Providentia

Treating Offenders with Mental Disorders

Faced with high and increasing rates of mental disorder within the criminal justice system (CJS), a range of interventions have been implemented in an effort to prevent continued involvement in criminal activities among this population. A recent meta-analytic review published in Law and Human Behavior was undertaken to consider the effectiveness of interventions for criminally involved adults with a mental disorder targeting either improved criminal justice or mental health outcomes. Furthermore, characteristics that were hypothesized to predict better outcomes were examined. Studies that considered sex offender interventions, or focused solely on antisocial personality, intellectual and cognitive, or substance use disorders were excluded. Results assuming a fixed-effects model combining 37 effect sizes from 25 studies (N = 15,678) support the effectiveness of these interventions in terms of reductions in any CJS involvement (d = 0.19 excluding one outlier). Interventions had no significant effect on an aggregate mental health outcome (d = 0.00). However, when considering distinct mental health outcomes, intervention participants had significantly better functioning (d = 0.20) and fewer symptoms (d = 0.12). There were no significant effects of the interventions on mental health service or medication use. Moderator analyses identified seven sample, intervention, and design characteristics that were related to the magnitude of the effect sizes for criminal justice outcomes, and suggest implications for service provision, policy, and research. Results suggested some relationship between intervention effects on mental health and criminal justice reinvolvement, although future research is needed in this area, especially given the absence of mental health outcome data in many studies.

For the abstract.

Visiting Ground Zero

In every generation, there seems to be a "what were you doing when you heard?" moment where one traumatic memory is shared by countless people.   For those of a certain age, the question used to be "What were you doing when you heard that President Kennedy was assassinated?" (or Robert Kennedy, Martin Luther King, John Lennon, etc).   

But that all changed on September 11, 2001.

In my case, hearing about the tragedy occurred after I had just come to work at Millbrook Correctional Centre near Peterborough, Ontario where I was working as a staff psychologist.  A guard somberly told me that a plane had crashed into the World Trade Center and a television in a back squad room was tuned to CNN.   We all watched in horror as events unfoled when the second plane hit and the World Trade Centre eventually collapsed completely.   Further news about the Pentagon crash, Flight Eleven, and the actual circumstances of the hijackings trickled in.   The Internet seemed completely frozen at times due to constant crashing as millions of people tried to log in for details.

In the months that followed, things slowly settled down although the enormity of what had happened seemed impossible to accept.   The violent deaths of thousands of Americans seemed surreal enough.  That this would eventually lead to the deaths of hundreds of thousands of people across Afghanistan and Iraq and bog Western nations down into a war that may never end acts as a continuing reminder how the world changed that terrible day.

Naturally enough, my visiting New York for the first time in twenty years made it essential that I add Ground Zero to my itinerary.   After arranging for a visitor pass online (no entering the monument site itself without authorization), I arrived at the site of the new One World Trade Center in plenty of time for the tour.   Even before my tour bus arrived, I could see one vivid memorial along the way, Tiles For America at the corner of Seventh Avenue and Eleventh Street.   With thousands of ceramic tiles along a chain-link fence contributed by ceramic studios around the world,  the memorial provides a shared memories of the victims that has already been featured in music videos and films. 

Finding Ground Zero itself was certainly no problem with the still-uncompleted lead building (a.k.a. 1 WTC or the Freedom Tower seen to the right) dominating the local skyline.    Still, it's the relatively tiny St. Paul's Chapel at 209 Broadway that is the usual starting point for most Ground Zero pilgrimages.  The 238 year-old Episcopalian chapel was already a prominent part of New York's history since George Washington worshipped there on his inauguration day in 1789.  The chapel took  on a new importance when it acted as a sanctuary for the
thousands of volunteers, emergency services workers, and family members of victims immediately after the 2001 attack.  For months afterwards, rescue workers sheltered at the church and, along with food and shelter, the chapel also had regular health care services in place including massage therapists, chiropodists, chiropractors and musicians to help make their stay easier.   Despite the extensive debris from the collapse of the World Trade Center, the chapel itself survived relatively unscathed.   It has since become a major landmark of the city and then-Mayor Rudolph Giuliani gave his farewell speech there in December, 2001.   On September 10, 2006, a memorial service was held there which was attended by numerous politicians including then-President George W. Bush and Senator Hilary Clinton.

