Author Archives: Carey Goldberg

Out Soon: First Official Consumer Guide To ‘The Bible Of Psychiatry’

The DSM-5, widely known as the "bible of psychiatry," is close to 1,000 pages and not exactly user-friendly. (Wikimedia Commons)

The DSM-5, widely known as the “bible of psychiatry,” is close to 1,000 pages and not exactly user-friendly. (Wikimedia Commons)

On average, says Dr. Paul Summergrad, the outgoing president of the American Psychiatric Association, he gets three or four calls a week that go something like this: “Hi, I’d love to chat — we haven’t talked in a while — but I’m calling about a personal problem — I’m worried.”

Almost always, Summergrad says, “It’s about a parent, an aunt, an uncle, a brother, a sister, a child — usually an adolescent or young adult who’s at the age of onset of these conditions, and they’re trying to figure out what to do.”

Summergrad, who’s also psychiatrist-in-chief at Tufts Medical Center, doesn’t mind a bit. “It’s actually the best job that I have, taking those calls,” he says. “That’s one of the most important things I ever do, because I’m trying to get people to the right sources of help.”

Now he has one more source to recommend: On May 1, the American Psychiatric Association is officially releasing its first-ever consumer guide to the DSM-5, the compendium of mental disorders that’s referred to in virtually every news story ever written about it — including this one, now — as “the bible of psychiatry.” The new consumer-oriented book is called “Understanding Mental Disorders: Your Guide To The DSM-5.”

The new consumer guide to the DSM-5 (Courtesy APA)

The new consumer guide to the DSM-5 (Courtesy APA)

The DSM-5 — DSM stands for Diagnostic and Statistical Manual — took more than a dozen years to develop and sparked controversies over some psychiatric disorders as it was compiled, drawing criticism both within the field and from without. But it was finally published in 2013, the latest version of the go-to reference on psychiatric diagnosis and treatment.

No one would call it user-friendly, though; it’s a thick tome of 991 pages in the paperback edition, and written for clinicians and researchers, not laypeople.

So the new consumer guide, Summergrad says, “is a way of trying to provide some help and guidance and understanding for either the individuals themselves, for their family members, or for other caregivers.”

It’s also intended for tables in the offices of primary care doctors, psychiatrists and psychologists, he says, to explain diagnoses in language for laypeople.

As one of those laypeople myself, I felt a little confused. The consumer guide, like the DSM itself, is organized in categories of diagnoses: psychotic disorders, bipolar disorders, anxiety disorders, and more. Continue reading

Why Do So Many Women Have Anxiety Disorders? A Hormone Hypothesis

(Stuart Anthony/Flickr)

(Stuart Anthony/Flickr)

Why do so many women suffer from anxiety? Is it something inherent in being female, are we more attuned to our moods? Or is that breath-clenching feeling of impending doom hard-wired?

According to the National Institute of Mental Health, women are 60 percent more likely than men to experience an anxiety disorder over their lifetime. (Obviously, men are not immune: taken together, anxiety disorders are among the most common mental health conditions — they affect about 40 million men and women age 18 and older, or about 18 percent of the U.S. population.)

Mohammed Milad is an associate professor of psychiatry at Harvard Medical School and director of the Behavioral Neuroscience Program at Massachusetts General Hospital. He studies the complex interplay of gender, fear and anxiety. More specifically, he’s looking at how hormones, notably estrogen, might play a role in the fear response and our ability to extinguish fear and anxiety.

I spoke with him about his work. Here, edited, is some of our conversation:

RZ: OK, can you just clearly explain the difference between fear and anxiety? Sometimes it’s a fine line indeed.

MM: I was thinking about taking my kids camping over the summer, and I was reading about bears and potential bear encounters, and considerations for taking cover and putting your food this distance away from your camping site, etc. Anxiety is when you’re camping and you have that heightened awareness — hyper-vigilance  — that’s anxiety, it’s sustained, it’s continuous, but it’s not at the point where it makes you run or look for cover. Fear is when you see the bear; fear is intense, it’s immediate, it’s right there in front of you.

RZ: Thanks for that. But I’m curious, how did you start studying how men and women are different when it comes to fear and anxiety?

MM: When I was in grad school we used to host kids from middle and elementary school…showing our lab to them, showing them the rats, and one kid, maybe 10, 12 years old, asked, are they male or female rats and I said they’re all male rats, and he asked, why, what about the female rats? And I didn’t know the answer, so I went to my mentor and asked, why don’t we study the females? And the answer, simply put, was they’re complicated.

