The Difficulties of Accessing Effective Treatment: OCD as an Example

I resonated with a recent article in Psychology Today about the difficulties people have in finding therapists who offer effective treatment. The authors Dean McKay and Scott Lilienfeld—especially Dr. Lilienfeld—have been extremely active in promoting science-based psychotherapies.

As an example, they offer the experience of “Jerry” (a pseudonym). Jerry struggled with obsessive-compulsive disorder (OCD). Having educated himself on OCD, Jerry knew that exposure and response (or ritual) prevention (ERP, for short) was the most researched and effective treatment for OCD. ERP involve systematically helping people with OCD learn to confront obsessions while resisting the urge to engage in compulsions or rituals.

Despite living in a major city, it took Jerry 3 years to find a therapist who offered and was proficient in ERP for OCD. Jerry’s experiences are similar to those of a Yale graduate student with OCD.

Many clients I’ve seen have similarly struggled. Some were misdiagnosed by prior therapists and did not even realize they had OCD until they did their own research. Some therapists correctly identified them as having OCD but when it came to treatment, they “just talked.”

Most people with OCD with whom I’ve worked have seen at least 1 or 2 therapists who have not been particularly helpful. Hair pulling (trichotillomania) and skin picking (excoriation) are two other problems that people with whom I’ve worked have struggled to find effective treatment.

The article by Drs. McKay and Lilienfeld provides a sober reminder that there are a number of people who would benefit from effective treatments such as ERP but cannot find therapists who practice it or are aware enough of their competency to refer out to a specialist. Unlike Jerry, many people with problems such as OCD, trichotillomania, and excoriation don’t even realize there’s a name for their struggles, let alone effective treatment, and they may drift in and out of therapists’ offices being misdiagnosed and receiving substandard treatment.

Drs. McKay and Lilienfeld recommend that:

The adoption of the new clinical practice guidelines is probably our field’s best hope for placing long overdue pressure on therapists to incorporate scientifically based approaches into their clinical practices. Practice guidelines would also assist mental health consumers with the daunting task of selecting more effective treatments.   

 

Sadly, there are many licensed therapists who do not believe in science-based approaches. For people with mild to moderate depression/anxiety, generic talk therapy and nonscientific approaches can offer some relief. For people like Jerry with OCD, these unscientific approaches are unlikely to be of much help.

I’m inspired that psychologists such as Drs. McKay and Lilienfeld take time from their busy schedules as full-time professors and respected researchers to promote scientific approaches. You can read their blog post here. I encourage readers to carefully research the therapists you or your loved ones see, and not to stay in therapy with someone who doesn’t seem to be very helpful.

Misophonia: what the heck is it and what’s a trigger?

Misophonia is a condition in which a person has an automatic, unpleasant internal reaction to specific sounds.  This reaction can vary from frustration to panic and even rage, and can be quite an intense experience for the sufferer.  Sounds that lead to this reaction are typically sounds from everyday life, such as others’ chewing food/gum, sniffling, or heavy breathing.  People with misophonia will often refer to “triggers”; a trigger, for someone with misophonia, refers to any sounds that produces the intense internal reaction.

Many people who have misophonia experience a lot of shame before they come to understand that this is a condition experienced by many others and that they are not alone in their struggles.  They can experience a lot of shame about both the intensity of the internal reaction and their response to those who have made a sound that is triggering.  I was one of those folks.

How I learned about my misophonia:

I learned about misophonia about 5 years ago.  I was talking with a colleague about my internal responses to certain noises and she noted that one of her clients had very similar experiences and told her that it was called misophonia.  I remember the first time I googled misophonia and found a video on YouTube, in which a man with misophonia was talking about his internal experiences of it.  After getting over the oddity of hearing this man talk about things I had never heard anyone else talk about, I began to feel so much more understood, by both myself and this larger community.  As I met others with misophonia, I discovered a community who could provide the sort of support that was difficult to garner from those who did not have misophonia.

Discovery and recovery:

Since discovering that I have misophonia, I have engaged with the misophonia community on a few different levels.  Given that I am a psychotherapist, I became interested in helping myself, and others with misophonia, learn to live with the condition and have relationships with others that thrive. I currently specialize in working with people with misophonia and am actively working on developing treatments that can help them to learn better ways to cope with the condition. I feel like being involved in the misophonia community and learning about the experiences of others has given me a lot of insight into the condition that I can share with others who are struggling. I feel grateful to have found this community and am thankful I get to pass on what I have learned to others.