Visitors to the chapel can still see the memorial altar as well asa commemorative shrine showing some of the various mementos left at the church to honour the dead.   The church has also set up a new public exhibit titled, "Unwavering Spirit: Hope and Healing at Ground Zero".   That includes various exhibits inside show the personal effects, cots, and memorials for many of the rescue workers who died.  

There is also a poignant firefighter's uniform on display as well as written testimonials by many of the visitors and former rescue workers praising the chapel and its staff for the support that they provided.  As a Red Cross disaster services volunteer myself, this may well have been one of the most poignant features of my visit. 

Along with the exhibits inside the chapel, there is also the iconic Bell of Hope that was presented to the chapel by the city of London.  The Lord Mayor of London personally attended the presentation ceremony in 2002.   The bell itself is in a prominent spot to the rear of the chapel.

 

After visiting the chapel, I went to the entrance of the Ground Zero monument on Liberty Street.  The new One World Trade Center (designed by Daniel Libeskind) is scheduled for completion in 2013 and will be the centrepiece of the expanded World Trade Center.    By the time it is finished, 1 WTC will be the tallest building in the Western hemisphere.   The entrance to the memorial itself includes the Flag of Honor containing the names of all those killed at the World Trade Center, at the Pentagon, and aboard the American and United flights on September 11,  2001 as well as in the February 26, 1993 bombing at the World Trade Center.   After the long lineup with hundreds of other visitors as well as passing through security (including metal detectors), I finally entered the memorial site itself. 

Designed by architect Michael Arad, the 9/11 memorial (click here for an aerial view) is located on the site of the former World Trade Center features two enormous waterfalls and reflecting pools, each set within the radius of the two former towers.  Designed to be ecologically friendly, more than 400 trees surround the reflecting pools along with enormous walkways and the sights and sounds of the continuing construction work.  Although the fencing surrounding the construction areas are carefully covered over to preserve the peaceful monument site, I was able to sneak in a couple of photographs as well...

Along with the North and South reflecting pools, there is also a Memorial Glade used for special occasions and memorial ceremonies.   And, yes, I did manage to get one picture of myself there as well (although trusting a total stranger with my expensive camera does not come easily...).

After leaving the Memorial site, I looked around the gift shop and explored the surrounding area a bit.  Aside from the presence of the new World Trade Center and the Memorial, the area seems little different from the rest of downtown Manhattan.    That a controversy sprang up in 2010 over building a mosque and Islamic education centre in the area reflects the ongoing determination by many Americans to declare the entire area to be a "sacred space" (and which is likely news to the various mundane businesses nearby).   Exactly why a mosque is more objectionable than a hot-dog franchise seems to be a question best left up to the people of Manhattan.  Still,  the animosity that the mosque project incurred - helped along by right-wing lobby groups across the country- shows just how powerful an icon Ground Zero has become. 

For the rest of Manhattan, life goes on as before.  And that may well be the best way to honour the memory of all those who died on that terrible day. 

Click here to learn more about supporting the 9/11  Memorial. 

 

 

 

 

 

 

 

 

 

 

Reading the Bumps (Part 2 of 2)

Continued from Part 1

Born in Steuben Country, New York in 1809, Orson Fowler attended Amherst College in Massachusetts.  While attending school there, he developed a keen interest in phrenology which he shared with his best friend, Henry Ward Beecher.   While Beecher went into ministry work after their graduation in  1834, Fowler had other ideas.  He and his brother, Lorenzo Fowler opened a phrenology office in New York City and launched a series of public lectures on phrenology, physiology,  psychology, and social reform.   Orson Fowler also became a popular writer and editor of the American Phrenological Journal and placed his own stamp on American phrenology by launching one of the largest mail-order firms in New York City.   At the height of the phrenology craze, Fowler's New York offices attracted as many visitors as the nearby museum run by P.T. Barnum.    Along with phrenology, the Fowlers also promoted a new "scientific" system of shorthand called phonography (they called it scientific since it was based on a specific set of rules).   Not that the Fowler family believed in limiting themselves in any way.   Orson's wife Lydia and sister, Charlotte, were both active suffragettes and the Fowler offices in New York became a gathering place where people could discuss anything from abolishing slavery (pre-Civil War) to the crusade against alcohol (did I forget to mention that they were also temperance movement supporters?). 

