness angle gets more, much more background.

Loughner was apparently enraptured with lucid, or "conscious" dreaming. (Sad irony, that Mr. Grammar Police called it "conscience dreaming" on his YouTube videos.

It even appears he had some dabbling in occult-type issues.

At the same time, showing how irrational movements can influence even those further beyond the rationality pale, Loughner may have had some connection with, and being influenced by, American Renaissance, a white supremacist group. At the same time, the Mother Jones story linked above about lucid dreaming references a Loughner acquaintance as saying his mother is Jewish.

Also per the Fox story linked immediately above, the rest of Loughner's family didn't totally impress the neighbors, either. The story doesn't say much about the family beyond "loners" with a cluttered yard, but, if they had political beliefs outside the mainstream, that will come out, too. I find it interesting that the family has commented very little on their sun, even before retaining any counsel that they may have.

Still no further word on a possible accomplice; if there is one, I would be VERY quiet, were I the head of American Renaissance.

And, The Daily Beast also notes that, even if Loughner is clinically mentally ill, the influences on that troubled mind seem to come pretty much from the far right. And, it's not just the Sarah Palins, it's the wingnuts posting comments on stories like this that reflect the problem.

Mental illness is in your 30,000 genes

In an understatement of the month story, researchers say genetic tests for mental illness propensity are far, far away.

Technically, it’s 30,000 gene variations, not 30,000 separate genes, for schizophrenia, but, headlines for blogs or Twitter can’t be too long.

Of course, this is another example, also, of how the highly-touted idea of genetically personalized medicine is just as much just around the corner as are peaceful nuclear fusion power and fuel-cell cars in mass production.

Anxiety and panic relief without the addiction

German researchers believe they have discovered an anxiolytic drug without addictive qualities of benzodiazepines such as Valium.

Now, anti-depressants can help a chronic tendency toward anxiety, but, for a person with new, and acute, anxiety symptoms, their four-six week latency period rules them out. XBD173, though worked within one hour of administration, in tests.

Single gene-depression link refuted

The original 2003 study claiming a single gene had a lot of responsibility for depression has been iffy for some time, now, but further research says it definitely doesn’t hold up to scrutiny.

On the “popular front” level, what does this mean?

Well, several popular Americanisms (some of them not just pop-level but held by a certain segment of scientists) get the kibosh.

1. A hypermechanistic, technological view of medicine, with quick fixes either here today or just around the corner.
2. Something that’s already been on the ropes over other issues, the one-gene, one-behavior theory, gets another good, swift kick. (That’s at the scientific as well as pop level.)
3. A simplistic view of life in general held by most Americans hand in hand with American exceptionalism. There are no easy solutions to most mental health issues, and, perhaps that’s why, in the U.S., depression is on the rise.

Schizophrenia – too much focus on self

A startling new explanation of schizophrenia is the finding of a new research study in the Proceedings of the National Academy of Sciences.

The nickel overview?

Areas of the brain devoted to self-attention and self-reflection are overactive in schizophrenics. Researchers say this could explain hallucinations and other symptoms, in that “normal” exterior stimuli aren’t perceived as external, due to the amount of self-focus.

(No, there’s nothing to indicate such undue self-focus is primarily an environmental effect, so Freudians can remain seated. In fact, the research study has good evidence for the heritability of this brain activity.)

Read the whole story; it sounds like a new line of research has just opened up.

Are your mom and dad fighting inside your brain?

No, I’m not talking Freudian psychology. Nor gestalt, nor modern humanistic or self-actualization theories.

I’m talking about the latest theory on the heritability of mental illness.

Bernard Crespi and Christopher Badcock claim this:

An evolutionary tug of war between genes from the father’s sperm and the mother’s egg can, in effect, tip brain development in one of two ways. A strong bias toward the father pushes a developing brain along the autistic spectrum, toward a fascination with objects, patterns, mechanical systems, at the expense of social development. A bias toward the mother moves the growing brain along what the researchers call the psychotic spectrum, toward hypersensitivity to mood, their own and others’. This, according to the theory, increases a child’s risk of developing schizophrenia later on, as well as mood problems like bipolar disorder and depression.