RZ: So the female rats were just too complicated. I get that. But considering far more women than men suffer from anxiety disorders, the fact that you were studying only male rats wasn’t such a great approach, was it?

MM: No, so I think that’s not an acceptable answer now.

RZ: In your experiments on rats and humans, you and your team use Pavlovian conditioning, as in Pavlov’s dogs, who were famously conditioned into drooling every time they heard a bell because they associated that sound with food. So, in these studies you repeatedly showed a blue light on a screen to men and women who would then receive a mild shock, until they came to expect — and fear — a shock every time they saw the blue light. Then, you stopped giving shocks when the blue light came on, to teach the subjects not to fear it. That’s “fear extinction.” And the next day, the men and women were tested to see if they still had a fear response to the blue light.

The results in these studies were all over the place, but most of the variance in fear response was among women in the experiment, right? The men were much more consistent. Why might that be?

MM: That’s what got me into beginning to think about hormones, because what could account for that other than maybe some women that we’re bringing in to the lab were at a particular phase of their menstrual cycle? And when we did that study we found that women who came in when their estrogen is elevated, they had their [fear] extinction capacity much better, in other words, they were able to control their fear, or express much less fear, compared to the women that came in in the early phase of their cycle… when they had low estrogen.

RZ: So just to be clear, high estrogen was linked to better control of fear, and low estrogen meant more potent and longer lasting fear?

MM: Right. Continue reading

Report Finds Stark Gaps In Mass. Addiction Care

The math is simple and starkly clear.

There are 868 detox beds in Massachusetts, where patients go to break the cycle of addiction. They stay on average one week. Coming out, they hit one of the many hurdles explained in a report out this week from the Center for Health Information and Analysis on access to substance abuse treatment in the state.

There are only 297 beds in facilities where patients can have two weeks to become stable. There are 331 beds in four-week programs.

As the table below shows, there are almost four times as many men and women coming out of detox, with its one-week average, as there are from a two- or four-week program.

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

From the CHIA report on Access to Substance Use Disorder Treatment in Massachusetts

Patients who can’t get into a residential program right away describe a spin cycle, where they detox and relapse, detox and relapse. Some seek programs in other states with shorter wait times.

Continue reading

Elmo’s New Buddy, The Surgeon General, And Other Health Chiefs Urge Vaccines

 

Vivek H. Murthy, video star and Friend of Elmo. Who’d have thought, back when Dr. Murthy’s appointment to be the U.S. surgeon general was facing political fire, that this would be the sequel? But there he is in a popular new video, cavorting with Elmo. Okay, not cavorting, but rather working nicely together with Elmo to help promote vaccinations while the recent Disneyland measles outbreak is still fresh in memory.

And Dr. Murthy’s big-city colleagues are also going visual to promote vaccinations: Public health chiefs from Los Angeles County to Boston are just out with a series of videos in which they personally urge their residents to get their kids immunized. See the full collection here, including Boston’s Huy Nguyen (below). The videos, part of the Big Cities Health Coalition, are aimed at health districts with a combined population of 14 million.

Recent history: When President Obama proposed Dr. Murthy, then at Brigham and Women’s Hospital, as surgeon general in late 2013, colleagues showered him with praise and said they expected him to be a progressive and visible leader. Then, last year, opposition from gun groups — Murthy had expressed support for gun control in the wake of the Newtown shootings — held up and threatened to scuttle his confirmation. But in December, in a squeaker vote, he got the nod.

And now here he is, living up to predictions that he would be “visible” — and on “Sesame Street,” no less. After Elmo gets his vaccination in the video above, he (it?) says, “That was so easy! Why doesn’t everyone get a vaccination?” Dr. Murthy strokes his chin: “That’s a good question, Elmo, that’s a good question…”

After 20 Hours, Mobility-Impaired Man Finishes Boston Marathon At 5 AM

Maickel Melamed, of Venezuela, speaks during a ceremony to honor him as the last participant to finish this year's Boston Marathon. (Bill Sikes/AP)

Maickel Melamed, of Venezuela, speaks during a ceremony to honor him as the last participant to finish this year’s Boston Marathon. (Bill Sikes/AP)

The last athlete to complete the 2015 Boston Marathon has received his race medal.