Although the American Phrenological Journal that Fowler edited folded up by 1842,  his company did brisk business with a range of other products.  Along with books and pamphlets (mostly written by Orson Fowler),  the company also sold phrenological charts, measuring tapes, craniometers, and the classic china Phrenology Heads which are still collectors' items today.     The Fowler brothers also took their show across the country as part of a regular lecture circuit although they often faced attacks by skeptics denouncing phrenology as "quackery".   While both Fowlers defended the science behind their work, that claim became harder to defend as mainstream medical researchers withdrew support.  Still, the Fowler brothers carried on their crusade and insisted that phrenology had just as much right to be labelled a science as mathematics, astronomy, or natural history.   Orson Fowler also stressed the theological importance of phrenology, which revealed "the hand-writing of God" since its principles, like all scientific truths as far as he was concerned,  were "of divine origin".    Lorenzo Fowler even argued that phrenologists were completing the work that Jesus Christ started in reforming human behaviour.

As for the Orson Fowler book in my collection, it seems fairly typical of the phrenological literature that he sold through his company.   The book's introduction begins with:  "Reproduction is Nature's paramount work;  because to all else what foundation is to house- its sine qua non.  It has its SCIENCE, or natural laws, prescribed modus operandi and, and instrumentalities.  GENDER IS ITS MASTER WORKMAN, and Nature's "male and female" arrangement, with its governing law, her chose "ways and means" or originating all life: which growth completes."   Covering nine sections in all, the book includes sections such as "Gender and Sexuality", "Love", "Sexual Selection", "Married Life",  "Generation" (the polite Victorian euphemism for sexual intercourse), "Maternity",  and "Sexual Restoration".    Despite these being taboo topics during the Victorian era in which Fowler was writing, his tenuous claim to medical expertise enabled him to present his phrenological advice in the form of a marriage manual for concerned adults trying to deal with different aspects of human sexuality.   While Orson Fowler proudly inserted the word "science" into his book as much as he could (usually in capital letters), there was very little, if any, empirical testing of the elaborate claims that he made in his book.  He certainly didn't believe in referencing his "facts" and, despite abundant illustrations, there doesn't seem to be any citations (aside from his own works).   The book also contains surprising little phrenology and mostly deals with Victorian ideals about the proper age for teaching children about sexual matters and the need for a "scientific" approach to sex and love.   The book seems to say more about Fowler's personal biases than any attempt at scientific objectivity.   As well, his insistence that producing children was the ultimate purpose for any sexual act marked him very much as a man of his time. 

Whenever critics  accused him of being more interested in making money than actually promoting phrenology, Orson Fowler simply defended himself by saying that he worked so hard because "I loved the science!".     Still,  the decline had begun setting in after 1860 and Lorenzo Fowler, sensing that the market was drying up, moved to Great Britain in 1863 to continue his phrenology crusade there.  Although Charlotte Fowler took over running the company and a new generation of Fowlers came on board to help with the mail-order business, phrenology's day was definitely past.  By the time Orson Fowler died in 1887, phrenology was just one of many different "sciences" being promoted by travelling hucksters giving lectures across the country.    As the phrenology market dried up, the ex-phrenologists drifted on to more profitable ventures, including spiritualist research and more evolutionary explanations for human behaviourism.  

Beginning in the 1870s,  Social Darwinist theories based (loosely) on Darwin's theory of evolution grew in popularity and social reformers shifted away from phrenology-based social reform towards improving human behaviour through "good breeding".  As phrenology societies faded, eugenics societies formed on both sides of the Atlantic with credible scientists using their research to boost the idea of improving society through genetics  (especially Charles Darwin's cousin, Francis Galton).   But that's another story.

While phrenologists tried every marketing strategy that they could, including the developing of mechanical phrenology devices (which I once tried myself at an American Psychological Association convention),  American phrenology never survived Orson Fowler's death.  Despite phrenology fading in the United States, the movement staggered on in parts of Europe despite most scientists denouncing its validity.   Several early 20th scientists, such as Bernard Hollander in the United Kingdom and Paul Bouts in Belgium, tried repackaging phrenology to make it more acceptable but their efforts are largely forgotten today. 

Although phrenology has long since been relegated to obscurity, the legacy that Gall, Spurzheim, and Fowler left behind still lingers.   Various pseudoscientific schemes for classifying people still enjoy some popularity, whether through classifying people by blood-type,  graphology (handwriting), or astrology, although none of them seem to have ever enjoyed the scientific respectability that phrenology could claim (at first).    

