PsychiatryTalk – Page 2 – by Dr. Michael Blumenfield

Getting The Most From Your Therapy- Interview with Jeffery Smith , M.D.

I am moving to a new phase of this blog. From time to time I will interview a person who I think might be of interest to the readers of this blog.

I am very pleased to interview psychiatrist Dr. Jeffery Smith who is the author of a new exciting book titled Getting the Most From Your Therapy- Become An Educated Consumer. Dr. Smith received his medical degree from UCLA and did his residency in Psychiatry at Albert Einstein Medical School in New York. He is an Associate Clinical Professor of Psychiatry at New York Medical College where I first met him before I came out to California. He has written two other books and has a blog about psychotherapy. The following interview is 35 minutes.

Any comments are welcome below. Please click the line below to listen to the interview : Interview with Dr, Jeffery Smith

What She Left Behind by Ellen Marie Wiseman (Book Review)

What She Left Behind

By Ellen Marie Wiseman

This book is composed of two interweaving stories. Clara, a woman who lived in the 1930s was committed to a mental institution against her will based on her wealthy father’s unhappiness about her Italian immigrant boyfriend and her refusal to marry the rich guy that her father picked out for her. The other story is about a current day teenager named Izzy who is a foster child of Peg and Harry after having lived with several previous foster parents since her mother unexplainably murdered her father. Peg is working on a museum project examining newly discovered suitcases of belongings of former patients (including those of Clara) of a now closed psychiatric facility, in order to gain some understanding of their lives. Izzy helps out with this project and finds the diary of Clara and becomes interested in her life.

Being a psychiatrist, I was initially drawn to this book with the idea that I would gain some insight into the lives and treatments of psychiatric patients living in the first half of the twentieth century. This was the case and it included vivid description of the treatment that was done at that time such as ice baths, insulin shock therapy and electroconvulsive therapy (ECT).

Although I never worked in a state hospital, when I toured them in the late 1960s, such treatments except occasional ECT under humane conditions were things of the past. As far as the possibility of someone spending most of their life committed to a mental institution based on the word of her father when she clearly did not have a mental illness, I would like to think that this would not have been possible. Certainly, in modern times from my experience someone being hospitalized against their will would have to go through a legal hearing with the patient being assigned an attorney if they don’t have one. Once in a hospital with treatment with modern-day medicines (which were not really available until the 1950s) most mental illness can be put at least in temporary remission with such treatment. Today, there would be reviews by multiple doctors with no mandate to keep the person in the hospital against their will unless they were a danger to themselves or others due to a mental illness. I would hope that nothing like Clara’s situation could occur today. Obviously, I can’t speak for every state hospital in the United States and certainly things were different in the 1930s.

There was another aspect of Clara’s case was particularly disturbing to me in that the psychiatrist in charge of her care was depicted as a mean, cruel, selfish man who was mainly responsible for Clara’s lost life. I felt it was an unfair indictment, which suggested all psychiatrists of that time might have been of the same cloth. I understand that the author has the creative choice to develop characters in whatever fashion she chooses. I probably would not be complaining if the character were a dishonest lawyer who did unsavory things in the interest of an interesting storyline but nevertheless, I felt that this book was stigmatizing my profession.

There was particular theme of this book, which also had a special interest to me. Three characters in the book were driven to try to understand their early origins. Izzy, understandably could not fathom why her beloved mother murdered her father. This ultimately led her to empathize with a schoolmate who had some parental trauma. It contributed to her mission to find Clara’s daughter who was essentially separated from her at birth, and hand over her mother’s diaries so she could know about her mother’s story. Clara’s daughter led a life of yearning to know what happened to her mother and Clara similarly went through life wanting to know what happened to her daughter. This is a variation of a theme, which I have seen played out in many people’s lives as well as in some interesting movies. Persons, sometimes separated at birth or when they are quite young often yearn to know their biological parent or parents with whom they may have had no relationship for decades. I have reflected on the psychodynamics of these issues in an earlier posting in this blog. Therefore, I was particularly interested to see how they played out as major motivating factors in the characters in this book.

I believe the author Ellen Wiseman has created an intriguing story that will hold the interest of the reader whether or not you come from a psychiatric background.

A Common Struggle: A Personal Journey through the Past and Future Mental Illness and Addiction By: Patrick J. Kennedy and Stephen Fried ( Book Review by Dr. Blumenfield)

A Common Struggle: A Personal Journey through the Past and Future Mental Illness and Addiction By: Patrick J. Kennedy and Stephen Fried

This is a story, told in the first person of Patrick J. Kennedy. It is really two stories presented to us simultaneously. It is about Patrick Kennedy, son of Edward Kennedy and nephew of JFK and Bobby Kennedy. He has been a US congressman from Rhode Island for eight terms and was one of the staunch advocates for parity legislation, for mental illness, and addiction. Yet at the same time that he was leading the fight in the United States Congress to bring about these major changes in our healthcare system, he himself was secretly battling mental illness and addiction.