My first thought? It may not be Freudianism, but it carries as much sexual stereotyping baggage as Freud did.

That said, the story notes that their work leans heavily on David Haig. A decade ago, he argued that pregnancy was in part a biological struggle for resources between the mother and unborn child, with natural selection favoring mothers who could limit the nutritional “vampirism” of fetusus and fathers whose offspring were greedy as they could be in the womb.

So, Crespi and Babcock aren’t totally barking up the wrong tree.

But, beyond their sexist-sounding take on mental illness, they seem to have a black-and-white view of genetic and epigenetic effects, too, which leads them into their one-axis view of all mental health conditions.

So, right now, if mom and dad are fighting inside you, they are more likely to be fighting inside your mind rather than in genetic or epigenetic coding in your brain.

‘Cuddle chemical’ can make you TOO trusting

Oxycontin, the so-called “cuddle chemical,” or lack thereof, may be a key to phobias, autism and other neural disorders. A study showed that people clearly betrayed by another person would continue to trust that person after a whiff of an oxycontin-containing nasal spray.

Get pregnant and get the flu – then cause schizophrenia?

It sounds far-fetched, especially when the mainstream media too often talks oversimplistically of “chemical imbalances” with depression and leaves hanging the idea that genes cause something similar to create schizophrenia.

Nonetheless, more and more evidence is coming out that a pregnant mother-to-be catching the flu can indeed increase that child’s chances of schizophrenia.

And, revising an idea that went out the door after the discovery of DNA and its double helix, scientists are investigating whether other mental conditions don’t have infectious roots as well:

• Mental illnesses once thought to be the result of neurological or psychological defects may be caused by viral or microbial infections.

• The strongest evidence links schizophrenia to prenatal influenza infection; pregnant women who become ill with the flu are more likely to give birth to children who will develop schizophrenia.

• The body’s immune reaction, rather than the infections themselves, may be to blame for the resulting brain damage and psychiatric symptoms.

• Understanding the relation between infections and psychiatric disorders may someday allow us to prevent mental illness using drugs or vaccines.

The story notes the connection is most compelling with schizophrenia, noting a 5-8 percent greater rate among children born in winter or spring. First trimester exposure to influenza caused the greatest increase in risk.

Studies of lab animals shows that infected mothers tend to have children with higher fear and anxiety levels, among other problems.

In some cases, it may not be the infection itself, but the response of the mother’s immune system that does something to the placental barrier.

Depression not just a ‘modern Western phenonomen’

A number of anecdotal comments, usually by non-psychologist types, have claimed that depression, anxiety, etc. are in large part an artifact of modern Western life. Some say they really exist, and their spike is caused by stresses of modern Western living. Others, along the lines of Wendy Kaminer, say the U.S. in particular is in large part nothing but a nation of psycho-malingering mental hypochondriacs.

Well, based on evidence from India, Kaminer and her ilk need to eat their words.

Last year, two new workers arrived (at a medical clinic in Siolim, India). Their sole task was to identify and treat patients suffering depression and anxiety. The workers found themselves busy. Almost every day, several new patients appeared. Depressed and anxious people now make up “a sizable crowd” at the clinic, said the doctor in charge, Anil Umraskar.

Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year.

A doctor at another clinic estimates one in three patients there may have depression or other problems. So, it’s not an issue of overdiagnosis here but underdiagnosis in developing nations.

Why? Simple.

Attention goes to physical health first, of necessity.

I'm getting published, and on a pretty important issue

Pardon me for tooting my own horn a bit, but ...

This February, I wrote an op-ed column in my newspaper about how the mentally ill often get "warehoused" in the Texas prison system. It caught the eye, online, of Chris Salazar, publisher of DOCTalk, a nationally-distributed, Texas-based physician advocacy bimonthly magazine. (The current issue's cover story is an in-depth interview with Michael DeBakey; inside stories include an interview with the director of Houston's M.D. Anderson cancer center; you can learn more about the mag here.)