Unfortunately, while pseudoscientific movements can be easily dismissed, more scientifically validated methods of personality classification using psychometric testing are prone to misuse as well (and often are).   Various media psychologists selling unscientific advice to the public through self-help books, radio, and television appearances often rely on the same selling strategies that worked for Orson Fowler,  however briefly.    Failing to acknowledge the very real scientific limits of psychology will almost certainly catch up to them in time however.   Whether the current pundits can learn from Orson Fowler's example remains to be seen.

 

 

 

 

How Practical is Brain Training?

Prior researchers have shown that the brain has a remarkable ability for adapting to environmental changes. The positive effects of such neural plasticity include enhanced functioning in specific cognitive domains and shifts in cortical representation following naturally occurring cases of sensory deprivation; however, maladaptive changes in brain function and development owing to early developmental adversity and stress have also been well documented. Researchers examining enriched rearing environments in animals have revealed the potential for inducing positive brain plasticity effects and have helped to popularize methods for training the brain to reverse early brain deficits or to boost normal cognitive functioning. In an article recently published in American Psychologist, two classes of empirically based methods of brain training in children are reviewed and critiqued: laboratory-based, mental process training paradigms and ecological interventions based upon neurocognitive conceptual models. Given the susceptibility of executive function disruption, special attention is paid to training programs that emphasize executive function enhancement. In addition, a third approach to brain training, aimed at tapping into compensatory processes, is postulated. Study results showing the effectiveness of this strategy in the field of neurorehabilitation and in terms of naturally occurring compensatory processing in human aging lend credence to the potential of this approach.

For the abstract.

Off To New York City

I'll be spending a few days in N.Y.C. and likely won't have much time for writing while I'm there.   If you notice a certain New York flavour to some of my upcoming posts, you'll know why.  To tide you nice people over, here are a few blog links that might interest you.

• The ever-fascinating Neuroskeptic blog has a new post up on social anxiety disorder, or is it "social phobia"?
• Karen Franklin at In The News provides up with her new disturbing new series on confidentiality in forensic evaluations.
• Scicurious weighs in on how environmental enrichment can make you sexy, at least if you're a rat..
• How was the most famous bet in the history of brain sciences won and lost?  Christian Jarrett of Brain Myths has the details.
• Disturbed by the recent Times cover picture?  What is the proper time that a child should stop breastfeeding?  Eric Michael Johnson of the Primate Diaries weighs in with his own observations.
• Ferris Jabr of Brainwaves has just launched a new series: titled Know Your NeuronsL The Discovery and Naming of the Neuron.  Here is the first installment.  
• The ever-reliable Vaughn Bell of Mind Hacks has a new post describing an important new article in Nature about the dangers of unreplicated studies in psychology.
• Should therapists be using tough love with their patients? A new post in the Wall Street Journal makes a good case for it.
• How are children affected by their parents' financial instability?  According to this Huffington Post article, the damage is just starting to be recognized.
• Can a patient be charged for not taking medication that might endanger other people?  Here is a news story from USA Today that should raise quite a few questions.
• Will we ever see an end to ex-gay therapy and its advocates?  A new ThinkProgress post finds NARTH's objections to ex-gay therapy restrictions rather easy to refute.
• While we try to understand what people suffering from severe depression, how often do we get to hear about it from the first-person perspective?  Natasha Tracy of Bipolar Burble gives us a gripping account of her own experiences.

Until later.

 

 

Reading The Bumps (Part 1 of 2)

One thing you could say about phrenologist and author, Orson Squire Fowler,  he certainly knew how to grab your attention.

Part of my collection of rare psychology books is an 1875 volume by Fowler.  The title certainly leaves little to the imagination: 

"Creative and Sexual Science: or Manhood, Womanhood, and Their Mutual Interrelations;  Love, Its Law, Power, ETC.;  Selection, or Mutual Adaptation; Courtship, Married Life, and PERFECT CHILDREN;  Their Generation, Endowment, Paternity, Maternity, Bearing, Nursing and Rearing; Together with Puberty,, Boyhood, Girlhood, ETC.;  SEXUAL IMPAIRMENTS RESTORED, Male Vigor ad Female Health and Beauty Perpetuated ad Augmented, ETC.,  as Taught By PHRENOLOGY AND PHYSIOLOGY " 

(Fowler was showman enough to make sure that the most important words were carefully capitalized). 

