Author: Andrew Marshall

Founder & Editor of the BootCampMilitaryFitnessInstitute.com, MilitaryGogglebox.com, and Mental-Health-Matters.org.

Who was Emil Kraepelin?

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Introduction

Emil Wilhelm Georg Magnus Kraepelin (15 February 1856 to 7 October 1926) was a German psychiatrist.

H.J. Eysenck’s Encyclopaedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics.

Kraepelin believed the chief origin of psychiatric disease to be biological and genetic malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later psychodynamic influence of Sigmund Freud and his disciples, enjoyed a revival at century’s end. While he proclaimed his own high clinical standards of gathering information “by means of expert analysis of individual cases”, he also drew on reported observations of officials not trained in psychiatry.

His textbooks do not contain detailed case histories of individuals but mosaic-like compilations of typical statements and behaviours from patients with a specific diagnosis. He has been described as “a scientific manager” and “a political operator”, who developed “a large-scale, clinically oriented, epidemiological research programme”.

Emil Kraepelin in his later years.

Family and Early Life

Kraepelin, whose father, Karl Wilhelm, was a former opera singer, music teacher, and later successful story teller, was born in 1856 in Neustrelitz, in the Duchy of Mecklenburg-Strelitz in Germany. He was first introduced to biology by his brother Karl, 10 years older and, later, the director of the Zoological Museum of Hamburg.

Education and Career

Kraepelin began his medical studies in 1874 at the University of Leipzig and completed them at the University of Würzburg (1877-1878). At Leipzig, he studied neuropathology under Paul Flechsig and experimental psychology with Wilhelm Wundt. Kraepelin would be a disciple of Wundt and had a lifelong interest in experimental psychology based on his theories. While there, Kraepelin wrote a prize-winning essay, “The Influence of Acute Illness in the Causation of Mental Disorders”.

At Würzburg he completed his Rigorosum (roughly equivalent to an MBBS viva-voce examination) in March 1878, his Staatsexamen (licensing examination) in July 1878, and his Approbation (his license to practice medicine; roughly equivalent to an MBBS) on 09 August 1878. From August 1878 to 1882, he worked with Bernhard von Gudden at the University of Munich.

Returning to the University of Leipzig in February 1882,[1] he worked in Wilhelm Heinrich Erb’s neurology clinic and in Wundt’s psychopharmacology laboratory. He completed his habilitation thesis at Leipzig; it was entitled “The Place of Psychology in Psychiatry”. On 03 December 1883 he completed his umhabilitation (“rehabilitation” = habilitation recognition procedure) at Munich.

Kraepelin’s major work, Compendium der Psychiatrie: Zum Gebrauche für Studirende und Aerzte (Compendium of Psychiatry: For the Use of Students and Physicians), was first published in 1883 and was expanded in subsequent multivolume editions to Ein Lehrbuch der Psychiatrie (A Textbook: Foundations of Psychiatry and Neuroscience). In it, he argued that psychiatry was a branch of medical science and should be investigated by observation and experimentation like the other natural sciences. He called for research into the physical causes of mental illness, and started to establish the foundations of the modern classification system for mental disorders. Kraepelin proposed that by studying case histories and identifying specific disorders, the progression of mental illness could be predicted, after taking into account individual differences in personality and patient age at the onset of disease.

In 1884, he became senior physician in the Prussian provincial town of Leubus, Silesia Province, and the following year he was appointed director of the Treatment and Nursing Institute in Dresden. On 01 July 1886, at the age of 30, Kraepelin was named Professor of Psychiatry at the University of Dorpat (today the University of Tartu) in what is today Estonia (see Burgmair et al., vol. IV). Four years later, on 05 December 1890, he became department head at the University of Heidelberg, where he remained until 1904. While at Dorpat he became the director of the 80-bed University Clinic. There he began to study and record many clinical histories in detail and “was led to consider the importance of the course of the illness with regard to the classification of mental disorders”.

In 1903, Kraepelin moved to Munich to become Professor of Clinical Psychiatry at the University of Munich.

In 1908, he was elected a member of the Royal Swedish Academy of Sciences.

In 1912, at the request of the DVP (Deutscher Verein für Psychiatrie; German Association for Psychiatry), of which he was the head from 1906-1920, he began plans to establish a centre for research. Following a large donation from the Jewish German-American banker James Loeb, who had at one time been a patient, and promises of support from “patrons of science”, the German Institute for Psychiatric Research was founded in 1917 in Munich. Initially housed in existing hospital buildings, it was maintained by further donations from Loeb and his relatives. In 1924 it came under the auspices of the Kaiser Wilhelm Society for the Advancement of Science. The German-American Rockefeller family’s Rockefeller Foundation made a large donation enabling the development of a new dedicated building for the institute along Kraepelin’s guidelines, which was officially opened in 1928.

Kraepelin spoke out against the barbarous treatment that was prevalent in the psychiatric asylums of the time, and crusaded against alcohol, capital punishment and the imprisonment rather than treatment of the insane. For the sedation of agitated patients Kraepelin recommended potassium bromide. He rejected psychoanalytical theories that posited innate or early sexuality as the cause of mental illness, and he rejected philosophical speculation as unscientific. He focused on collecting clinical data and was particularly interested in neuropathology (e.g. diseased tissue).

In the later period of his career, as a convinced champion of social Darwinism, he actively promoted a policy and research agenda in racial hygiene and eugenics.

Kraepelin retired from teaching at the age of 66, spending his remaining years establishing the institute. The ninth and final edition of his Textbook was published in 1927, shortly after his death. It comprised four volumes and was ten times larger than the first edition of 1883.

In the last years of his life, Kraepelin was preoccupied with Buddhist teachings and was planning to visit Buddhist shrines at the time of his death, according to his daughter, Antonie Schmidt-Kraepelin.

Theories and Classification Schemes

Kraepelin announced that he had found a new way of looking at mental illness, referring to the traditional view as “symptomatic” and to his view as “clinical”. This turned out to be his paradigm-setting synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of syndrome – common patterns of symptoms over time – rather than by simple similarity of major symptoms in the manner of his predecessors.

Kraepelin described his work in the 5th edition of his textbook as a:

“decisive step from a symptomatic to a clinical view of insanity. . . . The importance of external clinical signs has . . . been subordinated to consideration of the conditions of origin, the course, and the terminus which result from individual disorders. Thus, all purely symptomatic categories have disappeared from the nosology”.

Psychosis and Mood

Kraepelin is specifically credited with the classification of what was previously considered to be a unitary concept of psychosis, into two distinct forms (known as the Kraepelinian dichotomy):

Drawing on his long-term research, and using the criteria of course, outcome and prognosis, he developed the concept of dementia praecox, which he defined as the “sub-acute development of a peculiar simple condition of mental weakness occurring at a youthful age”. When he first introduced this concept as a diagnostic entity in the fourth German edition of his Lehrbuch der Psychiatrie in 1893, it was placed among the degenerative disorders alongside, but separate from, catatonia and dementia paranoides. At that time, the concept corresponded by and large with Ewald Hecker’s hebephrenia. In the sixth edition of the Lehrbuch in 1899 all three of these clinical types are treated as different expressions of one disease, dementia praecox.