Boston Police Commissioner William Evans, left, and Mayor Marty Walsh listen as Maickel Melamed, of Venezuela, speaks during a ceremony to honor him. (Bill Sikes/AP)

Boston Police Commissioner William Evans, left, and Mayor Marty Walsh listen to Melamed. (Bill Sikes/AP)

Maickel Melamed was bestowed his award by Boston Mayor Marty Walsh at City Hall on Tuesday, after completing the 26.2-mile course in about 20 hours.

The 39-year-old Venezuelan, who says he has a form of muscular dystrophy that severely impairs his mobility, crossed the finish line around 5 a.m. Tuesday morning.

Melamed and his team of volunteers endured torrential downpours, thunderstorms, biting wind and cold for the last few miles. They were greeted at the finish line by dozens of supporters.

Melamed said he completed the marathon — his fourth — to show that love is stronger than death.

He praised Boston for embracing his efforts.

Walsh called Melamed’s story “truly one of inspiration.”

This post was updated at 4:30 p.m.

Related:

Blankets And Broth: Hypothermia The Main Medical Issue At 2015 Boston Marathon

Lauri Perry, of Austin, Texas, is used to getting really hot when she runs. She thought she was being cautious ahead of Monday’s Boston Marathon, when she added a layer over her running top.

“I started out with something on and I threw it away at mile six because it was warmer. Then the rain started at about mile 10 or so, and then the wind got worse,” Perry said, her voice trailing off.

By the time Perry crossed the finish line on Boylston Street she was soaking wet, numb, blue and shaking.

“Uncontrollable shaking,” Perry repeated with emphasis. “I couldn’t even hold my drink because it was splashing out.”

Lauri Perry, of Austin, Texas, went into the medical tent to warm up after finishing the Boston Marathon Monday. (Martha Bebinger/WBUR)

Lauri Perry, of Austin, Texas, went into the medical tent to warm up after finishing the Boston Marathon Monday. (Martha Bebinger/WBUR)

Perry has run the Boston Marathon five times and notes with some pride that she has never needed medical assistance after the race. But Monday, when a member of the medical team asked if she wanted to step inside the big white tent, she gave in.

“I would normally say no,” Perry said, looking disappointed. “I’m a pretty strong person but I knew that I would not be able to walk all the way back to my hotel in the condition I was in.”

Perry and hundreds of runners on Monday fell victim to hypothermia, a condition where despite a runner’s hyper-exertion, their body temperature drops dangerously low. Inside a medical tent at the finish line, Perry peeled off her wet clothes and shoes and sat wrapped in multiple Mylar and cotton blankets, drinking warm fluids. But some runners needed more active warming.

Continue reading

Related:

Traumatic Turning Point: How The Marathon Bombing Shifted One Woman’s Depression

By Annie Brewster, M.D.

Jennifer on Marathon Monday 2013, before the runners started coming in (Courtesy)

Jennifer on Marathon Monday 2013, before the runners started coming in. (Courtesy)

Jennifer’s depression was deep and at times debilitating. For years, she tried various treatments but success was always temporary.

Something changed on the finish line at the Boston Marathon in 2013. It was, Jennifer says, “a turning point” in her life, but not in the ways you might expect.

As a marathon volunteer stationed a block from where the first bomb exploded, she witnessed the confusion and terror that ensued, and played an important role in helping one scared runner reunite with his family.

After the ordeal, Jennifer felt lucky to walk away alive. Her life goals changed that day and she says she now feels it’s her responsibility to help others. She continues to find concrete ways to do so.

Listen to Jennifer here:

She had already signed up to participate in a program at the  Benson-Henry Institute of Mind-Body Medicine at Massachusetts General Hospital the week following the bombing. Primed by her experience during and after the race, Jennifer devoured the class, which focused on relaxation techniques.  It deepened her sense of self-acceptance and gave her skills to manage her own depression, but also strengthened her resolve to help others. She ultimately went on to become a peer counselor at the institute.

Now, her central message is this: while we can’t necessarily control what happens to us in life, we can control the meaning we make of our experiences.

Jennifer says she’s determined to make the events of April 15, 2013, mean something, and to translate this meaning into action. As far as her depression, she has come around to recognizing “some of the good things about depression” — namely her appreciation for the small things in life, and her increased sense of empathy for others. “It’s like any other illness,” she says. “It doesn’t have to limit you. It’s all about making it mean something.”

Dr. Annie Brewster, M.D., is founder and executive director of Health Story Collaborative, a nonprofit in Boston.

Massachusetts Court Upholds $63M Judgment In Motrin Lawsuit

The highest court in Massachusetts has upheld a $63 million judgment against the manufacturer of Children’s Motrin awarded to a family whose daughter developed a life-threatening disease after taking the over-the-counter medicine.