Got all that?  Good.   But more on that later after I provide a little background on the beginnings of phrenology.

Although the idea that mental abilities were linked to specific locations in the brain dates back to Aristotle, true scientific work into the nature of brain functioning didn't begin until the late 18th century.   While early visionaries such as Emmanuel Swedenborg made some inspired guesses about how the brain worked, it was German neuroanatomist Franz Joseph Gall who can properly be considered the father of phrenology (not that he ever used that term).   After establishing his reputation as one of Austria's most prominent physicians, Gall turned his research interests to the human brain and developed the first true theory of cerebral localization.  By 1792, he began lecturing on his idea that the human cerebral cortex was actually a mosaic made up of different specialized organs.  Although many of his ideas were actually correct, including his observations on the significance of cerebral hemispheres and the importance of the frontal lobes in complex thinking, the pseudosciene linked to Gall's name has largely overshadowed his reputation as a medical pioneer.    The premises that Gall laid out in his lectures were that:

1. the brain is the organ of the mind,
2.  the mind is made up of seperate annd discrete faculties,
3. each faculty must have its own "seat" or organ in the brain,
4.   the size of each organ is a direct measure of its relative importance in the mind,
5.   the shape of the brain is determined by how each organ developed,
6. since the skull is formed from the shape of the brain, measuring the skull can provide an accurate assessment of individual aptitudes and tendencies.    

Gall identified nineteen mental faculties which he considered to be essentially animal in nature, these included "reproductive instinct," "love of one's offspring," "affection," "destructiveness or tendency to murder," and "desire to possess things."   In contrast, he also identified a series of exclusively human qualities such as "wisdom", "satire and wit", "sense of metaphysics",  "religious sentiment", and firmness of purpose".  

Public reaction to Gall's lectures were decidedly mixed.   Despite the lectures being popular, conservative Catholic authorities and even some of his medical colleagues accused him of subversion for daring to suggest that the brain was the centre of intellect rather than the soul (the Austrian empire was still Catholic at that time). Although Gall defended himself and his theories as much as he could, he was ordered to stop lecturing in 1801.   Realizing that he would never be allowed to teach freely in Austria, Gall went into exile to could teach and continue his brain research.   Along with giving lectures and public demonstrations of dissections in Denmark, Holland, Switzerland, and France, he took a keen interest in the brains of convicted criminals and gathered further material for his writings on brain functioning.    Settling in Paris in 1807, Gall began writing his masterpiece, ,  The Anatomy and Physiology of the Nervous System in General, and of the Brain in Particular, with Observations upon the possibility of ascertaining the several Intellectual and Moral Dispositions of Man and Animal, by the configuration of their Heads,  which was eventually published in 1819. 

It was Gall's chief supporter, Johann Spurzheim, who helped Gall develop many of his theories after they first met in 1800.   Although he wasn't the first to coin the term "phrenology", Spurzheim  quickly adopted it for the brain science that he and Gall developed.  Their relatively productive relationship end in 1813 over disagreements on how the brain should be classified.    While Gall's research on criminal brains led to his arguing that there were "evil" tendencies in those brains that needed to be suppressed (such as regions of the brain controlling "murder" and "theft"), Spurzheim rejected this completely and argued that criminal behaviour was caused by underdeveloped moral faculties.   He also changed Gall's classification system by adding new organs such as "hope" and "moral sense" to Gall's list.   The total number of organs in Spurzheim's revised list rose to thirty-three from Gall's original twenty-seven.    Spurzheim also rejected Gall's gloomy pessimism over changing human nature and argued that proper upbringing could help overcome criminal tendencies.     After their split, Gall publicly condemned many of Spurzheim's "innovations" in his own books and often denounced him as a plagiarist and a quack. 

And with good reason perhaps.  While Gall tried to link his conclusions to actual brain research, Spurzheim development of "practical phrenology" became extremely popular in England and Scotland (and eventually in the United States as well).   Gall was, well, galled by Spurzheim's success and, despite his refusal to use the term phrenology himself (he preferred to call his own science "organology" or "zoonomy"),  it was Spurzheim's term that won out.  Various critics had no problem linking their names together and one reviewer in 1815 denounced their theories as "a collection of mere absurdities, without truth, connexion, or consistency".   Despite some recognition for his original contributions to brain research, Gall remained bitter over never receiving the eminence he felt he deserved.  He died in 1828 after requesting that his own skull be added to the large collection of skulls that are still on display in the Rollet Museum in Baden bei Wien, Austria.