One of the cardinal principles of his method was the recognition that any given symptom may appear in virtually any one of these disorders; e.g. there is almost no single symptom occurring in dementia praecox which cannot sometimes be found in manic depression. What distinguishes each disease symptomatically (as opposed to the underlying pathology) is not any particular (pathognomonic) symptom or symptoms, but a specific pattern of symptoms. In the absence of a direct physiological or genetic test or marker for each disease, it is only possible to distinguish them by their specific pattern of symptoms. Thus, Kraepelin’s system is a method for pattern recognition, not grouping by common symptoms.

It has been claimed that Kraepelin also demonstrated specific patterns in the genetics of these disorders and patterns in their course and outcome, but no specific biomarkers have yet been identified. Generally speaking, there tend to be more schizophrenics among the relatives of schizophrenic patients than in the general population, while manic depression is more frequent in the relatives of manic depressives. Though, of course, this does not demonstrate genetic linkage, as this might be a socio-environmental factor as well.

He also reported a pattern to the course and outcome of these conditions. Kraepelin believed that schizophrenia had a deteriorating course in which mental function continuously (although perhaps erratically) declines, while manic-depressive patients experienced a course of illness which was intermittent, where patients were relatively symptom-free during the intervals which separate acute episodes. This led Kraepelin to name what we now know as schizophrenia, dementia praecox (the dementia part signifying the irreversible mental decline). It later became clear that dementia praecox did not necessarily lead to mental decline and was thus renamed schizophrenia by Eugen Bleuler to correct Kraepelin’s misnomer.

In addition, as Kraepelin accepted in 1920, “It is becoming increasingly obvious that we cannot satisfactorily distinguish these two diseases”; however, he maintained that “On the one hand we find those patients with irreversible dementia and severe cortical lesions. On the other are those patients whose personality remains intact”. Nevertheless, overlap between the diagnoses and neurological abnormalities (when found) have continued, and in fact a diagnostic category of schizoaffective disorder would be brought in to cover the intermediate cases.

Kraepelin devoted very few pages to his speculations about the aetiology of his two major insanities, dementia praecox and manic-depressive insanity. However, from 1896 to his death in 1926 he held to the speculation that these insanities (particularly dementia praecox) would one day probably be found to be caused by a gradual systemic or “whole body” disease process, probably metabolic, which affected many of the organs and nerves in the body but affected the brain in a final, decisive cascade.

Psychopathic Personalities

In the first through sixth edition of Kraepelin’s influential psychiatry textbook, there was a section on moral insanity, which meant then a disorder of the emotions or moral sense without apparent delusions or hallucinations, and which Kraepelin defined as “lack or weakness of those sentiments which counter the ruthless satisfaction of egotism”. He attributed this mainly to degeneration. This has been described as a psychiatric redefinition of Cesare Lombroso’s theories of the “born criminal”, conceptualised as a “moral defect”, though Kraepelin stressed it was not yet possible to recognise them by physical characteristics.

In fact from 1904 Kraepelin changed the section heading to “The born criminal”, moving it from under “Congenital feeble-mindedness” to a new chapter on “Psychopathic personalities”. They were treated under a theory of degeneration. Four types were distinguished: born criminals (inborn delinquents), pathological liars, querulous persons, and Triebmenschen (persons driven by a basic compulsion, including vagabonds, spendthrifts, and dipsomaniacs).

The concept of “psychopathic inferiorities” had been recently popularised in Germany by Julius Ludwig August Koch, who proposed congenital and acquired types. Kraepelin had no evidence or explanation suggesting a congenital cause, and his assumption therefore appears to have been simple “biologism”. Others, such as Gustav Aschaffenburg, argued for a varying combination of causes. Kraepelin’s assumption of a moral defect rather than a positive drive towards crime has also been questioned, as it implies that the moral sense is somehow inborn and unvarying, yet it was known to vary by time and place, and Kraepelin never considered that the moral sense might just be different.

Kurt Schneider criticised Kraepelin’s nosology on topics such as Haltlose for appearing to be a list of behaviours that he considered undesirable, rather than medical conditions, though Schneider’s alternative version has also been criticised on the same basis. Nevertheless, many essentials of these diagnostic systems were introduced into the diagnostic systems, and remarkable similarities remain in the DSM-V and ICD-10. The issues would today mainly be considered under the category of personality disorders, or in terms of Kraepelin’s focus on psychopathy.

Kraepelin had referred to psychopathic conditions (or “states”) in his 1896 edition, including compulsive insanity, impulsive insanity, homosexuality, and mood disturbances. From 1904, however, he instead termed those “original disease conditions, and introduced the new alternative category of psychopathic personalities. In the eighth edition from 1909 that category would include, in addition to a separate “dissocial” type, the excitable, the unstable, the Triebmenschen driven persons, eccentrics, the liars and swindlers, and the quarrelsome. It has been described as remarkable that Kraepelin now considered mood disturbances to be not part of the same category, but only attenuated (more mild) phases of manic depressive illness; this corresponds to current classification schemes.

Alzheimer’s Disease

Kraepelin postulated that there is a specific brain or other biological pathology underlying each of the major psychiatric disorders. As a colleague of Alois Alzheimer, he was a co-discoverer of Alzheimer’s disease, and his laboratory discovered its pathological basis. Kraepelin was confident that it would someday be possible to identify the pathological basis of each of the major psychiatric disorders.

Eugenics

Upon moving to become Professor of Clinical Psychiatry at the University of Munich in 1903, Kraepelin increasingly wrote on social policy issues. He was a strong and influential proponent of eugenics and racial hygiene. His publications included a focus on alcoholism, crime, degeneration and hysteria.

Kraepelin was convinced that such institutions as the education system and the welfare state, because of their trend to break the processes of natural selection, undermined the Germans’ biological “struggle for survival”. He was concerned to preserve and enhance the German people, the Volk, in the sense of nation or race. He appears to have held Lamarckian concepts of evolution, such that cultural deterioration could be inherited. He was a strong ally and promoter of the work of fellow psychiatrist (and pupil and later successor as director of the clinic) Ernst Rüdin to clarify the mechanisms of genetic inheritance as to make a so-called “empirical genetic prognosis”.

Martin Brune has pointed out that Kraepelin and Rüdin also appear to have been ardent advocates of a self-domestication theory, a version of social Darwinism which held that modern culture was not allowing people to be weeded out, resulting in more mental disorder and deterioration of the gene pool. Kraepelin saw a number of “symptoms” of this, such as “weakening of viability and resistance, decreasing fertility, proletarianisation, and moral damage due to “penning up people” [Zusammenpferchung]. He also wrote that “the number of idiots, epileptics, psychopaths, criminals, prostitutes, and tramps who descend from alcoholic and syphilitic parents, and who transfer their inferiority to their offspring, is incalculable”. He felt that “the well-known example of the Jews, with their strong disposition towards nervous and mental disorders, teaches us that their extraordinarily advanced domestication may eventually imprint clear marks on the race”. Brune states that Kraepelin’s nosological system “was, to a great deal, built on the degeneration paradigm”.

