26% OF THE US POPULATION IS EXPERIENCING MENTAL HEALTH PROBLEMS?

The Holy Inquisition was regarded as we today regard the practice of psychiatry. A heretic was a very sick man. He was much to be pitied because he held a false view he was doomed to suffer forever in the most exquisite torture chamber ever imagined. Think of entertaining that idea as seriously as we regard ... schizophrenia today. We feel that in curing a person of disease almost anything is justified: ... people undergoing shock treatment; people locked in the colorless, monotonous corridors of mental institutions not knowing if they will ever get out because they cannot understand what is expected of them, and the psychiatrists do not know either. It is kind of Kafka-like nightmare. We think these ... psychiatrists are very good people, that they are righteous men working to alleviate human suffering. Well, they thought exactly the same thing about the Inquisitors. In all good faith, they knew that witchcraft and heresy were terrible things, awful plagues imperiling people's souls forever. Any means were justified to cure people of heresy; and we have not changed. We are doing the same thing today but under different names. We can look back and see how evil that was, but we cannot see it in ourselves.

When reforms are needed, the phrase "There is no reason to reinvent the wheel" is often given to prevent reforms and maintain the status quo. While the wheel does not need to be reinvented, periodic maintenance, including checking the alignment, rebalancing the wheels, and checking the pressure and wear on the tires to see if they need replacement, is required. This needs to be done in the mental health system as soon as possible, preferably today.

Drugs have played an important role for many who have received a mental health diagnosis, but most of the scientific advancements made outside the field of pharmaceuticals have largely been overlooked, ignored, or dismissed by many in the forefront of the mental health system, causing needless suffering by many. Recovery from mental illness should and can be the norm while the prevention of the various mental illnesses is within reach, but it cannot and will not happen as long as drugs are the primary—and often the only—option considered.

Mental Disorders Are Common

Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older—about one in four adults—suffer from a diagnosable mental disorder in a given year.

When applied to the 2004 US Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.

Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion—about 6 percent, or 1 in 17—who suffer from a serious mental illness. In addition, mental disorders are the leading cause of disability in the US and Canada. Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.

We are at a crossroads: One path leads to greater cooperation and harmony among the peoples not just of this nation but of the world. The other path leads to greater conflicts and disharmony with individuals, nations, religions, and corporate entities insisting they are superior to all others and therefore have the right to impose their will on all others.

There has been much research in various scientific fields regarding mental health. While there are differences in approach and perspective, nearly all agree that it is a combination of factors that produces good mental health.

Psychology originally focused on the ego and unconsciousness as the source of anxiety and stress, which meant that anxiety and stress were considered a product of social conditioning. On the other hand, neurologists have followed a trail that leads to the interaction of certain parts of the brain as a source of the emotions, while physiologists focused on the role of the nervous system in stress and anxiety. Yet another group of researchers—psychobiologists—focused on the neuropeptides and other chemicals generated in the brain and transmitted throughout the body as a major contributor to stress and anxiety ... it's becoming increasingly clear that these different routes of research into how we experience stress, anxiety, and trauma are leading us to the recognition that body and mind are intricately linked.

Overlooked Medical Ailments in Psychiatric Populations

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), cautions against using the manual in a cookbook fashion, yet many in the field of mental health use it exactly that way. The problem of overlooked medical ailments in psychiatric populations was so significant that by 1988 the California legislature mandated an exploration into a means of reducing the risk of missed medical conditions. Lorrin Koran, MD, of Stanford University was tasked with leading the development of a corrective procedure. The results of his team's work were reported to the California Department of Mental Health and local mental health programs in 1991 as the Medical Evaluation Field Manual.

The mental health system had detected 58 percent of test-group patients with a disease at a cost of $230 per patient. Many mental health programs are not staffed with physicians practiced in medical diagnosis and thus are unprepared to detect a large proportion of physical diseases in their patients. As described elsewhere, California's state mental health programs fail to detect many diseases that could be causing or exacerbating psychiatric disorders.