As fpr Spurzhim and his own chief supporter, George Combe, the practical phrenology that they both advocated had less and less to do with any actual brain science as time went on.   While Spurzheim still had some actual medical credentials and gave public demonstrations of brain dissections, his death in 1832 left George Combe as the chief spokesman for phrenology.  Since Combe had no actual medical training (he was a lawyer),  that also meant that phrenology's tenuous claim to science was weaker than ever.   Still, as phrenology shifted away from brain science towards more"personality-oriented" applications, social reformers, innovators, and criminologists became attracted by its appeal.  Cesare Lombroso incorporated many aspects of Gall and Spurzheim's ideas into his own system of identifying "born criminals".     Educators saw phrenology as a way of classifying students according to their ability to learn while psychiatrists began studying patient skulls to find better ways of dealing with asylum inmates. 

By the time of Johann Spurzheim's death, there were at least twenty-nine different phrenological societies in Great Britain alone (George Combe personally founded the Edinburgh Phrenological Society in 1820).  George Combe's books became international best-sellers and his best-known book, The Constitution of Man, sold more than seventy thousand copies by 1838 alone (and would eventually go on to sell more than three hundred thousand copies).   Even the British royal family consulted Conde since Prince Albert had been worried that one of his sons was a slow learner.   Conde also evaluated Queen Victoria (from a distance) and concluded that her broad and high forehead reflected her "firmness of purpose, great self-control, and awareness of moral principles".   

Despite the controvery over phrenology and increasingly successful attacks by eminent scientists,  phrenology spread across the Atlantic and American phrenological societies sprang up as well.  Still,  phrenology didn't last particularly long as a serious movement in the United States.   Eminent American surgeon John Collins Warren attended many of Spurzheim's lectures and recognized its significance aalthough he never became a member of a phrenological society himself.  He also carried out the autopsy on Johann Spurzheim after his death in Boston during an American tour (leading to Spurzheim's skull being added to the growing Harvard medical collection).    Other eminent medical researchers such as Charles Caldwell and John Bell also attended Spurzheim's lectures and founded Pennsylvania's first phrenological society (Caldwell went to write the first American textbook on phrenology).    Although George Combe visited the United States on lecture tours (and met several American presidents in the process), the movement began fading after 1840 and largely became relegated to a pseudoscience before the decade was out.

Which brings us back to Orson Fowler and his brother...

Continue to Part 2

 

 

 

Adapting to Facial Paralysis

How do people incapable of making facial expressions function in society?  Although there has been little research on the adaptive behavior of people with congenital compared to acquired disability, there is reason to predict that people with congenital conditions may be better adapted because they have lived with their conditions for their entire lives (Smart, 2008).   In a recent paper published in Rehabilitation Psychology, researchers examined whether people with congenital facial paralysis (FP), compared to people with acquired FP, compensate more for impoverished facial expression by using alternative channels of expression (i.e., voice and body).   Participants with congenital (n = 13) and acquired (n = 14) FP were videotaped while recalling emotional events. Expressive verbal behavior was measured using the Linguistic Inquiry Word Count (Pennebaker, Booth, & Francis, 2007). Nonverbal behavior and FP severity were rated by trained coders. Results showed that people with congenital FP, compared to acquired FP, used more compensatory expressive verbal and nonverbal behavior in their language, voices, and bodies. The extent of FP severity had little effect on compensatory expressivity.  This study provides the first behavioral evidence that people with congenital FP use more adaptations to express themselves than people with acquired FP. These behaviors could inform social functioning interventions for people with FP.