Influence

Kraepelin’s great contribution in classifying schizophrenia and manic depression remains relatively unknown to the general public, and his work, which had neither the literary quality nor paradigmatic power of Freud’s, is little read outside scholarly circles. Kraepelin’s contributions were also to a large extent marginalized throughout a good part of the 20th century during the success of Freudian etiological theories. However, his views now dominate many quarters of psychiatric research and academic psychiatry. His fundamental theories on the diagnosis of psychiatric disorders form the basis of the major diagnostic systems in use today, especially the American Psychiatric Association’s DSM-IV and the World Health Organization’s ICD system, based on the Research Diagnostic Criteria and earlier Feighner Criteria developed by espoused “neo-Kraepelinians”, though Robert Spitzer and others in the DSM committees were keen not to include assumptions about causation as Kraepelin had.

Kraepelin has been described as a “scientific manager” and political operator, who developed a large-scale, clinically oriented, epidemiological research programme. In this role he took in clinical information from a wide range of sources and networks. Despite proclaiming high clinical standards for himself to gather information “by means of expert analysis of individual cases”, he would also draw on the reported observations of officials not trained in psychiatry. The various editions of his textbooks do not contain detailed case histories of individuals, however, but mosaiclike compilations of typical statements and behaviours from patients with a specific diagnosis. In broader terms, he has been described as a bourgeois or reactionary citizen.

Kraepelin wrote in a knapp und klar (concise and clear) style that made his books useful tools for physicians. Abridged and clumsy English translations of the sixth and seventh editions of his textbook in 1902 and 1907 (respectively) by Allan Ross Diefendorf (1871-1943), an assistant physician at the Connecticut Hospital for the Insane at Middletown, inadequately conveyed the literary quality of his writings that made them so valuable to practitioners.

Among the doctors trained by Alois Alzheimer and Emil Kraepelin at Munich at the beginning of the 20th century were the Spanish neuropathologists and neuropsychiatres Nicolás Achúcarro and Gonzalo Rodríguez Lafora, two distinguished disciples of Santiago Ramón y Cajal and members of the Spanish Neurological School.

Dreaming for Psychiatry’s Sake

In the Heidelberg and early Munich years he edited Psychologische Arbeiten, a journal on experimental psychology. One of his own famous contributions to this journal also appeared in the form of a monograph (p.105) entitled Über Sprachstörungen im Traume (On Language Disturbances in Dreams). Kraepelin, on the basis of the dream-psychosis analogy, studied for more than 20 years language disorder in dreams in order to study indirectly schizophasia. The dreams Kraepelin collected are mainly his own. They lack extensive comment by the dreamer. In order to study them the full range of biographical knowledge available today on Kraepelin is necessary.

Bibliography

  • Kraepelin, E. (1906). Über Sprachstörungen im Traume. Leipzig: Engelmann. ([1] Online.)
  • Kraepelin, E. (1987). Memoirs. Berlin, Heidelberg, New York: Springer-Verlag. ISBN 978-3-642-71926-4.

Collected Works

  • Burgmair, Wolfgang & Eric J. Engstrom & Matthias Weber et al., eds. Emil Kraepelin. 9 vols. Munich: belleville, 2000–2019.
  • Vol. I: Persönliches, Selbstzeugnisse (2000), ISBN 3-933510-90-2
  • Vol. II: Kriminologische und forensische Schriften: Werke und Briefe (2001), ISBN 3-933510-91-0
  • Vol. III: Briefe I, 1868–1886 (2002), ISBN 3-933510-92-9
  • Vol. IV: Kraepelin in Dorpat, 1886–1891 (2003), ISBN 3-933510-93-7
  • Vol. V: Kraepelin in Heidelberg, 1891–1903 (2005), ISBN 3-933510-94-5
  • Vol. VI: Kraepelin in München I: 1903–1914 (2006), ISBN 3-933510-95-3
  • Vol. VII: Kraepelin in München II: 1914–1920 (2009), ISBN 978-3-933510-96-9
  • Vol. VIII: Kraepelin in München III: 1921–1926 (2013), ISBN 978-3-943157-22-2
  • Vol. IX: Briefe und Dokumente II: 1876-1926 (2019), ISBN 978-3-946875-28-4

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Emil_Kraepelin >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 20 June [2022]

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People (Births)

  • 1884 – Johannes Heinrich Schultz, German psychiatrist and psychotherapist (d. 1970).

Johannes Heinrich Schultz

Johannes Heinrich Schultz (20 June 1884 to 19 September 1970) was a German psychiatrist and an independent psychotherapist.

Schultz became world-famous for the development of a system of self-hypnosis called autogenic training.

On This Day … 18 June [2022]

Published on by Andrew Marshall1 Comment

People (Births)

  • 1948 – Sherry Turkle, American academic, psychologist, and sociologist.

Sherry Turkle

Sherry Turkle (born 18 June 1948) is the Abby Rockefeller Mauzé Professor of the Social Studies of Science and Technology at the Massachusetts Institute of Technology.

She obtained an AB in Social Studies and later a PhD in Sociology and Personality Psychology at Harvard University. She now focuses her research on psychoanalysis and human-technology interaction. She has written several books focusing on the psychology of human relationships with technology, especially in the realm of how people relate to computational objects.

What is the Abraham Low Self-Helps Systems?

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Introduction

Abraham Low Self-Help Systems (ALSHS) is a non-profit organisation formed from the merger of Recovery International and the Abraham Low Institute.

ALSHS facilitates the estimated 600 worldwide Recovery International meetings and all projects formerly run by the Abraham Low Institute including the Power to Change programme. The organisation is named after Abraham Low, founder of the mental health self-help organisation now known as Recovery International.

Brief History

Recovery, Inc., often referred to simply as Recovery, was officially formed 07 November 1937, by neuropsychiatrist Abraham Low in Chicago, Illinois. Low created the organisation to facilitate peer support self-help groups for former mental patients and later allowed for participation of those who had not been hospitalised, but with a desire to improve their mental health. During the organisation’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. As of 2008 there were over 600 weekly Recovery International meetings held throughout North America, Ireland, the United Kingdom, Israel and India.

The Abraham Low Institute was founded in 1989 to develop programmes, in addition to Recovery, based on Low’s self-help principles. The Institute awarded grants to further scholarly research on Low’s work, provided research resources for people interested in Low’s methods, and developed the Power to Change programme and The Relatives Project.

On 01 January 2008 Recovery International merged with The Abraham Low Institute and provisionally renamed the new organisation Recovery International / The Abraham Low Institute (RI/TALI). Celinda Jungheim, a community volunteer from Los Angeles, was elected as president of the Board of Directors. Abraham Low Self-Help Systems was incorporated on 01 January 2009, completing the merger of Recovery International and The Abraham Low Institute. Abraham Low Self-Help Systems is now the provider of Recovery International community, phone and online meetings and The Power to Change programme, which was a programme of The Abraham Low Institute.

