Archetype Writing Blog

Nonfiction:
The official contract is all signed, so now I can tell you more about the deal.  *Big grin*

Now I'm working on connecting with someone who has spent time working in a state institution, because there's a difference between private hospitals and state-funded institutions.  Because you know how much money goes toward mental health care in our communities?  Not much.

Here's a picture of the old insane asylum that used to stand in Columbus, Ohio.  I believe the date on the picture is 11-7-1909.  According to some accounts, this was the largest asylum in the world at one point, with 1,300 beds.  It seems to me that Bedlam must have been bigger, but it's still an interesting bit of trivia.


Fiction
My friend Mary brutalized my ToM manuscript, and I can't believe I couldn't see some of the problems until she pointed them out.  Can I just tell you how valuable honest, trustworthy crits are?  I always feel a little (and sometimes a lot) embarrassed by my manuscript's shortcomings, but I am SO thankful when someone I trust cares enough to really be honest and give it to me straight.  I've been doing major rewrites.

My other projects -- SW and my NaNo novel -- are taking a breather while I work on this.

Want more info on this whole WIP Weds thing?  Here's Kate's original post.

How are your projects coming?

Even if you avoid tabloid rumors like the plague, you probably know all about Britney's latest troubles.

The front of People magazine has a picture of her from better years, and below the looming headline that you can't miss from anywhere in the supermarket: MENTAL ILLNESS.

As is usually the case, though, the terms are all tossed together into a hodgepodge that makes little sense, and none of it is flattering.

On January 3rd, Britney was taken from her home on a gurney after a disagreement with police about returning her children to her ex-husband.

A "Psycho Psychotic Mental Patient"

According to US Weekly:

"She went completely psycho," says an eyewitness. "They had to strap her down like a mental patient. She was going between laughing and crying hysterically. A total psychotic breakdown."

First, what exactly does "psycho" mean? Nothing except "bizarre." Which, you have to admit, kind of fits the situation, even if it is a bit of a slur. And "mental patient"? Means the same thing, and my issue is not that the speaker is suggesting Britney is out of control and needed to be strapped down, it's the suggestion that everyone with a psychological problem is and does.

And "psychotic" means a complete disconnection from reality as other people experience it. That may also be the case with Britney, but there's no real evidence from news reports that she was, for example, hearing voices or seeing things (ie having hallucinations) and it's not clear whether she was having ideas not based at all in shared ideas of reality (ie delusions).

It really bothers me when people toss around such loaded words without thinking about it. Why? Because, for example, if someone takes an "antipsychotic," everyone thinks things like "psycho killer" and "crazy psycho Britney" without understanding that some people take them as antidepressants and have never had a psychotic episode in their lives! And even if they have, it's because something is wrong with their brain chemistry, not because they chose to have problems, anymore than someone chooses to have cancer.

An Ambulance to the Hospital

And the fact that she was taken in an ambulance -- let me explain what happens when someone needs to be taken to the hospital for a psychological assessment. If the emergency folks on the scene determine that someone is an immediate danger to herself (ie suicidal) or to someone else (ie homicidal), they can mandate a trip to the hospital for an assessment. Typically the person gets plenty of chances to say "ok," including being told that they can be forced to go in handcuffs if they choose to really make a scene.

In most cases, people choose to go. After all, there's no guarantee they're going to be admitted, they're just going to be checked out so someone can make an informed decision about whether they're dangerous. (When doctors have admitting privileges, that makes the process quicker, partly because it's darn hard to commit someone in the US, especially against their will. Sometimes the hospital will say "Sorry, we have no place to put them. You're going to have to deal with it or find another hospital." But this is Britney. I'm sure they had no problems finding someone to assess her.)

Since there were fire and ambulance rescue personnel on site, it's not uncommon to use an ambulance to transport, especially when most of the media on the Western seaboard are flying over taking pictures. The goal is to stigmatize as little as possible. And you have to admit, going in an ambulance is less stigmatizing than going in the back of a police car.

According to the article in US, "Police offered her a choice of leaving in a cop car or an ambulance."

Britney might have issues, but she knew what to do when offered that choice!

It does sound like they pink-slipped to keep an eye on her, but the time she was kept for was so brief that in spite of all the reports that they had her on suicide watch, that's highly unlikely. She would never have been allowed to leave the hospital the next morning if anyone truly believed she was likely to walk out and kill herself. Emergency personnel have explained this to the media, but I guess that doesn't make such a good story. (US says, "LAPD officer Sara Faden explains the medical stay, which can be as long as 72 hours, to Us: 'Medical professionals attend the person and determind that they are not going to harm themselves or others. The person may be released earlier if it is determined they are no longer a danger." Or never were a suicide risk to start, no matter how much more exciting the story might have been if they were.)

Let me also note there that no matter how bizarre or erratic someone's behavior is, if they're an adult, in the United States they cannot be kept in a hospital against their will unless they are an immediate danger to themselves or someone else. (You can read more about suicide assessments on the Archetype site.) So if you're wondering why someone doesn't just get Britney some help...they literally can't, unless she does become suicidal, and nothing except rumor suggests that; the fact that she was kept for less than 12 hours in the hospital says she's not even hinting at suicidality.

Then, as everyone knows, Dr. Phil showed up. This just makes me want to bang my head on the wall, because everything I see suggests that he's making the most of a media situation to get himself publicity. That opinion went from tentative to very firm when I saw that Dr. Phil was forced to "cancel a hoped-for Spears family reunion for his Dr. Phil Now show, stating that the situation was 'too intense at this time.'" In other words, she didn't want nothin' to do with it. Or him. Neither would I if I had even an inkling that someone who's supposedly in the helping profession might exploit me and my family.