For the abstract

Final Public Review for Draft Version of DSM-5 Now Underway

As part of their ongoing review process,  the American Psychiatric Association's DSM-5 Task Force will be soliciting public feedback on the draft fifth edition of the Diagnostic and Statistical Manual of Mental Disorders  (DSM-5) from May 2 through June 15, 2012.    This is the final public review period and follows the previous review period of May-June 2011.   Already the  subject of considerable controversy, the DSM-5 is due for release in May 2013 and is likely to shape mental health policy across North America for years to come.   Along with changes to the diagnostic criteria for many established psychiatric disorders, the DSM-5 will also be introducing new diagnosed such as Suicidal Behavior Disorder,  Non-Suicidal Self-Injury Disorder, and Persistent Complex Bereavement Disorder. Among the significant changes proposed for existing psychiatric diagnoses, the DSM-5 task force is recommending:

• A redefining of current autism diagnoses  into a single diagnosis know as Autism Spectrum Disorder intended to accomodate all of the complex problems faced by children and adults currently diagnosed as autistic.  This is meant to include Asperger's Syndrome, childhood disintegrative disorder, and pervasive development disorder- not otherwise specified (PDD-NOS).    By combining these different diagnoses into a single diagnostic category into a single diagnostic category, the DSM-5 task force is hoping to eliminate potential confusion given the similar symptoms displayed by individuals with the different diagnoses.
• Redefining Major Depressive Disorder to allow for he often devastating consequences of grief.   Since patients dealing with  bereavment often mimic some or all of the diagnostic criteria of Major Depression.  Due to the possibility of misdiagnosis by untrained people using diagnostic checklists, the new DSM-5 will include footnotes to help clinicians recognize how loss reactions can be distinguished from mental illness.
• Due to c0ncerns about the proposed diagnosis of  Attenuated Psychosis Syndrome (which in turn replaces the even more controversial Psychosis Risk Syndrome diagnosis) as well as Mixed Anxiety Depressive Disorder, these two diagnosis have been deferred for further study and possible inclusion in future versions of the DSM. 
• Communication disorders have now been expanded to Language Disorder and Speech Disorder.  A third diagnosis, Social Communication Disorder is proposed (which is distinguished from Autism Spectrum Disorder).  
• Under the general category of Sleep-Wake Disorders  (formerly Sleep Disorders in the DSM-IV-TR) are a range of new diagnoses including Insomnia Disorder, Hypersomnolence Disorders, Obstructive Sleep Hypopnea Syndrome, Nightmare Disorder, Restless Legs Syndrome,  Rapid Eye Movement Sleep Behavior Disorder and Substance-induced Sleep Disorder.
• Trauma and Stressor-Related Disorders will be placed in a separate category and Posttraumatic Stress Disorder will be given a new subtype for preschool children.   This category will also include Acute Stress Disorder,  Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, and Trauma- or Stressor-Related Disorders Not Elsewhere Classified.
• The Sexual and Gender Identity Disorders Work Group has proposed a new diagnostic term Gender Dysphoria with subcategories for children, adolescents and adults.   The new diagnostic label will replace existing categories of Gender Identity Disorder and Transvestic Fetishism and has already generated enormous opposition by transgender activists.
• Existing DSM-IV-TR diagnoses often linked to antisocial behaviour in children and adults including Conduct Disorder, Oppositional Defiant Disorder and Intermittent Explosive Disorder are now categorized under Disruptive, Impulse Control and Conduct Disorders.   Antisocial Personality Disorder (also termed Dyssocial Personality Disorder) is included in this category along with Disruptive Behavior Disorder Not Otherwise Classified.
• The category Substance Use and Addictive Disorder has been expanded to include Gambling Disorder (formerly classified as an Impulse Control Disorder), Tobacco Use Disorder, and Tobacco Withdrawal.   A group of diagnoses linked to Unknown Substance Use are also included for the first time.   As well, Caffeine Use Disorder, Internet Use Disorder, and Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure have been added to Section III of the DSM-5 for further study.
• There is also a radical redefinition of personality disorders proposed for the DSM-5 with a streamlined approach to diagnosis and an extensive guide for implementation.  A series of examples will be included to help clinicians make a proper diagnosis.
• Paraphilic Disorders are now listed in a separate category.  Pedophilic Disorder has been expanded to include a new Hebephilic subtype to reflect sexual attraction to post-pubescent children.    Including hebephilia in the DSM-5 has been extremely controversial with mental health professionals opposing its inclusion on various grounds.   The Sexual and Gender Disorders Work Group are also recommending the inclusion of Hypersexual Disorder and Paraphilic Coercive Disorder for inclusion in Section III of the DSM-5 for further study.