The Relatives Project

The Relatives Project, found in 1993, provides support for family and friends of people who have mental and emotional problems. The Relatives Project teaches coping skills and stress management through meetings similar to those held in Recovery International groups, but using literature written by Abraham Low specifically for the families of his patients. Relatives are taught to maintain empathy and unconditional positive regard for their ill relative, while reframing their domestic environment to provide an empowering atmosphere for all members. The Relatives Project groups are open to adults and teenagers, and allow professionals to observe but only to participate if it is in support of a family member’s mental health. Mental health becomes a shared goal for a family, and all family members share in responsibility to achieve it.

Power to Change

Power to Change is a cognitive-behavioural peer-to-peer programme based on Low’s self-help principles. Power to Change primarily teaches at-risk students and ex-prisoners principles of Low’s Self-Help system in peer-to-peer groups. Power to Change groups generally consist of 8-12 members, meeting weekly, who learn the principles of the Low Self-Help System by describing their personal experience of disturbing events and commenting on each other’s experiences using a highly structured format.

Specifically, Power to Change consists of five components:

  • A peer-to-peer process intended to provide a safe environment for members to disclose their experiences to a supportive group,
  • A meeting structure intended to keep discussion on topic,
  • A four-part format to help members frame their experiences as useful examples, and
  • Group feedback utilising a set of tools (principles of Abraham Low’s therapeutic technique).

The four-part example consists of an objective description an event; a report of the feelings, sensations, thoughts, and impulses experienced in the members mind and body; how the member used the Power to Change tools to manage the experience; and a self-endorsement to remind the member of the progress made and to reward their effort. The Power to Change groups use much of the language suggested in the Recovery International programme, such as identifying “temper” and avoiding judgment of right and wrong.

The W.K. Kellogg Foundation has provided grants for Power to Change since 2003. The most recent grant was awarded in November 2008, and will provide funding until November 2010.

Chicago Public Schools

In 2007 Urban Networks Associates (UNA) conducted an evaluation of Power to Change as it was implemented in seventeen secondary and middle schools in the Chicago Public School system. In each school 12-24 group sessions were held and facilitated by either staff from the Abraham Low Institute or by a local facilitator trained by the Abraham Low Institute. Participating students showed significant improvement in prosocial behaviour as measured by pre-testing and post-testing of emotional intelligence, specifically increasing self-restraint and decreasing violent behaviours. Although statistically significant, the effect sizes of changes were low or medium.

UNA’s SEM evaluation of the Power to Change logic model, the required steps and conditions for the program to be effective, found it fit the data collected well. To improve the effectiveness of the program UNA recommended improving communication with and training of local facilitators, encouraging students to develop plans to apply programme tools outside of the group, updating the literature used to make it more age appropriate for the young students, adding activities to encourage confidentiality of what was said in group meetings and developing more interactive activities to teach programme concepts. UNA also suggested asking for a commitment from participating schools to guarantee facilities were always available and that students would not be prohibited from attending group sessions.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Abraham_Low_Self-Help_Systems >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

Who was Abraham Low?

Published on by Andrew Marshall3 Comments

Introduction

Abraham Low (1891 to 1954) was an American neuropsychiatrist noted for his work in establishing self-help programmes for people with mental illness, and for his criticism of Freudian psychoanalysis.

Refer to Abraham Low Self-Help Systems (ALSHS).

Early Years

Low was born 28 February 1891, in Baranów Sandomierski, Poland.

Low attended grade school, high school and medical school in France from 1910 to 1918. He continued his medical education in Austria, serving in the Medical Corps of the Austrian Army. He graduated with a medical degree in 1919, after his military service, from the University of Vienna Medical School. After serving an internship in Vienna, Austria from 1919 to 1920, he immigrated to the United States, obtaining his US citizenship in 1927.

Career

From 1921 to 1925 he practiced medicine in both New York, New York and Chicago, Illinois. In 1925 he was appointed as an instructor of neurology at the University of Illinois College of Medicine and became an associate professor of psychiatry. In 1931 Low was appointed assistant director and in 1940 became acting director of the university’s Neuropsychiatric Institute.

From 1931 to 1941 he supervised the Illinois State Hospitals. During this time he conducted demanding seminars with the staff and interviewed the most severe mental patients in the wards. In 1936, Low’s Studies in Infant Speech and Thought was published by the University of Illinois Press. Some sixty papers are by Low dealing variously with such topics as: Histopathology of brain and spinal cord, studies on speech disturbances (aphasias) in brain lesions, clinical testing of psychiatric and neurological conditions, studies in shock treatment, laboratory investigations of mental diseases; and several articles on group psychotherapy had been published in medical periodicals.

Death and Legacy

Low died in 1954 at the Mayo Clinic in Rochester, Minnesota. His contributions to the psychiatric and mental health communities are often not well known, but his work has and continues to assist numerous individuals in the area of mental health. The psychologist and founder of REBT, Albert Ellis, credits Low as a founder of cognitive behavioural therapy.

Recovery International

In 1937, Low founded Recovery, Inc. where he served as its medical director from 1937 to 1954. During this time he presented lectures to relatives of former patients on his work with these patients and the before and after scenarios. In 1941, Recovery Inc. became an independent organization. Low’s three volumes of The Technique of Self-help in Psychiatric Aftercare (including “Lectures to Relatives of Former Patients”) were published by Recovery, Inc. in 1943. Recovery’s main text, Mental Health Through Will-Training, was originally published in 1950. During the organisation’s annual meeting in June 2007, it was announced that Recovery, Inc. would thereafter be known as Recovery International.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Abraham_Low >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Recovery International?

Published on by Andrew Marshall3 Comments

Introduction

Recovery International (formerly Recovery, Inc., often referred to simply as Recovery or RI) is a mental health self-help organisation founded in 1937 by neuropsychiatrist Abraham Low in Chicago, Illinois.

Recovery’s programme is based on self-control, self-confidence, and increasing one’s determination to act. Recovery deals with a range of people, all of whom have difficulty coping with everyday problems, whether or not they have a history of psychiatric hospitalisation. It is non-profit, secular, and although it uses methods devised by Low, most groups are currently led by experienced non-professionals.

Brief History

In 1937, Abraham Low, a neuropsychiatrist, was on the faculty at the University of Illinois at Chicago, and participants in Recovery were limited to those who had been hospitalised in the Psychiatric Institute at the University. At that time, Recovery Inc. was an entity of the Neuropsychiatric Institute at the University of Illinois Research and Education Hospital. The original thirty-seven founding members had recovered their mental health after receiving insulin shock treatments at the Institute.

Low began the groups as part of an attempt to improve the patient’s care following discharge from his hospital. In the early years of the organisation he encouraged members to advocate for improvements in social policies regarding state mental health regulations. Following backlash from the medical community to these efforts, Low disbanded the group in 1941. His patients, however, asked to be trained to teach Recovery’s methods to others and in 1942 Low began to teach members to lead groups in their homes.

The organization separated from the Psychiatric Institute in 1942, operating out of private offices in Chicago. New membership at this time was drawn largely from patients in Low’s private psychiatry practice. During the first years following its separation Low remained in close contact with all Recovery groups and received regular reports from group leaders. As the membership and number of meetings grew, it made this level of cooperation with the groups untenable. In 1952, Low allowed expansion of Recovery outside of Illinois, giving control of local groups to former patients who had become group leaders. Following Low’s death in 1954, Recovery transitioned completely from a professionally run treatment adjunct, to a peer-run self-help group.