Misophonia Treatment at Portland Psychotherapy

Get help coping with your loved one who has persistent mental illness

Do you have a loved one with Bipolar Disorder, Schizophrenia, or another type of persistent mental illness? Having a loved one with a persistent mental illness can feel stressful and overwhelming. The mental health system can be confusing and resources can be difficult to find. I specialize in working with family members to help them develop practical and useful skills to cope with their loved one’s mental illness and improve family relationships.

I offer one-to-one or group training based on evidence-based principles shown to reduce relapses of mental health problems, and improve the well-being of family members. The training is done in a collaborative and supportive style, and is focused on the hands-on skills you can use to improve your and your loved one’s mental health. As a family member of someone with a persistent mental illness, you may have that you are to blame for your family member’s illness. You are NOT to blame for their illness, but there ARE things you can do to improve the quality of life for your family and loved one with mental illness.

Why do I use evidence-based principles in what I do?

The whole team at Portland Psychotherapy has a strong commitment to using evidence-based principles in our work. Evidence-based means that techniques, treatments, or principles were tested in rigorously controlled experimental studies, as well as in studies in settings similar to our center (i.e., outpatient treatment centers), and were shown to be effective in reducing distress, relapses, or functioning. We use what works based on scientific findings, not on fads or untested techniques. Although we have a strong commitment to evidence based principles, we work hard to flexibly tailor these principles to best meet the needs of the individual and the family.

What kinds of things will help me and my family member?

Numerous research studies have shown that certain techniques are more effective in improving your well-being and your family member’s mental health. Communication skills, particularly skills that decrease the expression of negative emotions, can decrease symptoms of and relapses of persistent mental illnesses, such as schizophrenia (Butzlaff & Hooley, 1998). Problem solving and education about mental health problems and treatments can improve your well-being and help your loved one and family resolve problems more effectively (Malouff, Thorsteinsson,  & Schutte, 2007; Dixon, Stewart, Burland, Delahanty, Lucksted et al., 2001). Self-care strategies for family members can decrease stress, anxiety, and even, health problems (Cuijpers & Stam, 2000). I help family members learn these evidence-based skills that will help you and your family member improve your lives.

What will I learn if I work with you?

If you contact me, we will schedule an initial consultation, from which we will develop a plan on how to help you with your family member. The plan could include any of the following elements:

  1. Information about the mental illness your loved one has and treatments for that mental illness.
  2. Information about the mental health system and community resources.
  3. Communication skills training to more effectively express your needs and emotions, set limits, and reward your loved one’s actions.
  4. Help with identifying limits you are comfortable with and how to reward actions that promote mental health and recovery.
  5. Problem solving skills that generate multiple solutions tailored to your unique circumstances.
  6. Realistic self-care strategies that you can implment in your life.
  7. You will also get access to a support group of families struggling with a similar situation that I run.

What can I expect during our meetings?

In the first couple of sessions we will focus on a developing a detailed understanding of your loved one’s mental health symptoms, the impact of the symptoms in your lives, and your own mental health. Then, we will create specific and action-oriented goals that we will use to evaluate our progress. The following sessions will focus on learning and practicing skills described in the section above (i.e., communication skills, problem solving, education about mental health, and self-care). You will be asked to practice the skills in between meetings so we can make any revisions or adjustments to how you use the skills.

I do my best to create a supportive and collaborative environment. I will work with you to learn and tailor the skills to your unique situation. You have valuable information and knowledge about the situation you are in. I actively seek out your contributions and experiences and incorporate them into the learning process. I work hard to create an accepting and positive environment where you can share your experiences and practice the skills. You are not defined by your difficulties, therefore, your strengths and values will also be incorporated into the training.

Resources

General Mental Health Resources

Resources for Specific Mental Health Problems

  • Schizophrenia.com has list of resources on schizophrenia and topics related to schizophrenia (e.g., schizophrenia and drug use).
  • Pendulum.org is a website that has information about Bipolar Disorder, including links to support groups.
  • Depression and Bipolar Support Alliance is a national organization for individuals with depression and Bipolar disorder. It includes a helpful tip sheet for family members of what to say and what not to say to a loved one with Bipolar Disorder.
  • The National Center for PTSD is part of the Veterans Administration dedicated to researching, educating, and treating PTSD. Although there is a strong focus on Veterans, the website includes useful information and resources on PTSD for people who are not Veterans.
  • Families for Depression Awareness is a national organization for families who have loved ones with depression.
  • Anxiety and Depression Association of America has information and resources for people with anxiety disorders or depression.
  • Substance abuse resource website at Portland Psychotherapy has links to information about, organizations, and support groups (for people with addictions and for family members of people with addictions) for addictions.