The Koran Algorithm

The Koran screening algorithm has several appealing characteristics:

1. It is limited to those findings that best predict the presence of physical disease in a sample of patients cared for within the California public mental health system.

2. It saves the effort and expense of gathering data that may not help in detecting physical disease.

3. The data used in the algorithm can be obtained by mental health staff and do not require a physician, nurse, or physician assistant.

In 1995 a study found that from 5–40% of psychiatric patients have medical ailments that would adequately explain their symptoms. The next year, in 1996, Sydney Walker III, MD, a psychiatrist, in his book A Dose of Sanity, claimed studies have shown that from 41% to 75% of individuals are initially misdiagnosed, often due to overlooked treatable conditions. In 2009, it was found that up to 25% of mental health patients have medical conditions that exacerbate psychiatric symptoms. Yet most of the debate today centers on forcing drugs on individuals, not providing adequate diagnosis and effective treatment.

Walker points out that the DSM has encouraged practitioners to label patients quickly rather than pursue the more time-consuming deductive work of differential diagnosis. According to Walker, labeling leads to fitting patients into groups rather than treating them as the individuals they are, carefully taking medical histories, and performing physical examinations—all of which being absolute requirements for a valid diagnosis. Walker presents many appalling examples of patients who were routinely assigned DSM labels that then became masks for such often dangerous physical diseases as bowel blockage, lupus, brain tumors, and Tourette's and Klinefelter's syndromes. Walker stresses that many of the masked diseases are treatable if caught early and that many of the drugs psychiatrists prescribe are dangerous or addictive.

Ruling out the various physical ailments that can cause or exacerbate psychiatric disorders needs to be done prior to labeling a person as mentally ill. This label negatively impacts individuals for decades after he or she has made a complete recovery—even if the label was applied erroneously.

Recommendation

The Koran algorithm should be used regularly at emergency rooms when people are brought in for evaluations, as well as before anyone is committed to a psychiatric hospital or is sent to prison. Ideally the Koran algorithm should be performed by general practitioners every three to five years, beginning around puberty and continuing to middle age, when the onset of mental health problems begins to wane. Perhaps it should again be periodically performed when individuals enter their senior years.

According to the International Classification of Functioning, Disability, and Health (ICF), the medical model views disability as a problem of the person directly caused by disease, trauma, or other health condition that requires medical care provided in the form of individual treatment by professionals. Management of the disability is aimed at cure or the individual's adjustment and behavior change. The social model of disability sees the issue mainly as a socially created problem and a matter related to the full integration of individuals into society.

According to the social model, disability is not an attribute of the individual, but rather a complex collection of conditions, many of which are created by the social environment: the approach to disability requires social action and is a responsibility of society.

The National Institutes of Health in May 2013 declared the methods of American psychiatry as "lacking in validity" and stated that "patients deserve better." Their key criticism was they have no objective test showing that their diagnoses are right. While a growing number of psychologists and psychiatrists decry the actions and even the motives of many within the APA, a large percentage of psychiatrists, in less than fifteen or often less than five minutes of speaking to an individual, prescribe powerful mind-altering drugs to those who have come to them for help. Patients do deserve better.

Currently, the diagnosis of mental disorders is based on clinical observation—identifying symptoms that tend to cluster together, determining when the symptoms appear, and determining whether the symptoms resolve, recur, or become chronic. However, the way that mental disorders are defined in the present diagnostic system does not incorporate current information from integrative neuroscience research, and thus is not optimal for making scientific gains through neuroscience approaches.

Trauma as a Factor in Mental Health Diagnoses

Trauma is a factor for the overwhelming numbers of people who have received a mental health diagnosis. "Trauma exposure has been linked to later substance abuse, mental illness, increased risk of suicide, obesity, heart disease, and early death." Unfortunately, the silo mentality that has developed in the mental health system has worked to prevent the various nondrug trauma treatments from being more well-known.

The research into trauma can be quite enlightening for anyone interested in reducing the number of individuals with mental health diagnoses, using illegal drugs, committing suicide, or having other health problems, yet the APA ignored trauma symptoms except in the section on posttraumatic stress disorder (PTSD) in the 2013 release of the DSM-V. The various symptoms of trauma nearly mimic all the diagnoses in the DSM series with variations often easily explained by individual stress responses and personality type.