Effective 01 January 2007 Recovery, Inc. formally changed its name to Recovery International. On 02 January 2008 Recovery International merged with The Abraham Low Institute and provisionally renamed the new organisation Recovery International / The Abraham Low Institute (RI/TALI). On 01 January 2009, Abraham Low Self-Help Systems was incorporated to umbrella several new programmes, and the group continues operations as Recovery International and Abraham Low Self-Help Systems in various states and internationally.

Fundamental Concepts

Symptoms

The causes and classification of mental illnesses are considered irrelevant in the Recovery method. Recovery members are simply viewed as people who have developed disturbing symptom-reactions leading to ill-controlled behaviour. Symptoms are threatening sensations; including feelings, impulses, and obsessive thoughts. The phrase, “symptomatic idiom” describes the mental association of danger with symptoms.

The symptomatic idiom implies that there is an impending catastrophe of physical collapse, mental collapse, or permanent handicap. In the first instance, for example, a person may consider heart palpitations as signalling that sudden death is imminent, or that a painful headache is caused by a brain tumour; phobias, compulsions, and ruminations would eventually cause a mental collapse. The fear of permanent handicap insists that there is no cure or relief for one’s mental illness and that recovery is impossible.

Temper

Temper is a combination of a feeling and a judgement about oneself or others. The feeling is related to one of the two types of temper, fear or anger. The judgment is that one has been wronged by another, or that one has done something wrong. “Fearful temper” arises from thoughts that one has made a mistake (has done something wrong) which in turn causes feelings such as fear, shame and inadequacy. “Angry temper” results from the belief that one has been wronged which in turn creates feelings of indignation and impatience. There is a two-way relationship between temper and symptoms. Symptoms induce emotions such as fear and anger, which in turn induce temper, which increases the intensity of the symptoms.

“Temperamental lingo” describes language related to judgments of right and wrong, and the use of defeatist language when discussing symptoms. When discussing symptoms, temperamental lingo includes the use of adjectives such as “intolerable,” “uncontrollable,” “unbearable,” and similar language that places an emphasis on the dangerous and fatalistic implications of feelings, impulses, or thoughts.

Will

Free will is fundamental to Recovery’s method. The subconscious, as it is known in psychoanalysis, as well as viewpoints emphasizing unconscious motivations, drives, and instincts are considered to be self-defeating. Recovery considers adults as capable of behaving based on deliberate plans, settled decisions, reasoned conclusions and firm determinations. Will gives adults the ability to accept or reject thoughts and impulses. Recovery members achieve mental health by training their Wills to reject self-defeating thoughts and impulses, countering them with self-endorsing thoughts and wellness-promoting actions.

External and Internal Environment

Recovery distinguishes between the External Environment, the realities of a situation, and the Internal Environment, one’s own subjective feelings, thoughts, impulses, and sensations. Two components of the Internal Environment, thoughts and impulses, can be directly controlled by Will. Control of thoughts and impulses allows indirect control over sensations and feelings. For instance, thoughts of insecurity and anxiousness can be replaced with thoughts of security. Similarly, a feeling of fear can be disposed by removing the associated belief of danger (symptomatic idiom). While the Internal Environment can be changed with cognitive reframing, changing one’s External Environment may or may not be possible.

Nervousness

Recovery focuses on treating former mental patients, sometimes referred to as post-psychotic persons, as well as psychoneurotic persons. The latter group is most often referred to as “nervous” or “nervous patients”. Recovery members may refer to themselves as “nervous patients” regardless of whether they are being treated by a physician or other professional. Sociologist Edward Sagarin described this as a compromise between the term neurotic and the more colloquial phrase “nervous breakdown”.

Common Techniques

Recovery encourages members to cognitively reframe their experiences using several techniques. Spotting, reframing defeatist language, self-endorsement and creating Examples are the most commonly cited in scholarly reviews of Recovery.

Spotting

Spotting is an introspective relabelling of thoughts and symptoms. When a thought arises related to angry temper, fearful temper, or associating danger with a symptom it must be spotted and reframed. Members practice spotting and reacting appropriately to the distressing thought or symptom.

Reframing Language

Recovery developed its own language for labelling psychiatric symptoms and responding to them. This language is centred around two concepts, “authority” and “sabotage.” It is suggested that members rely on the authority of a physician’s diagnosis with respect to their symptoms. For instance, if a member self-diagnoses a headache as being caused by a brain tumour, but a physician has diagnosed it otherwise, then the member is said to be sabotaging the physician’s authority. This is similarly true for the member’s prognosis, if a member despairs that their condition is hopeless, but a physician has found the prognosis to be good, this is also sabotage of the physician’s authority. Using the physician’s perspective to reframe defeatist thoughts is intended to help members recognise that they have not lost control, and their situation can be coped with.

Self-Endorsement

Members practice self-endorsement of every effort made to use a Recovery method, no matter how small and regardless of the outcome. In this way, similar subsequent efforts will require less work and are more likely to be successful. Similarly members are taught to change their behaviour in “part acts” (small steps), to simply “move their muscles” to complete tasks, however small, to eventually complete larger overwhelming tasks.

Creating Examples

The Example format was created by Low as a means to allow Recovery to function as a stand-alone lay self-help group that would not require professional supervision. Members create Examples by following a four-part outline, each part requiring a description.

  • Details of an event that caused distress.
  • The symptoms and discomfort that the event aroused.
  • How Recovery principles were utilised to cope with the event.
  • How the member would have behaved in response to the event before joining Recovery.

Examples are a formalised way to practice the Recovery programme. A successful outcome is not required to create an Example, as all attempts at practicing Recovery methods are endorsed.

Meetings

1937 to 1952

During the first fifteen years of Recovery, Low required members to attend classes and meetings for at least six months at a cost of ten dollars per month, not including the membership dues of two dollars per year. Members would meet at least three days a week and on Wednesdays take part in panel discussions as panellists or audience members held at a private home. Panel discussions would consist of three to four panellists with considerable experience in Recovery discussing a topic from Low’s literature, focusing on spotting and conquering symptoms. Dr. Low would address the audience at the end of each panel discussion summing up the discussion and correcting any misinformation given about Recovery. Every Thursday Low would conduct a group psychotherapy class for Recovery members.

No meetings were held between Saturday and Wednesday. Commonly, novice members would have a “setback,” a relapse of psychiatric symptoms, during this time. As setbacks were considered unavoidable, the novice members were assigned to a more experienced member to call or visit should they need assistance. If the assistance provided by the experienced member was not helpful, they could contact a chairperson in their area (a member who functioned like the physician’s deputy), and if that was still not satisfactory they could contact the physician, Dr. Low.

1952 to Present

At the meetings, members share examples from their lives that caused nervous symptoms, the thoughts that occurred just beforehand, how they spotted them and reacted to them. Other members offer alternative ways of looking at the situation and suggest how to better handle similar symptoms in the future. Meetings range in size from 6 to 30 members and follow a rigid schedule to ensure adherence to Recovery methods. Each meeting has a leader in a permanent position; leadership duties do not rotate from meeting to meeting. Each meeting is split into five parts. Members introduce themselves by first name only, as is practiced in Alcoholics Anonymous.