So, he's running the column in his next issue, as part of a series on mental health issues. On this particular issue, the "advocacy" part includes getting parity on mental health insurance coverage and many other issues, which of either state or federal legislative action in many cases.

This is tragic, that vets aren’t getting better mental health insurance

The biggest problem, other than Tricare’s stinted coverage and lack of therapists in its coverage, is that Guard and Reserve troops called to active duty aren’t getting active-duty level mental health insurance coverage.

Soldiers returning from war are finding it more difficult to get mental health treatment because military insurance is cutting payments to therapists, on top of already low reimbursement rates and a tangle of red tape.

Wait lists now extend for months to see a military doctor and it can takes weeks to find a private therapist willing to take on members of the military. The challenge appears great in rural areas, where many National Guard and Reserve troops and their families live.

Tricare itself needs to be improved, and Guard and Reserve on active duty should get 100 percent payment of premiums while called up.

How Mental Health Mental Retardation and the Texas Department of Criminal Justice have failed, and crushed a man: the local story

My news story and column on a local mentally ill person's horrors in the criminal justice and mental health systems.

News story: The nightmare: Mental illness George's ultimate jailer; county staff, funds 'jailed' too

For many years, Aaron George has all too often been trapped by prisons of his own mind.

Unfortunately, when George is mentally incarcerated due to the effects of schizophrenia and bipolar disorder, plus post-traumatic stress disorder and anxiety disorder - and, for the last year, a brain cyst - he often winds up also being physically confined in a jail cell.

His current residence, since Thanksgiving Day, is the Grimes County Jail.

Sheriff Donald Sowell has the unpleasant, and often frustrating, duty of being his jailer.

He, too, is incarcerated, in a sense. He is "locked up" by a small county's small jail budget, which includes not only a relative lack of manpower but no special facilities and no special training to give full care to people like George, who is the worst but not the only casualty of the state's, and nation's, mental health system to end up in his custody.

Read here for the rest of the news story:

And the column: The state of Texas' mental health care: It's criminal

Aaron George sits in the Grimes County Jail, deteriorating every day, becoming less and less functional, less and less himself, less and less "human" as a human being, all while leaving the sheriff and jail staff frustrated and helpless.

Sheriff Donald Sowell, through no fault of his own, is in an unenviable position. District Attorney Tuck McLain is left to potentially prosecute a case he'd rather not, even as the wheels of the judicial system grind so slowly George's case has not even gone before the grand jury yet for possible indictment.

It's criminal.

Whether Aaron George is a criminal now, or was in 1992, it's criminal that a bipolar schizophrenic sits in a county jail cell rather than a state mental hospital.

It's criminal that he sits there without proper medication, literally beating himself against the walls because voices and compulsions tell him to do so.

It's criminal that Donald Sowell, a small-county sheriff has to deal with cases like George's because jails like his become dumping grounds for mentally ill people who may commit crimes because of inadequate treatment.

It's criminal that the state mental health system leaves them stuck there, sometimes for a year or more.

It's criminal that mental illness, besides any actual crimes committed by a mentally ill person, still has a quasi-criminal taint to it, whether in Grimes County or anywhere else in the state.

It's criminal that many people may still think mental illness issues can just be swept under the rug.

It's criminal that state officials believe this enough that the prison system faces another serious lawsuit, this one from advocates for mentally ill inmates.

It's criminal that the Mental Health Mental Retardation budget gets slashed year after year.

It's criminal that MHMR doesn't have more state hospitals and beds, along with halfway houses or group homes.

It's criminal that more and more of the functions of Child Protective Services get privatized to untrained people by Gov. Rick Perry and the Texas Legislature.

Read here for the rest of the column.

For an excellent blog with more on Texas criminal justice issues, including mental health and due process, read Read Grits For Breakfast.

For information and links on the new lawsuit against the state of Texas, alleging that criminally confined mental health patients are being deprived of Constitutional due process due to their cases taking WAY too long to process, read Read this post of his.