The DSM-5 editors stress that the proposed changes are not final and will undergo further revisions before the end of 2012.  The DSM-5 website will be soliciting comments from the public until June 15th to allow for sufficient feedback.  Anyone with concerns about the current form of the DSM-5 is welcome to  provide feedback.  Given that the importance of ensuring that the DSM-5 will be as fair and unbiased as possible, the time to act is now.

Click here for the link.

 

How Do Hormones Affect Cognition During Pregnancy?

A longitudinal study recently published in Behavioral Neuroscience investigated the possible influence of estradiol (E₂), progesterone (P), testosterone (T), cortisol (CORT), and prolactin (PRL) levels on cognitive functioning during late pregnancy and the early postpartum period. The performance of 55 pregnant women on a battery of neuropsychological tests, tested once during the third trimester of pregnancy and once during the early postpartum period, was compared with that of 21 nonpregnant controls matched for age and education. Women in the pregnancy group had significantly lower scores than the controls during both the pre- and postpartum visits on tasks of verbal recall and processing speed. CORT levels were significantly associated, in an inverted-U function, with verbal recall scores at both the pregnancy and at postpartum periods and with spatial abilities at postpartum only. During pregnancy, PRL levels were associated in both a linear and an inverted-U function with scores on tests of paragraph recall and in a linear function with scores on tests of executive function. At postpartum, E₂ and CORT were negatively associated in a linear fashion with attention scores. These findings provide new evidence that fluctuating hormone levels during late pregnancy and early postpartum may modulate selected cognitive abilities.

For the abstract.

Celebrating Mental Health Week and National Mental Health Month

The Canadian Mental Health Association (CMHA) has declared May 7 to May 13, 2012 as Mental Health Week.    With the theme "Mental Health For All",  Mental Health Week is an annual national event designed to encourage people to learn, talk, reflect and engage with others on all issues surrounding mental health.    Along with regional and local events, the Assocation is focusing on key topics highlighting the different ways that mental health issues can affect us all.

These topics include :

• "Kids Can Have Stress, Too!"

The Kids Can Have Stress Too! program was developed to boost childrens's ability to handle the normal stress of growing up.   Educating parents, caregivers, and teachers on how to recognize stress in children, the program is also designed to give them the knowledge and insight to help the children in their care cope with stress in healthy ways.  The original program was developed for classroom use with children aged five to nine but a second pre-schooler program has also been developed for pre-school children.   The CMHA is working with social service agences and public health units to bring these programs to every province in Canada.

•   Resiliency: at Home, at School, and at Work

What is resiliency?  It is defined as "a combination of skills and positive attributes that people gain from their life to help them solve problems, cope with challenges and bounce back from disappointments".   As part of their Mental Health Week initiative, CMHA is encouraging adults to develop their resiliency skills to help them function at work and to teach those essential skills to their children.  

•  Mental Health is Everyone's Concern

Although research shows that one in five Canadians will suffer a mental illness at some time in their lives, the stigma surrounding mental illness remains unacceptably strong.   Along with being present in every family, mental illness is also the leading cause of disability in Canada accounting for nearly thirty percent of all disability claims and costs the Canadian economy 50 billion dollars a year in health care costs and lost revenue.  To prevent mental illness from being "swept under the carpet", the CMHA is working to combat many of the myths surrounding mental illness that can prevent people from getting the help that they need or becoming reintegrated into society afterward.   As the fact sheets available on the CMHA site show, most people with mental illness can, and do, get better and return to their normal lives.

Contact the CMHA to learn more about Mental Health Week events in your community or to download the Mental Health Week 2012 Toolkit. 

Also, in the United States,  Mental Health America is celebrating May as "Mental Health Month".    First started in 1949,  marking May as Mental Health Month raises awareness of the one in four Americans who suffer from mental health issues and to improve mental wellness for all.  This year's two main themes are: 

• "Do More for 1 in 4"

Providing a call for action for the one in four Americans who live with diagnosible and treatable mental illnesses.    Download the Do More For 1in4 Toolkit.

• Healing Trauma's Invisible Wounds

Dealing with trauma can often take a lifetime and many trauma sufferers are either unwilling or unable to get the help they need.   Traumatic events can affect entire communities as much as they affect individuals.    Download the Healing Trauma's Invisible Wounds Toolkit.

Contact Mental Health America to learn more about Mental Health Month and their other resources.