An important part of his personal story was a discussion of alcoholism in his family. Not only was the author an alcoholic but his brother, mother, and father, Ted Kennedy also struggled with this condition. It is significant that all of them except his father ultimately recognized their problem and entered various programs to help themselves. His mother battled alcoholism for a prolonged period of time and yet her condition was not recognized by family members despite the fact that they knew about several hospitalizations and treatment programs that she had undergone.

One of the most revealing insights about his father that he revealed in this book is how Ted Kennedy was traumatized by the tragic death of his three brothers, JFK, Bobby Kennedy, and his oldest brother, Joe Jr., who was killed in World War II. An additional major trauma for Ted Kennedy was the death of the young woman in Chappaquiddick, an incident well covered by the press.

It was not a simple pathway for the author to recognize his own problems. Even after a period of therapy with Psychiatrist Peter Kramer, author of the well known book (Listening to Prozac). Kennedy felt this treatment was helpful but did not eliminate his addiction problem or allow full acceptance of his bipolar condition. He vividly described how he would convince himself that he didn’t have any problems if he didn’t drink in public or take “illegal” drugs.

Patrick Kennedy served in the Rhode Island legislature and was elected as the youngest member of the US Congress in 2004 during a period that his addiction and mental illness was hidden from the public. It was also pretty much hidden from himself.

His colleagues in the US Congress ultimately became aware of his attempts to hide his drinking problem. Kennedy describes an important event for him when in 1996, Minority Leader, Dick Gephardt, offered him the prestigious chairmanship of the Congressional Campaign Committee on the condition that he stop drinking. This made him realize how he was denying that he had a problem that was known to others.

It wasn’t until 2005 that he publicly admitted that he was suffering from a mood disorder that was being treated by a psychiatrist. While his own struggle continued, he became more effective in his advocacy in the US Congress. One misconception he believed had to be clarified concerned Nancy Reagan’s “Just Say No” campaign against drugs. He felt that this missed the main point that addiction is not something you can simply say no to, just as you can’t say no to cancer. It is a disease and by implying you can just say no stigmatized people who have the genetic propensity to have this disease.

As much as the story of Kennedy’s recognition of his own illness of addiction and mental disease and how he battled it is quite enlightening, the battle for a definitive bill in the US Congress is just as revealing.

The events leading up to the 2008 Wellstone and Domenici Mental Health Parity and Addiction Equity Act are quite interesting and complicated. They are also quite personal to Patrick Kennedy. It took place at the time that he was relapsing to alcohol and painkillers and also was having an exacerbation of his bipolar condition. While Patrick Kennedy was one of the leading champions in the House of Representatives for this legislation, his father, Ted Kennedy, was a major supporter of this bill in the US Senate. This was also at a time that the senior Kennedy was dying of a brain tumor. Compromises had to be made in the bill and the Senate was reluctant for the legislation to be as comprehensive in various aspects and details of the bill as was wanted by the House of Representatives. There also was a question how the legislation would deal with the new surge of mental health problems occurring in soldiers returning from the war. There was a concern that it should cover PTSD as well as addiction in the returning servicemen. Patrick Kennedy described the dramatic moment that his dying father came to the senate floor to vote for the final version of the bill to the applause of the US Senate.

Even with the passage of this extraordinary legislation, the battle for adequate parity for healthcare support was far from over. The proof and the success of this landmark bill would depend on the implementation by the federal and state governments and certain local rulings are expected to eventually reach the Supreme Court. The 2016 presidential race can certainly also be expected to impact the success of implementation of this legislation. As of this writing, it appears that the Republican candidates may be reluctant to support the implementation of this legislation and provide funding for new programs.

Patrick Kennedy decided to leave the United States Congress in 2010. Since departing from Congress, he has continued to be a leading advocate to bring about implementation of the 2008 legislation for mental illness and addiction. In this regard, among many other things, he has worked with two important organizations in which he plays very active roles. The Kennedy Forum (kennedyforum.org) gathers experts in mental health and addiction and holds important conferences that they hope will ensure implementation of the 2008 legislation. They are also committed to promoting a translation of neuroscience into the preventative and treatment interventions for mental health and addiction. The second organization in which Patrick Kennedy is involved is One Mind (onemind.org), which is dedicated to the promotion and support of “brain health” and creating a fast track for treatment. Their current focus is on new approaches to treat and cure PTSD but they look forward to applying solutions for all brain disease including depression, Parkinsons, ALS, dementia, Alzheimer’s disease, and addictions.

Patrick Kennedy does not bemoan problems. He is clearly a man not only with a vision but with plans and solutions. He concluded his book with a scorecard of how we should rate our public officials who have the opportunity to pass legislation and make changes. Also at the end of the book, he had a section for people who are dealing with their own mental illness and addiction. He tells them not to be alone in this struggle and how important it is to get treatment. Finally, sandwiched in this book was a series of photographs of many well known members of his family. It brought back many memories to this reader of the great accomplishments of many members of the Kennedy family and of the tragic events that they experienced.