To learn more:

You can learn more about me at my therapist page. If you’d like help coping with mental illness in your family or learning how to better support your loved one who is suffering, I am here to help. If you have any questions or want to set up an appointment, please give me a call at 503-281-4852 x5. You can also contact me using the confidential contact form below.

Is K Okay? Using Ketamine to Treat Depression

There have been some articles on the National Public Radio (NPR) website about the use of the drug ketamine as a fast acting treatment for depression (See here and here). Originally developed as an anesthetic, ketamine is better known to the public as the club drug Special K. Beginning with a study published in 2006 from a group of researchers with the National Institute of Health (NIH), ketamine has been explored as possible treatment for depression, and researchers are currently looking for chemically similar alternatives to ketamine with less potential for abuse.

A shortcoming for current antidepressants such as a Prozac is that it usually takes weeks to kick in, and even then, 30-40% of people don’t benefit. By contrast, studies suggest that intravenously-administered (IV) ketamine can improve mood in a matter of hours, and that change appears to last a week or two. For someone who is profoundly depressed and suicidal, this may be a useful alternative to inpatient hospitalization.

Ketamine targets a particular neurotransmitter — glutamate. Current antidepressants more commonly target serotonin, and often dopamine and/or norepinephrine, blocking their reuptake and increasing levels in the brain.

In one of the NPR articles, researcher Dr. Carlos Zarate compares depression to a “leaky faucet in the brain.” Current antidepressants, according to Dr. Zarate, “shut down the water plant,” which means that it a takes a long time for “water to stop flowing through the miles of pipes that eventually lead to the leaky faucet.” Ketamine, he suggests, stops the leaky faucet itself.

Although this metaphor is useful for making the distinction between a fast acting drug and one that takes longer to kick-in, it may also be misleading. The notion that a drug stops the “leaky faucet” of depression at the source sounds very precise and scientific. What may surprise some readers is that our understanding of the biology of depression is still pretty crude.

The Myth of the Chemical Imbalance

Once upon a time, psychiatry had a dream. The sudden introduction of antipsychotics and antidepressants in the 1950’s had a galvanizing effect on the field. It held out the possibility of developing medications that precisely targeted the biological causes of mental health problems.

Decades later, although providers still talk about antidepressants as restoring chemical imbalances, the evidence supporting this view has been pretty disappointing.

Earlier I mentioned that commonly prescribed antidepressants increase levels of some combination of the neurotransmitters serotonin, dopamine, and/or norepinephrine in the brain. As you might imagine, drug companies have poured millions into research to show that deficiencies in these neurotransmitters lead to depression—what is known as the Monoamine Hypothesis. Unfortunately, the research hasn’t found any compelling evidence these neurotransmitters cause depression—or at the very least the relationship between the two is not that simple.

For example, although not marketed in the US, there’s an antidepressant called tianeptine that decreases concentrations of serotonin in the brain. Research suggests it’s just as effective as antidepressants that increase concentrations in the brain. This is a bit of a conundrum for the chemical imbalance theory of depression.

Therefore, there’s not a lot of evidence to support the popular notion that antidepressants restore a chemical imbalance. Instead, it’s more accurate to say that antidepressants artificially increase levels of certain neurotransmitters in ways that some people find reduce feelings of depression and anxiety.

Fast Acting Drugs are Not Necessarily Better: The Case of Anxiety

Another thing that concerns me about ketamine is that fast acting drugs are not always a good thing. Case in point: antianxiety medications. No one particularly enjoys feeling anxious. We often want instant relief, or at least something to take the edge off. There’s a class of medications that do just that—benzodiazepines, which including some more commonly known drugs such as Xanax and Ativan. These drugs tend to work pretty quickly, often within 30 minutes.

Although they are commonly prescribed, the problem with benzodiazepines is that long-term use can lead to long-term problems. First of all, these medications pose a high risk of abuse, dependency, and, withdrawal problems. In addition, there is research to suggest that many people experience “rebound effects” once they stop taking these medications—that is, they find that their anxiety is even worse than when they started taking the medication. For these reasons, although many providers continue to prescribe benzodiazepines in the short-term, most experts would agree that antidepressant medications which also tend to blunt anxious feelings are a safer alternative in the long-term.