Impact of Pandemic (2020-2021)

Due to COVID-19, more than 300 community meetings were closed, and many new telephone and online meetings were added. This gives people access to more meetings at various times during the week, regardless of geography.

Reading of Recovery Literature

The beginning of a meeting is generally reserved for reading from Recovery literature. Members take turns reading sections of a chapter or article. Group leaders will often call on new members during this period, or members who are hesitant to volunteer. After finishing a paragraph a group leader will often ask a member if they experienced any symptoms while reading the literature and will endorse them for the efforts to continue reading despite feelings of discomfort or fear of making mistakes.

Presentation of Examples

Only members who have read Mental Health Through Will Training are allowed to participate in this portion of the meeting. Those participating form a “panel” although they are usually seated face-to-face around a table. The group leader reminds the members that examples should be constructed around day-to-day events as Recovery is a non-professional organisation and cannot help people with major problems. This statement is qualified, however, with Low’s opinion that the majority of a nervous patient’s problems are related to “trivial” incidents. Rather than being a limitation of Recovery’s programme, this is intended to be a novel treatment approach. A day-today trivial event may generalise to other problems experienced by the member. Discussion of trivialities is less threatening than complex problems, making a discussion of coping mechanisms possible.

A survey of groups in Chicago in 1971 and 1977 found that most examples presented were stories of successful application of the Recovery method, less than 10% represented “problem examples” where the application was not successful.

Group participation

After an Example has been given, the meeting is opened for “group spotting”. During this period other members of the panel are allowed to comment on the Example based on Recovery principles. This group leader usually makes the first comments, and if there are no volunteers to continue, he or she may call on panel members to provide commentary. Comments not based on Recovery’s concepts or not related to the example are stopped by the group leader. Comments are either classed as positive, praise for application of a Recovery method, or negative, related to an instance where a method was not applied. An Example rarely passes without mention of additional Recovery techniques that could be applied to it. This serves as a constant reminder that Recovery’s method can never be practiced perfectly; members can always learn from experience and benefit from group practice.

For example, a person may experience “lowered feelings” (depression) because they are aiming for a perfect performance. Trying to be perfect or trying to appear perfect leads one to feel down if one makes even the slightest mistake. All improvements, no matter how small, are acknowledged and members are encouraged to endorse themselves for their efforts – not for their successes. Longstanding members are encouraged to share their success with the Recovery methods to help newcomers. Low saw the sharing of successes by veteran members as an essential component of meetings, as it demonstrates that distressing sensations can be endured, impulses can be controlled, and obsessions can be checked.

Question and Answer

Following the panel presentation, about fifteen minutes are set aside for a question and answer period. Any member may ask a question of the panel during this time, newcomers are especially encouraged to participate. Discussion, however, must be limited to the Examples given and related Recovery concepts. Discussion questioning Recovery’s method is not allowed. Discussion of psychological theories outside of Recovery is similarly discouraged. In a case where a member brings up a disagreement between his physician and a Recovery concept, he or she is told that the panel is not qualified to provide an answer not related to the Examples presented. Members are expected to follow the advice of their professional; Recovery is not intended as a substitute for psychiatric services, but a self-directed programme that can be used as an adjunct to professional treatment, or alone when professional treatment is not available.

Mutual Aid Meeting

The formal meeting ends with the question and answer period, and an informal “mutual-aid” gathering usually follows. During this time refreshments are usually served. Members may speak freely with one another and discuss problems or ask for advice, although there is an attempt to keep the discussion within the bounds of Recovery concepts. By convention, discussion of problems are limited to five minutes in an attempt to discourage self-pity and complaining.

Organisational Structure

From 1952 to 2008, Recovery was run from its office in Chicago by a twelve-member Board of Directors, a number of committees, organisation officers, and a full-time paid administrative staff. The Board of Directors was elected at Recovery’s annual meeting and served for a period of three years. Authority from the Board of Directors was passed to Area Leaders then to Assistant Area Leaders, District Leaders, and lastly to Group Leaders. Leaders are trained to run Recovery meetings, but are not considered experts or authorities. Policies and practices of Recovery were made by the Board of Directors.

Family Participation

In the early years of Recovery, an event was held on Saturday afternoons at Recovery’s office in Chicago for Recovery members as well as their relatives and friends. Later, family and friends of members were allowed to attend meetings, although not to participate. In 1943 Low published a book, Lectures to Relatives of Former Patients to help assist them with the recovery effort; this information was later reprinted in Peace Versus Power in the Family: Domestic Discord and Emotional Distress in 1967.

Effectiveness

In 1945, Abraham Low found the average member improved considerably after the first or second week in the programme as it existed at that time. However, members were required to lose their major symptoms within two months of membership and class attendance. If they did not, this was taken as an indication that the member was still sabotaging the physician’s efforts.

A 1984 study found that following participation in Recovery, former mental patients reported no more anxiety about their mental health than the general public. Members rated their life satisfaction levels as high, or higher, than the general public. Members who had participated two years or more reported the highest levels of satisfaction with their health. Members who participated for less than two years tended to still be taking medication and living below the poverty level with smaller social networks.

A 1988 study found that participation in Recovery decreased members’ symptoms of mental illness and the amount of psychiatric treatment needed. About half of the members had been hospitalised before joining. Following participation, less than 8% had been hospitalised. Members’ scores of neurotic distress decreased, and scores of psychological well-being for longstanding members were no different from members of a control group in the same community. Long-term members were being treated with less psychiatric medication and psychotherapy than newer members.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Recovery_International >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 17 June [2022]

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People (Births)

  • 1919 – William Kaye Estes, American psychologist and academic (d. 2011).

William Kaye Estes

William Kaye Estes (17 June 1919 to 17 August 2011) was an American psychologist.

A Review of General Psychology survey, published in 2002, ranked Estes as the 77th most cited psychologist of the 20th century. In order to develop a statistical explanation for the learning phenomena, William Kaye Estes developed the Stimulus Sampling Theory in 1950 which suggested that a stimulus-response association is learned on a single trial; however, the learning process is continuous and consists of the accumulation of distinct stimulus-response pairings.

What is Paraphrenia?

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Introduction

Paraphrenia is a mental disorder characterised by an organised system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) and without deterioration of intellect or personality (its negative symptom).

This disorder is also distinguished from schizophrenia by a lower hereditary occurrence, less premorbid maladjustment, and a slower rate of progression. Onset of symptoms generally occurs later in life, near the age of 60. The prevalence of the disorder among the elderly is between 0.1% and 4%.

Paraphrenia is not included in the DSM-5; psychiatrists often diagnose patients presenting with paraphrenia as having atypical psychosis, delusional disorder, psychosis not otherwise specified, schizoaffective disorders, and persistent persecutory states of older adults. Recently, mental health professionals have also been classifying paraphrenia as very late-onset schizophrenia-like psychosis.