It should be noted that at the time that Patrick Kennedy wrote this book, he was three and a half years sober. He has shown that he is a very accomplished and insightful man. I believe we are going to hear a great deal about him in his advocacy. He has provided in this book a valuable historical account of the reasons to fight for the proper care of mental illness and addiction. I am sure he has a bright future and many people will benefit by his skills and his passion.

Review of Newly Released DVD: Robert Wallerstein: 65 Years at The Heart of Psychoanalysis

Robert Wallerstein: 65 Years at the Heart of Psychoanalysis – Interviewed and Produced by Shelley Nathans (Available in DVD and streaming from www.psychotherapy.net)

If you are a psychoanalyst, a psychoanalytically oriented psychiatrist, mental health professional or a student of psychoanalysis, you will appreciate this interview with Dr. Robert Wallerstein by Dr. Shelley Nathans. It presents Dr. Wallerstein as a warm, knowledgeable man who understands the legacy of his profession.

Dr. Wallerstein was born in Germany in 1921 and came to New York City with his mother at age two, to join his father, a physician who had come the previous year. He grew up in the depression and recalled apples being sold by grown men for five cents apiece in order to make a living. He graduated from high school at the age of 15 and was sent to live with his uncle in Mexico City and then returned to Columbia University, graduating in 1941 at the age of 20. After medical school, he joined the army as the war was ending. He then took his psychiatric and psychoanalytic training at Menninger Clinic. His years at the Menninger Clinic, of course, are quite intriguing. I never realized that the program there had at one time 100 residents, which was one-eighth of the total number of psychiatric residents in the United States. He notes that during his psychiatric residency, the main tools to treat severe mental illness were Chloral Hydrate, ECT and lobotomies.

Although his training was in the United States, he was a witness and then a participant in the growth of psychoanalysis in this country. In the interview, Dr. Wallerstein was able to trace the plight of Jewish psychoanalysts in Germany and then in Austria, who during the pre-World War II years were not able to take Arian patients and then ultimately had to leave their native country. American psychoanalysts set up funds to bring these psychoanalysts to the United States, mostly to New York. Dr. Wallerstein described the fascinating details of this situation and also spoke of the German, probably Nazi oriented psychoanalysts, who came to Brazil and the unusual circumstances that happened in that country in the post-war years. He had occasion to conduct an investigation into the details of this situation in the 1980s.

As a faculty member at the Menninger Clinic he proudly described hiring a young psychiatrist from Chile by the name of Otto Kernberg. He also discussed his two personal analyses and candidly admits that he felt that they could have gone further than they did. He tells about meeting his wife Judith and her career as a well-known researcher who studied and wrote about the impact of divorce on children.

Dr. Wallerstein was barely at his mid-career when he moved to San Francisco in 1966 and became established at Mt. Zion Hospital. Perhaps, his greatest insights into the psychoanalytic world came during his front row seat as President of the American Psychoanalytic Association and then President of the International Psychoanalytic Association. He describes the famous “lawsuit” which, of course, was a turning point in allowing non-psychiatrist to join the American Psychoanalytic Association and take an equal role in psychoanalysis in the United States. From his unique perspective, Dr. Wallerstein was able to reflect on the roles of different schools of psychoanalysis and their influence in the United States and even labeled Anna Freud’s recognition as the “crown princess.”

Dr. Shelley Nathans showed excellent technique in her interview as she stayed out of the way of Dr. Wallerstein and gently led him to new topics. This interview was done in July 2013 one and half years before Wallerstein died. While this DVD was only 1 hour and 22 minutes, there are a total of over five hours of the interview with him available in the archives. We are very appreciative of the efforts of the team led by Dr. Nathans that captured this interview and most of all, to Dr. Robert Wallerstein for his many contribution to our profession.

To learn more information about obtaining this and other related videos, contact psychotherapy.net

Psychiatric Ethical Position on Role of Psychiatrists in the Interrogation and Torture of Prisoners

The ethical position of the American Psychiatric ( APA) Association and the code of ethics for psychiatrists about torture came to prominence about 10 years ago when I was Speaker of the Assembly of the American Psychiatric Association. At this time the Assembly endorsed the position of the Board of Trustees of the APA about this issue. Recently this topic has surfaced again as described in the article below in the the APA News . I would suggest that this article should be read and then for further clarification I would like to present a video interview that I had in 2009 with the late Dr. Abraham Halpern. Dr. Halpern was a prominent American psychiatrist who was leading spokesperson on number of ethical issues.

And now please view the interview that I did with Dr. Halpern on this subject in October 2009. https://www.youtube.com/watch?v=oULhHzC8E_8

Please feel free to add any comments that you have about this subject in the comment section below and they will be published shortly.