BTW: Did You Know Ketamine Intoxication Can Mimic Schizophrenia?

Low doses of ketamine appear to reduce depression very quickly. But as the Neuroskeptic blog noted a few years ago, there’s also a strain of research that shows that high doses of ketamine can cause symptoms that mimic schizophrenia.

This finding in itself doesn’t mean the drug is bad. Medications for Parkinson’s disease, which increase dopamine, can also cause schizophrenia-like symptom. (Conversely, long-term use of antipsychotics can cause Parkinsonian-like symptoms in people with schizophrenia.) My point here is that, although researchers have found another potential treatment for depression, it’s unlikely they’ve uncovered the core biological root of depression.

Where Does That Leave Us?

For these reasons, I wince when I hear people talk of “miracle drugs” for psychological problems. It’s not that I see no future for ketamine in depression treatment. It’s more that I found the NPR articles overly optimistic.

As a scientist, I support the continued study of ketamine and related drugs as a potential treatment for depression; however, I’m skeptical about the breadth of its usefulness based on all the other times we’ve gone down this road of “miracle drug” cures. Consequently, although I think ketamine has the potential to be a genuinely new medical approach (i.e., not another minor tweak of an already prescribed antidepressant) to dealing with profound depression, I think we should temper our optimism a bit. The first study on the use of ketamine to treat depression was published in 2006, and the data of if, under what circumstances, and how this drug may be useful are still very much unknown.

It may be, for example, that researchers find ketamine can be useful for people who show up in Emergency Departments suicidally depressed. Rather than sending them to a locked ward, which costs over $1,000 a day, emergency physicians may give them an IV of ketamine. If they respond and mood improves, they can be given an appointment with an outpatient specialist that week and be sent home without further disruption to their lives.

Perhaps this is even how the NIH researchers have conceived of the drug—if so, it wasn’t conveyed in the NPR articles. It seems there is potential for ketamine to be useful in this kind of a scenario, but again, we just don’t have the data yet to know with any certainty. What concerns me is that, based on reports in the media like those on NPR suggesting a “miracle drug” or a “cure,” people may think “I’m depressed—I need some ketamine.” This is a dangerous path where short-term gains could lead to long-term consequences.

PLEASE NOTE: PORTLAND PSYCHOTHERAPY IS NOT INVOLVED IN KETAMINE TREATMENT.

There’ve been some articles on the National Public Radio (NPR) website about the use of the drug ketamine as a fast acting treatment for depression (See here and here). Originally developed as an anesthetic, ketamine is better known to the public as the club drug Special K. Beginning with a study published in 2006 from a group of researchers with the National Institute of Health (NIH), ketamine has been explored as possible treatment for depression, and researchers are currently looking for chemically similar alternatives to ketamine with less potential for abuse.

A shortcoming for current antidepressants such as a Prozac is that it usually takes weeks to kick in, and even then, 30-40% of people don’t benefit. By contrast, studies suggest that intravenously-administered (IV) ketamine can improve mood in a matter of hours, and that change appears to last a week or two. For someone who is profoundly depressed and suicidal, this may be a useful alternative to inpatient hospitalization.

Ketamine targets a particular neurotransmitter glutamate. Current antidepressants more commonly target serotonin, and often dopamine and/or norepinephrine, blocking their reuptake and increasing levels in the brain.

In one of the NPR articles, researcher Dr. Carlos Zarate compares depression to a “leaky faucet in the brain.” Current antidepressants, according to Dr. Zarate, “shut down the water plant,” which means that it a takes a long time for “water to stop flowing through the miles of pipes that eventually lead to the leaky faucet.” Ketamine, he suggests, stops the leaky faucet itself.

Although this metaphor is useful for making the distinction between a fast acting drug and one that takes longer to kick-in, it may also be misleading. The notion that a drug stops the “leaky faucet” of depression at the source sounds very precise and scientific. What may surprise some readers is that our understanding of the biology of depression is still pretty crude.

The Myth of the Chemical Imbalance

Once upon a time, psychiatry had a dream. The sudden introduction of antipsychotics and antidepressants in the 1950’s had a galvanizing effect on the field. It held out the possibility of developing medications that precisely targeted the biological causes of mental health problems.

Decades later, although providers still talk about antidepressants as restoring chemical imbalances, the evidence supporting this view has been pretty disappointing.