In the Russian psychiatric manuals, paraphrenia (or paraphrenic syndrome) is the last stage of development of paranoid schizophrenia. “Systematised paraphrenia” (with systematised delusions i. e. delusions with complex logical structure) and “expansive-paranoid paraphrenia” (with expansive/grandiose delusions and persecutory delusions) are the variants of paranoid schizophrenia (F20.0). Sometimes systematised paraphrenia can be seen with delusional disorder (F22.0). The word is from Ancient Greek: παρά – beside, near + φρήν – intellect, mind.

Brief History

The term paraphrenia was originally popularised by Karl Ludwig Kahlbaum in 1863 to describe the tendency of certain psychiatric disorders to occur during certain transitional periods in life (describing paraphrenia hebetica as the insanity of the adolescence and paraphrenia senilis as the insanity of the elders.

The term was also used by Sigmund Freud for a short time starting in 1911 as an alternative to the terms schizophrenia and dementia praecox, which in his estimation did not correctly identify the underlying condition, and by Emil Kraepelin in 1912/1913, who changed its meaning to describe paraphrenia as it is understood today, as a small group of individuals that have many of the symptoms of schizophrenia with a lack of deterioration and thought disorder. Kraepelin’s study was discredited by Wilhelm Mayer in 1921 when he conducted a follow-up study using Kraepelin’s data. His study suggested that there was little to no discrimination between schizophrenia and paraphrenia; given enough time, patients presenting with paraphrenia will merge into the schizophrenic pool. However, Meyer’s data are open to various interpretations. In 1952, Roth and Morrissey conducted a large study in which they surveyed the mental hospital admissions of older patients. They characterised patients as having:

“paraphrenic delusions which… occurred in each case in the setting of a well-preserved intellect and personality, were often ‘primary’ in character, and were usually associated with the passivity failings or other volitional disturbances and hallucinations in clear consciousness pathognomonic of schizophrenia”.

In recent medicine, the term paraphrenia has been replaced by the diagnosis of “very late-onset schizophrenia-like psychosis” and has also been called “atypical psychoses, delusional disorder, psychoses not otherwise specified, schizoaffective disorders, and persistent persecutory states of older adults” by psychotherapists.[4] Current studies, however, recognize the condition as “a viable diagnostic entity that is distinct from schizophrenia, with organic factors playing a role in a significant portion of patients.”[4]

Signs and Symptoms

The main symptoms of paraphrenia are paranoid delusions and hallucinations. The delusions often involve the individual being the subject of persecution, although they can also be erotic, hypochondriacal, or grandiose in nature. The majority of hallucinations associated with paraphrenia are auditory, with 75% of patients reporting such an experience; however, visual, tactile, and olfactory hallucinations have also been reported. The paranoia and hallucinations can combine in the form of “threatening or accusatory voices coming from neighbouring houses [and] are frequently reported by the patients as disturbing and undeserved”. Patients also present with a lack of symptoms commonly found in other mental disorders similar to paraphrenia. There is no significant deterioration of intellect, personality, or habits and patients often remain clean and mostly self-sufficient. Patients also remain oriented well in time and space.

Paraphrenia is different from schizophrenia because, while both disorders result in delusions and hallucinations, individuals with schizophrenia exhibit changes and deterioration of personality whereas individuals with paraphrenia maintain a well-preserved personality and affective response.

Causes

Neurological

Paraphrenia is often associated with a physical change in the brain, such as a tumour, stroke, ventricular enlargement, or neurodegenerative process. Research that reviewed the relationship between organic brain lesions and the development of delusions suggested that “brain lesions which lead to subcortical dysfunction could produce delusions when elaborated by an intact cortex”.

Predisposing Factors

Many patients who present with paraphrenia have significant auditory or visual loss, are socially isolated with a lack of social contact, do not have a permanent home, are unmarried and without children, and have maladaptive personality traits. While these factors do not cause paraphrenia, they do make individuals more likely to develop the disorder later in life.

Diagnosis

While the diagnosis of paraphrenia is absent from recent revisions of the DSM and the ICD, many studies have recognised the condition as “a viable diagnostic entity that is distinct from schizophrenia, with organic factors playing a role in a significant portion of patients.” As such, paraphrenia is seen as being distinct from both schizophrenia and progressive dementia in old age. Ravindran (1999) developed a list of criteria for the diagnosis of paraphrenia, which agrees with much of the research done up to the time it was published.

  1. A delusional disorder of at least six months duration characterized by the following:
    1. Preoccupation with one or more semi-systematised delusions, often accompanied by auditory hallucinations.
    2. Affect notably well-preserved and appropriate. Ability to maintain rapport with others.
    3. None of:
      1. Intellectual deterioration.
      2. Visual hallucinations.
      3. Incoherence.
      4. Flat or grossly inappropriate affect.
      5. Grossly disorganised behaviour at times other than during the acute episode.
    4. Disturbance of behaviour understandable in relation to the content of the delusions and hallucinations.
    5. Only partly meets criterion A for schizophrenia. No significant organic brain disorder.

Management

Research suggests that paraphrenics respond well to antipsychotic drug therapy if doctors can successfully achieve sufficient compliance. Herbert found that Stelazine combined with Disipal was an effective treatment. It promoted the discharging of patients and kept discharged patients from being readmitted later. While behaviour therapy may help patients reduce their preoccupation with delusions, psychotherapy is not currently of primary value.

Prognosis

Individuals who develop paraphrenia have a life expectancy similar to the normal population. Recovery from the psychotic symptoms seems to be rare, and in most cases paraphrenia results in in-patient status for the remainder of the life of the patient. Patients experience a slow deterioration of cognitive functions and the disorder can lead to dementia in some cases, but this development is no greater than the normal population.

Epidemiology

Studies suggest that the prevalence of paraphrenia in the elderly population is around 2-4%.

Sex Differences

While paraphrenia can occur in both men and women, it is more common in women, even after the difference has been adjusted for life expectancies. The ratio of women with paraphrenia to men with paraphrenia is anywhere from 3:1 to 45:2.

Age

It is seen mainly in patients over the age of 60, but has been known to occur in patients in their 40s and 50s.

Personality Type and Living Situation

It is suggested that individuals who develop paraphrenia later in life have premorbid personalities, and can be described as “quarrelsome, religious, suspicious or sensitive, unsociable and cold-hearted.” Many patients were also described as being solitary, eccentric, isolated and difficult individuals; these characteristics were also long-standing rather than introduced by the disorder. Most of the traits recognised prior to the onset of paraphrenia in individuals can be grouped as either paranoid or schizoid. Patients presenting with paraphrenia were most often found to be living by themselves (either single, widowed, or divorced). There have also been reports of low marriage rate among paraphrenics and these individuals also have few or no children (possibly because of this premorbid personality).

Physical Factors

The development of paranoia and hallucinations in old age have been related to both auditory and visual impairment, and individuals with paraphrenia often present with one or both of these impairments. Hearing loss in paraphrenics is associated with early age of onset, long duration, and profound auditory loss.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Paraphrenia >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Paranoia Network?

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Introduction

The Paranoia Network, founded in November 2003, is a self-help user-run organisation in Sheffield, England, for people who have paranoid or delusional beliefs.

Background

In contrast to mainstream psychiatry, that tends to see such beliefs as signs of psychopathology, the Paranoia Network promotes a philosophy of living with unusual and compelling beliefs, without necessarily pathologising them as signs of mental illness. It was partly inspired by the Hearing Voices Network’s approach to auditory hallucinations.