A Superior Court jury ruled in 2013 that Johnson & Johnson failed to provide sufficient warnings about the potential side effects of Motrin.

Samantha Reckis was 7 in 2003 when she was given the ibuprofen product to reduce a fever. She suffered a rare skin disease known as toxic epidermal necrolysis and was blinded.

Continue reading

On Point: Adulthood With Autism, And The ‘Cliff’ As Kids Age Out Of Care

In this May 23, 2014 photo, Colleen Jankovich works with her 11-year-old autistic son, Matthew, who is non-verbal and requires 24/7 care, in Omaha. (AP)

In this May 23, 2014 photo, Colleen Jankovich works with her 11-year-old autistic son, Matthew, who is non-verbal and requires 24/7 care, in Omaha. (AP)

It’s not surprising that this week’s On Point hour on the “stark realities of autistic adulthood” drew a raft of calls from parents: Rates of diagnosed autism in America have risen dramatically in recent years, and now, a whole generation of autistic children are entering young adulthood.

As WBUR’s Martha Bebinger recently reported in a powerful piece titled “Troubled Future For Young Adults On Autism Spectrum,” this is a “pioneer generation” that often lacks supports in place.

Our colleagues at On Point have posted a write-up of the many calls from parents that their segment prompted, including these:

“This is the first time I’ve broken up about this,” caller Lisa from Nashville said. “I have a 21-year old daughter here in Nashville. She has moderately severe autism, severe speech impairment, intellectual disabilities.”

A backlog of applicants waiting for state support in Nashville has led Lisa to leave her state once her daughter ages out of the school-age care currently provided her.

“My plan is to relocate and to leave the state of Tennessee,” Lisa told us. “We’ll be able to provide housing for her, but how can a family that’s not making 300,000 and up provide that 24/7 care that she needs? There is no safety net for these people.”

Other callers, like Maisel in New Orleans, found school-age care for children with autism no better than the nonexistent care for adults. Continue reading

This Blind Man Climbs Every Mountain, And Now Has Run The Boston Marathon

Randy Pierce with his guide dog, Autumn, at WBUR (Robin Lubbock/WBUR)

Randy Pierce with his guide dog, Autumn, at WBUR (Robin Lubbock/WBUR)

Note: This post has been updated.

In 1989, Randy Pierce was fresh out of college, living in southern New Hampshire and working happily as a computer hardware designer. One day in fencing class, his instructor noticed that his blind spot was oddly enlarged. You need to go to the doctor, the instructor said. Today.

A neurological disease was attacking Pierce’s optic nerve. Within two weeks he had lost all the sight in his right eye, and half the sight in his left. In the following years, he lost the last remnants of his sight, and damage to his cerebellum destroyed his balance, landing him in a wheelchair.

On Monday, he ran the Boston Marathon. And he turned in a personal marathon best: 3 hours, 50 minutes and 37 seconds for the 26.2-mile course.

Pierce, 48, ran on Team With A Vision, which supports the Massachusetts Association for the Blind and Visually Impaired. He ran to raise money — and to make a point, about what he calls “ability awareness.”

“I have a disability — I can’t see,” he says. “We all have disabilities, things that we can’t do. I think it’s so much more important to put the focus of our lives on things we can do. And if something is important enough to you, I say anything is possible, you’re just going to have to problem-solve and persevere to get there.”

An example of problem-solving: Last year, Pierce became the first blind American to complete a Tough Mudder obstacle course, and last month he repeated the feat. (See the video below.)

From a platform 25 feet high, he had to leap out about 8 feet, grab a T-shaped, trapeze-like bar, swing farther out and release his grip at just the right moment to hit a remote hanging bell before plunging down into the muddy water below. He used his cane to feel for where the T-bar was, to form a mental image of it, and friends’ descriptions of where the bell was hanging.

The crowd went wild.

“You know, those are just moments — every one of those people out there would have told you this is impossible. Now they won’t,” Pierce says. “They’ll believe me when I say everything’s possible — or they’ll believe in themselves, which is the more important part.”

As for the perseverance Pierce talks about, he used it to fight his way out of the wheelchair that he occupied “for one year, eight months and 21 days — which tells you how I feel about it. Pretty challenging.”

Pierce’s wife, Tracy, says that somehow, his struggles and losses led him to adopt the supremely positive attitude that uplifts him now. Continue reading