When a traumatic event occurs, the individual feels overwhelmed and the experience seems unbearable. However it is precisely because of this overwhelming experience that the individual is forced out of their old way of thinking into a new way of being in the universe. Mahatma Gandhi, Nelson Mandela, Martin Luther King, Mother Theresa, all experienced trauma and used their painful encounters to develop a more moral and ethical response to their traumatic circumstances. Their lives demonstrate to us that the trauma recovery process contains the possibility of helping the human person develop into a more moral and ethical species. If we can repeat this process for thousands or millions of people, we can use the transforming power inherent in the trauma recovery process to transform the ethical and moral foundations of the human person.

Several proven nondrug methodologies are available to treat trauma, including Somatic Experiencing (SE), Eye Movement Desensitization and Reprocessing (EMDR), and Tension and Trauma Releasing Exercises (TRE) developed by David Berceli, PhD.

The Wellness Recovery Action Plan (WRAP), devised by Mary Ellen Copeland is recognized by the Substance Abuse Mental Health Services Administration (SAMHSA) as an evidence-based practice, yet few outside the peer networks know much about it. In my opinion, WRAP is especially helpful when a trauma occurred at a young age, yet its primary focus is helping individuals plan for their recovery, including the reduction of symptoms.

At least 75% of children in the juvenile justice system have experienced traumatic victimization. As many as 50% of these youth may have symptoms of Post-Traumatic Stress Disorder. 93% of children in detention report exposure to adverse events. These adverse and potentially traumatic events include accidents and serious illnesses, physical abuse, sexual abuse, neglect, traumatic loss, domestic and community violence, growing up in a household with an alcohol or drug abuser, an incarcerated household member, someone who is chronically depressed, suicidal, institutionalized or mentally ill ... Exposure to these adverse experiences increases a youth's risk for: Major Mental Illness; Substance Abuse; AIDS and Sexually Transmitted Diseases; Impaired Physical Health; Academic Difficulties; Early Death.

Trauma can result in shrinkage of the hippocampus which is adjacent to the amygdala, and can be considered the emotional center of the brain. This shrinkage affects the communication between areas of the brain and is responsible for heightened fear and anger responses. For this reason it is recommended that individuals who have experienced significant trauma take courses on managing anger. (Chapter 2 contains information on Transforming Anger.)

Most would agree that war, rape, betrayal or abandonment during childhood, severe emotional, physical, or sexual abuse—neglect, or catastrophic injury and illness can cause trauma. But were you aware that less obvious incidents, such as minor auto accidents, invasive medical and dental procedures, falls, minor injuries, natural disasters, illness, young children who are left alone, prolonged immobilization, exposure to extreme heat or cold, sudden loud noises, and even the stress of birth to both infant and mother can cause trauma?

According to Healing Trauma, by Peter Levine, PhD, all of the above can be causes of trauma. Dr. Levine relates in his book how he became interested in trauma. A man had gone into a convenience store at 6:30 in the morning on July 5th, and held it up for a few dollars, showing only a protrusion from his jacket pocket where his hand was. He then went to his car and waited for the police who arrested him without any resistance. As they were booking him, they noticed he was a Vietnam vet, and had been arrested several times before, every time on July 5th at 6:30 in the morning, and every time he had waited in his car for the police to show up. He was sent to a mental health facility where it was discovered that on July 4th, his entire squad had been killed except for himself and one other, who had been severely wounded. It was at 6:30 the morning of the 5th when a rescue helicopter showed up. About the same time, his buddy also died.

A compulsion can develop to repeat the actions that caused the problem in the first place. We are inextricably drawn into situations that replicate the original trauma in both obvious and less obvious ways ... We may find ourselves re-experiencing the effects of trauma either through physical symptoms or through a full-blown interaction with the external environment.... Once he became aware of his feelings and the role the original event had played in driving his compulsion, the man was able to stop re-enacting this tragic incident.