What would otherwise seem to be a relatively minor disagreement over theory is complicated by the fact that people diagnosed as delusional can often be detained under mental health law and treated without their consent. Therefore, many of the criticisms of the diagnosis or definition have important ethical and political implications, which often leads to heated public debate.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Paranoia_Network >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What was the New Freedom Commission on Mental Health?

Published on by Andrew Marshall3 Comments

Introduction

The New Freedom Commission on Mental Health was established by US President George W. Bush through Executive Order 13263 on 29 April 2002 to conduct a comprehensive study of the US mental health service delivery system and make recommendations based on its findings. The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.

The President directed the Commission to identify policies that could be implemented by Federal, State and local governments to maximise the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance. The commission, using the Texas Medication Algorithm Project (TMAP) as a blueprint, subsequently recommended screening of American adults for possible mental illnesses, and children for emotional disturbances, thereby identifying those with suspected disabilities who could then be provided with support services and state-of-the-art treatment, often in the form of newer psychoactive drugs that entered the market in recent years.

A broad-based coalition of mental health consumers, families, providers, and advocates has supported the Commission process and recommendations, using the Commission’s findings as a launching point for recommending widespread reform of the nation’s mental health system.

A coalition of opponents questioned the motives of the commission, based on the results from a similar 1995 Texas mandate while Bush was Governor. During the Texas Medication Algorithm Project mandate, psychotropic medication was wrongfully prescribed to the general public. Specifically, TMAP and drug manufacturers marketed ‘atypical antipsychotic drugs’, such as Seroquel, Zyprexa, and others, for a wide variety of non-psychotic behaviour issues. These drugs were later found to cause increased rates of sudden death in patients.

In addition to atypical antipsychotic drugs, earlier versions of psychotropic medications, including Prozac, were found to sharply increase rates of suicide, especially during the first month of drug use. Also during TMAP, psychotropic medication was wrongfully prescribed to people not suffering from mental illness, including troublesome children and difficult elderly people in nursing homes. In 2009, Eli Lilly was found guilty of wrongfully marketing Zyprexa for non-psychotic people.

Opponents also assert the New Freedom initiative campaign is a thinly veiled proxy for the pharmaceutical industry to foster psychotropic medication on mentally healthy individuals in its pursuit of profits. Opponents also contend that the initiative’s wider objectives are to foster chemical behaviour control of American citizens, contrary to civil liberties and to basic human rights.

Reports

Interim Report

The commission issued an interim report on 01 November 2002. Findings in the report included estimated prevalence of severe mental illness among adults and severe emotional disturbance in children, the existence of effective treatments, and barriers to care.

Final Report

On 22 July 2003, the President’s commission returned a report containing nineteen formal recommendations, organised under six proposed national goals for mental health. The commission emphasised recovery from mental illness, calls for consumer and family-centred care, and recommendations that states develop a more comprehensive approach to mental health.

The commission reported that “despite their prevalence, mental disorders often go undiagnosed,” so it recommended comprehensive mental health screening for “consumers of all ages,” including preschool children, because “each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders.”

In contradiction, the Congressional Research Service, stated the commission did not specifically recommend a nationwide screening programme for mental illness, while it did discuss the need to identify mental illness in certain settings (juvenile detention facilities, foster care). The commission also recommended deeper study of the safety and effectiveness of medication use, especially among children.

Recommendations

Noting the country’s services for people with mental illness and disabilities were “fragmented,” the commission’s final report offered 19 recommendations within six larger goals to improve service coordination, move toward a recovery model, and help all individuals with mental illness and disability recover:

  • Americans Understand that Mental Health Is Essential to Overall Health.
    • Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.
    • Address mental health with the same urgency as physical health.
  • Mental Health Care Is Consumer and Family Driven.
    • Develop an individualised plan of care for every adult with a serious mental illness and child with a serious emotional disturbance.
    • Involve consumers and families fully in orienting the mental health system toward recovery.
    • Align relevant Federal programmes to improve access and accountability for mental health services.
    • Create a Comprehensive State Mental Health Plan.
    • Protect and enhance the rights of people with mental illnesses.
  • Disparities in Mental Health Services Are Eliminated.
    • Improve access to quality care that is culturally competent.
    • Improve access to quality care in rural and geographically remote areas.
  • Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice.
    • Promote the mental health of young children.
    • Improve and expand school mental health programmes.
    • Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies.
    • Screen for mental disorders in primary health care, across the life span, and connect to treatment and supports.
  • Excellent Mental Health Care Is Delivered and Research Is Accelerated.
    • Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illnesses.
    • Advance evidence-based practices using dissemination and demonstration projects and create a public–private partnership to guide their implementation.
    • Improve and expand the workforce providing evidence-based mental health services and supports.
    • Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care.
  • Technology Is Used to Access Mental Health Care and Information.
    • Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.
    • Develop and implement integrated electronic health record and personal health information systems.

Opposition

Opponents of the plan see little in the way of potential benefits from the plan, except increased profits for pharmaceutical companies, and have concerns about the potential for unnecessarily causing neurological damage and contributing to increased substance abuse and drug dependence. Critics are also concerned by what they see as the pharmaceutical industry’s use of front organisations and the compromise of scientific integrity under colour of authority, look askance at the irony of the commission’s ‘freedom’ descriptor, contending the commission is yet another example of the excesses of drug industry marketing, and that the effects of its recommendations will simply foster drug use rather than the prevention of mental illness and use of alternative treatment modalities.

Screening Recommendations

Mad in America author Robert Whitaker criticized the commission’s screening recommendations as “fishing for customers.” A coalition of over 100 advocacy organisations, united under the banner of Mindfreedom.org in representing the psychiatric survivors movement, has been galvanised by their strong opposition to the New Freedom Commission. Using celebrity to advance their opposition, the MindFreedom coalition has again enlisted the support of long-time member and Gesundheit Institute founder Patch Adams, a medical doctor made famous by the movie that bears his name. Since 1992, Adams has supported MindFreedom campaigns, and in August, 2004, he kicked off the campaign against the New Freedom Commission by volunteering to screen President Bush himself. “He needs a lot of help. I’ll see him for free,” said Adams.

Others, including Congressman Ron Paul (R-TX14), were more concerned by the commission’s suggestion to use schools as a site for screening. Paul’s concern led to the introduction of H.R. 181 Parental Consent Act of 2005 in the US House of Representatives on 04 January 2005. The bill, which died in committee, would have forbidden federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents. Paul introduced similar bills in May 2007 (H.R. 2387), April 2009 (H.R. 2218), and August 2011 (H.R. 2769); those, likewise, died in committee.

TMAP Origin Criticism

Critics also contend that the strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.

TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in prisons and State psychiatric hospitals. The person primarily responsible for bringing these issues to the public’s attention is Allen Jones, a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.

Jones wrote a lengthy report in which he stated that, behind the recommendations of the New Freedom Commission, was the “political/pharmaceutical alliance.” It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive antipsychotics and antidepressants. He further claimed this alliance was “poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab.”

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/New_Freedom_Commission_on_Mental_Health >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.