The American Psychiatric Association will hold its annual meeting in San Francisco from May 18-22. This year the theme is "Pursuing Wellness Across the Lifespan."
In reviewing the meetings, programs, courses, lectures, scientific sessions, symposia, workshops, etc., what stood out for me was the state of the art and science in psychiatry, not to mention a big introduction of the much anticipated, much needed and highly controversial APA and insurers' bible, The Diagnostic and Statistical Manual of Mental Disorders -- fifth edition, aka DSM 5.
I am confident that within a couple years time, the controversies and debates will settle down and it will be a highly useful, though clearly imperfect, publication that will serve the profession, patients and insurers well.
However, what also struck me is the discrepancy between the aspirational theme of "Pursuing Wellness Across the Lifespan" and a conference and profession that still has a long way to move from a pathology-based to a wellness-based identity.
Stigma is sadly alive and well at a time when there are more effective treatments for mental disorders than ever. The sadness is that there is still a high and unacceptable percentage of people walking around with treatable mental illnesses that will never seek treatment, not the least of all are our returning military who have sacrificed so much for all of us and are riddled with as much invisible wounds of war, and taking their lives at an alarming rate, as they are with physical wounds.
Stigma is a fear-based way of identifying groups of people as "other than" and threatening to us and of thereby justifying keeping them at arm's length. Despite all the protests of mental illness being a physical and brain disease and something that should be treated as such and with parity when compared to physical medical illness, the irrational fear-based view of mental illness remains.
I think this greatly adds to people's reluctance to admitting they have a mental disorder because to do so means owning up not to having a treatable illness but to being a pariah that society does its best to shun.
Over the past couple years I have stopped my clinical psychiatric practice after 35 years and have been searching for anything that will lessen the stigma and that will cause those with mental disorders to seek and receive treatment.
In that time it has been my good fortune to become closely acquainted with the LEAP Institute and the Life Adjustment Team.
The LEAP Institute is the creation of New York-based psychologist Dr. Xavier Amador, who searched for a way to reach his schizophrenic brother or at least a way to have him accept treatment. Like many with that disorder, Amador's brother had something called anosognosia, which is a deficit in the self-awareness of a condition. This is one of the greatest contributors to people with schizophrenia refusing treatment and the medications that might help them.
Amador's LEAP method stands for: Listen, Empathize, Agree and Partner. With it, he was able to reach his brother and get his brother to accept medication even though his brother never quite accepted that he had an illness. Amador explains the reason for that being that the anosognosia is one of the symptoms of schizophrenia. And just as you wouldn't yell at a diabetic for having elevated blood sugar, it is just a ludicrous to lecture a schizophrenic on their denial of their illness when that is one of the very symptoms. The LEAP method is now being taught widely across the United States and beyond and is finding application wherever people are trying to overcome other people's resistance to doing anything that is in their best interest. Amador is due to participate at this year's meeting in the symposia, entitled Assessment and Intervention for Domains of Schizophrenias, that will be led by Charles Schulz, M.D., head of the department of psychiatry at the University of Minnesota.
The Life Adjustment Team (LAT) is a Southern California-based program that has provided psychosocial rehabilitation for over 30 years. In that time, they have greatly reduced the relapse and re-hospitalization rates of their clients and have greatly increased the adherence to psychiatric treatment and compliance in following their psychiatrist's treatment recommendations that include taking their medications. These issues have dogged the psychiatric profession for decades. This explains why their greatest source of referrals are psychiatrists and psychiatric hospitals who use LAT essentially as a "hospital without walls."
The secret to LAT's success is the dedication of their highly-committed case managers and the fact that they treat their clients where they live in their homes or sober living facilities, taking them to their doctor's appointments, involving them in activities that psychologically unlock them and coaching, mentoring and teaching them how to be productive and in doing so, to feel increased self worth and, even more importantly, hope. LAT is also participating in this year's convention as an exhibitor.
LAT is primed to expand geographically due to the dramatic increase in demand for a time proven program that greatly reduces recidivism in severe mental disorders.
I single out these programs as two participants at this year's APA meeting that are most aligned with the theme of "Pursuing (and delivering) Wellness Across the Lifespan." The secret sauce that they both have in common is that their clients do not feel like patients with a demeaning stigma prone mental disorder label. Instead, their clients feel like people with messed-up lives, to which there is no stigma, because that describes all of us to a greater or lesser degree.
For more by Mark Goulston, M.D., click here.
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