Dr. Phil Arrives

Dr. Phil apparently told Entertainment Tonight that "I've been working with this family behind the scenes for a long time."

Going well, ain't it? Keep up the good work, Phil.

Dr. Phil, and I'll try to keep this brief, got thrown out of psychology by our governing body, the APA, for misrepresenting psychology to the world. They asked him to note that what he does on TV is entertainment, because it's nothing like therapy. He refused, and they had to throw him out for what amounts to fraud. So whatever "work" he's doing isn't kosher by psychology's handbook.

And that's the problem. What most people believe to be psychology...isn't. At all. The client/patient comes first, and therapists listen rather than boss you around. Don't we all get bossed around enough at work and at home and by people we don't even know? Why would we pay someone to do more of it? I have my students do an exercise where they imagine Dr. Phil giving them advice for a problem they haven't been able to solve. After having over 100 students do it, only one has come out of the exercise with a fix. Granted, that's 1 person who's life is better, but it's also 1%, and that's a rotten success rate for anything. In fact, it's far less than the rate of improvement left to time or chance alone.

So What's Wrong with Britney?

Anyhow. So what's wrong with Britney? There's been a lot of talk of bipolar disorder, and I've seen some suggestions that she has borderline personality disorder. The fact that her erratic behavior doesn't seem to be caused (for the most part) by drugs, one does have to wonder about mania. Here are the critieria for mania (from the DSM-IV-TR):

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
(1) inflated self-esteem or grandiosity
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas [ideas jumping from one thing to the next very quickly, or thoughts are moving very fast] or subjective experience that thoughts are racing
(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation [jitteriness or fidgetiness]
(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

And here are the criteria for Borderline Personality Disorder (also from the DSM-IV-TR), which is often comorbid with Bipolar disorder (some say in about 1/3 of cases):

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment.
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self-image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria [sadness or sad mood], irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms

So what's actually wrong with Britney? I'm not sure. Some of it may be the fact that she has a lot of money and her star status gives her a lot of freedoms. But yes, it does look like maybe some of the things listed above fit her situation.

A new study suggests that all the hubbub about drugs like Prozac "causing" suicide -- which led to the FDA's "black box" warning on them -- led physicians to be more conservativew about prescribing the meds. And that appears to have caused the suicide rate to go up in children and teens.

Now, the first caution is that this is correlational data. That means we know that as the emphasis on the "dangerousness" of antidepressants went up, so did the suicide rate. That doesn't necessarily mean that one caused the other. It just looks pretty darn suspicious.

But there's a bigger problem here, and that is that we're still focusing on the wrong thing: the drugs.

Healthy, psychologically sound people who feel like there's hope don't commit suicide. People who feel there is no other option commit suicide, and teens tend to be more impulsive, so their suicide rate is a little higher than average. (The teen suicide rate is not the highest, by any means. The elderly population, especially elderly white males, are far more likely than any other group to commit suicide.)

Research shows that most antidepressant prescriptions are written by general practitioners, not psychiatrists. Now, GPs are writing them because they want to help, and that's what they can do to help -- they see people briefly, write a prescription or provide some other specific advice, and send the person out the door. In some cases they recommend therapy, but with a scrip in hand, the average person ignores the therapist's name.

And the average person doesn't realize that each antidepressant works differently (that's why there are so many of them -- gasp!) and that figuring out which is the best can be a trial-and-error process that may involve different dosages and different combinations of drugs.

So people go home, pop their Prozac, and by day 2 or 3 they feel great! They don't realize, of course, that it takes 2-6 weeks for Prozac to start working, and that they're getting a placebo effect. So at the end of week 1 they're not feeling so great and by the end of week 2 they quit taking the med becuase it's "stopped working." And they feel hopeless.

Or they feel a little better, but not a lot better, but they assume Zoloft is like penicillin -- it works or it doesn't, and there's not a lot of in between. They begin to think that feeling this bad is normal, and they're just not handling it well. Nor do they want to. And they feel hopeless.

Or the drug causes side effects they don't like, so they figure that the whole drug class is useless to them. And they feel hopeless.

See how this works?

Plus, in a lot of cases, even if the drug works great, it can't rout out the cause of the problem like an antibiotic. An antibiotic kills the infection and gets rid of the symptoms, too. With mental illness you may eliminate the symptoms and even get the brain chemistry working better, but if the psychological problem, or the bad living situation, or the learning disability, or whatever is still there, you haven't dealt with the true "infection," and you're still going to struggle with depression. That's exhausting. So you feel hopeless.

My point is, it's not as simple as a drug causing or not causing suicide rates. It has a lot to do with understanding that a drug is a tool, and an important tool, but only a tool. We shouldn't put it on a pedestal or blame it for the world's ills.

SSRIs (the class of antidepressants that includes Prozac, Zoloft, Wellbutrin, etc.) were one of the most important chemical revolutions in psychiatry. They help a lot of people who couldn't otherwise live normal lives live very normal lives. But they're drugs, not magic in a bottle.

You know how they say, "Guns don't kill people, people kill people"? Well, antidepressants don't cause suicide, but they also don't usually cause miracles. It's not that simple, and until we stop trying to make it that simple, we're not using the tools as effectively as we should be.