Earlier I mentioned that commonly prescribed antidepressants increase levels of some combination of the neurotransmitters serotonin, dopamine, and/or norepinephrine in the brain. As you might imagine, drug companies have poured millions into research to show that deficiencies in these neurotransmitters lead to depression—what is known as the Monoamine Hypothesis. Unfortunately, the research hasn’t found any compelling evidence these neurotransmitters cause depression—or at the very least the relationship between the two is not that simple.

For example, although not marketed in the US, there’s an antidepressant called tianeptine that decreases concentrations of serotonin in the brain. Research suggests it’s just as effective as antidepressants that increase concentrations in the brain. This is a bit of a conundrum for the chemical imbalance theory of depression.

Therefore, there’s not a lot of evidence to support the popular notion that antidepressants restore a chemical imbalance. Instead, it’s more accurate to say that antidepressants artificially increase levels of certain neurotransmitters in ways that some people find reduce feelings of depression and anxiety.

Fast Acting Drugs are Not Necessarily Better: The Case of Anxiety

Another thing that concerns me about ketamine is that fast acting drugs are not always a good thing. Case in point: antianxiety medications. No one particularly enjoys feeling anxious. We often want instant relief, or at least something to take the edge off. There’s a class of medications that do just that—benzodiazepines, which including some more commonly known drugs such as Xanax and Ativan. These drugs tend to work pretty quickly, often within 30 minutes.

Although they are commonly prescribed, the problem with benzodiazepines is that long-term use can lead to long-term problems. First of all, these medications pose a high risk of abuse, dependency, and, withdrawal problems. In addition, there is research to suggest that many people experience “rebound effects” once they stop taking these medications—that is, they find that their anxiety is even worse than when they started taking the medication. For these reasons, although many providers continue to prescribe benzodiazepines in the short-term, most experts would agree that antidepressant medications which also tend to blunt anxious feelings are a safer alternative in the long-term.

BTW: Did You Know Ketamine Intoxication Can Mimic Schizophrenia?

 Low doses of ketamine appear to reduce depression very quickly. But as the Neuroskeptic blog noted a few years ago, there’s also a strain of research that shows that high doses of ketamine can cause symptoms that mimic schizophrenia.

This finding in itself doesn’t mean the drug is bad. Medications for Parkinson’s disease, which increase dopamine, can also cause schizophrenia-like symptom. (Conversely, long-term use of antipsychotics can cause Parkinsonian-like symptoms in people with schizophrenia.) My point here is that, although researchers have found another potential treatment for depression, it’s unlikely they’ve uncovered the core biological root of depression.

Where Does That Leave Us?

For these reasons, I wince when I hear people talk of “miracle drugs” for psychological problems. It’s not that I see no future for ketamine in depression treatment. It’s more that I found the NPR articles overly optimistic.

As a scientist, I support the continued study of ketamine and related drugs as a potential treatment for depression; however, I’m skeptical about the breadth of its usefulness based on all the other times we’ve gone down this road of “miracle drug” cures. Consequently, although I think ketamine has the potential to be a genuinely new medical approach (i.e., not another minor tweak of an already prescribed antidepressant) to dealing with profound depression, I think we should temper our optimism a bit. The first study on the use of ketamine to treat depression was published in 2006, and the data of if, under what circumstances, and how this drug may be useful are still very much unknown.

It may be, for example, that researchers find ketamine can be useful for people who show up in Emergency Departments suicidally depressed. Rather than sending them to a locked ward, which costs over $1,000 a day, emergency physicians may give them an IV of ketamine. If they respond and mood improves, they can be given an appointment with an outpatient specialist that week and be sent home without further disruption to their lives.

Perhaps this is even how the NIH researchers have conceived of the drug—if so, it wasn’t conveyed in the NPR articles. It seems there is potential for ketamine to be useful in this kind of a scenario, but again, we just don’t have the data yet to know with any certainty. What concerns me is that, based on reports in the media like those on NPR suggesting a “miracle drug” or a “cure,” people may think “I’m depressed—I need some ketamine.” This is a dangerous path where short-term gains could lead to long-term consequences.

Recovery from Schizophrenia? Yes, it’s Possible!

If you live in a major city you have probably encountered a person who is dressed strangely, mumbling to himself, not making eye contact, and perhaps pacing back and forth or engaging in some other repetitive behavior. You may have sighed and felt a twinge of sympathy mixed with a sense of resignation, “this person is never going to get better” you think as you move quickly to the next place you need to be. Although the person in this example may not be diagnosed with Schizophrenia, a mental illness characterized by unusual perceptual experiences and strong beliefs that seem strange to others (e.g., being under surveillance), this person is likely suffering from some sort of serious mental illness.

While our media is often filled with stigmatizing and inaccurate portrayals of people with mental illness, I’ve been happy to see that there has also been some recent press showing a more realistic and non-stigmatizing viewpoint. For example, the New York Times is currently running a series on living with serious mental illness. The first article in the series, the revelation of Dr. Marsha Linehan’s personal struggles with serious mental illness as child and young adult, was covered in our blog in July. The second article in the series was released in early August and shares the story of Joe Holt, a computer programmer and entrepreneur, who is living with the diagnosis of Schizophrenia.

What I like about this story

Part of what I like about the NY Times story is that it nicely illustrates an idea that is increasingly being acknowledged in the treatment community — that people with serious mental illness can and do recover.  The NY Times’ story of Joe Holt also shows us that the path of recovery is not straight, that it is filled with bumps, detours, and unexpected side trips; yet, people with serious mental illness do lead productive, enriching, and fulfilling lives.

It may be shocking for you to hear that people with illnesses like Schizophrenia can recover. For the early part of my career, I was under the impression that most people diagnosed with serious mental illness had a pretty hopeless future.  I only learned that this impression is false in 2006, when I stumbled across two studies on people released from the long-term units of two New England state hospitals. One state implemented programs based on a recovery model (more on that below) and the other received more standard treatment, typically a combination of medication and supportive therapy. The results were astounding! I remember sitting there shocked as I read the results from the study over and over again. In the study that just examined the outcomes of the people who received the recovery-oriented services, the majority (68%) of people did not show symptoms of schizophrenia at the 20-year follow-up, and nearly 50% did not show any symptoms of mental illness (Harding et al., 1987)! In the study that compared the people who received recovery-oriented services vs. those who received care as usual, people who received recovery-oriented care were more likely to live on their own (over 45% were living independently, i.e., not in boarding houses or half-way homes), were more likely to be/have been employed, and had fewer mental health symptoms (DeSisto et al., 1995). Results from groundbreaking studies like these provided the momentum to create a new approach to treatment called the recovery movement or recovery model.

What is the Recovery Model?

The principles of the recovery model can be grouped into four themes:

  1. Mental health care should be person-centered and directed
  2. Mental health and recovery exist on a continuum (i.e., mental health and recovery are more than just “you’re well” or “you’re ill”)
  3. The person is more than his/her mental illness and thus, treatment is more than just management of symptoms
  4. Cultural and social identities and experiences should be incorporated into treatment (e.g., helping the person overcome stigma attached to mental illness).

The 12 principles of recovery listed by the Substance Abuse and Mental Health Services Administration (SAMHSA) are:

•There are many pathways to recovery.

•Recovery is self-directed and empowering.

•Recovery involves a personal recognition of the need for change and transformation.

•Recovery is holistic.

•Recovery has cultural dimensions.

•Recovery exists on a continuum of improved health and wellness.

•Recovery is supported by peers and allies.

•Recovery emerges from hope and gratitude.

•Recovery involves a process of healing and self-redefinition.

•Recovery involves addressing discrimination and transcending shame and stigma.

•Recovery involves (re)joining and (re)building a life in the community.

•Recovery is a reality. It can, will, and does happen.

While it may seem obvious that the 12 principles of recovery should be a part of every mental health treatment a person receives, I am glad to be part of a mental health movement and system that are  actively working to incorporate recovery principles into their treatments. I am also delighted to see that the media is starting to promote recovery (even if it is not explicitly acknowledged as such) with positive and inspiring stories about people with serious mental health conditions living with and beyond their diagnoses. If you’d like to learn more about recovery (September is Recovery Awareness Month), here are some resources:

Substance Abuse and Mental Health Services Administration

Recovery Month Website

United States Psychiatric Rehabilitation Association

National Alliance on Mental Illness (NAMI)

Oregon division of NAMI

Portland Hearing Voices (from their website:  “a community group to promote mental diversity”)

References

DeSisto, M. et al. (19xx). The Maine and Vermont three decade studies of serious mental illness. II.
Longitudinal course comparisons. British Medical Journal of Psychiatry, 167, 338 – 342.

Harding, C. M., Brooks, G. W., Ashikaga, T., Strauss, J. S., & Breier, A. (1987). The Vermont longitudinal study of persons with severe mental illness, I:  Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry, 144, 718 – 726.