Tuesday, August 30, 2016

Adult Sibling Rivalry and Family Dysfunction

Ahmet and Dweezil Zappa with their Mom, Gail, in happier times?

When adult siblings are continually at one another's throats, the conflicts have often been set up, either openly or covertly, by the behavior of one or both of the parents over an extended period of time - usually dating back to the siblings' childhood. Such parental behaviors are particularly effective for this purpose if started when the children were very young and have been continued, with minor variations, throughout their lives. 

There are a number of relatively straightforward techniques for parents to accomplish this goal. 

Here are a few common ones; there are undoubtedly a whole lot more.

1. The parent gossips and complains about each sibling behind that sibling's back to the all the rest of the other siblings.

2. The parents make constant negative comparisons of one sibling with another. For example, they might repeatedly scream, "Why can't you be more like your brother?!?"

3. The parent consistantly focuses only on those siblings who are creating repetitive, ongoing problems for themselves - and for everyone else in the family - and pays no or minimal attention to the siblings who are doing well and who are functioning independently.

4. Parents may leave the bulk of their estate to one or two siblings after they pass away, and much less - or even a pittance - to the rest. This is especially effective if they give almost all the money to the biggest screw up, or to the ones that did not come over and help take care of them when they were sick or indisposed in some way.

The picture at the top of the post are musician Frank Zappa's wife Gail and his two sons, Ahmet and Dweezil. Although there is no way to be certain from news stories orTwitter wars, a recent public feud in the family might possibly be an example of what I'm talking about. 
According the the Los Angeles Times:

 "Frank Zappa’s rich musical and cultural legacy, and which children have a right to profit off it, have recently become the subject of a public and contentious family battle. The children of Frank and Gail Zappa – Moon Unit, Dweezil, Ahmet and Diva – were left unequal shares of the Zappa Family Trust, which owns the rights to a massive trove of music and other creative output by the songwriter, filmmaker and producer — more than 60 albums were released during Zappa’s lifetime and 40 posthumously. Thanks to a decision by their mother, who died in 2015, Ahmet, 42, and his younger sister, Diva, 36, share control of the trust — to the dismay and anger of their two older siblings, Dweezil, 46, and Moon, 48, who received smaller portions."

For more on this interesting family, see:

Tuesday, August 16, 2016

Bipolar versus Borderline: Disease Mongering Pill Pushers Stack the Deck

In my Psychology Today blogpost of 12/11/11, Bipolar or Borderline, I described how disease mongering, pill-pushing psychiatrists have done their utmost best to blur the distinction between the mood (affective) instability seen in borderline personality disorder (BPD) with the mood episodes characteristic of true bipolar disorder. 

This distinction is important because BPD is clearly a disorder of interpersonal relationships and behavior mixed in with a history of trauma and family dysfunction, while true bipolar disorder is a serious biogenic brain disease. BPD, while some of its symptoms do respond quite well to the right medications, should be treated primarily with psychotherapy, while bipolar disorder should be treated primarily with medication.

In the prior post I discussed the use of invalid symptom checklists in studies to exaggerate the incidence of bipolar disorder. They are also used by some incompetent psychiatrists to make diagnoses that justify snowing every patient who walks in the door with potentially toxic antipsychotic medication. In the June 2016 issue of the Journal of Personality Disorders, researcher Mark Zimmerman goes into some detail about exactly how corrupt researchers use slight of hand to distort their data (Improving the Recognition of Borderline Personality Disorder in a Bipolar World, pp. 320-335).

They are very good at it. And it matters. Zimmerman states: "Although BPD is as frequent as (if not more frequent than) bipolar disorder, as impairing as (if not more impairing than), and as lethal as (if not more lethal than) bipolar disorder, it has received less than one tenth [emphasis mine] the level of funding from the NIH [the National Institutes of Health] and has been the focus of many fewer publications in the most prestigious psychiatric journals."

And, Zimmerman points out, the difference is not due to just the fact that there were more drug studies for bipolar disorder. In fact, the amount of funding for the drug treatment of bipolar disorder was just a little more than 10% of the total.

As I have mentioned several times in this blog, self-report symptom checklists are meant to be screening devises. This means that if you are positive for bipolar disorder on the screen, it does not mean you have bipolar disorder. It means you should be evaluated further! Screening tests are designed to have a lot of false positives - people who come out as positive on the test but who do not actually have the disorder. In fact, the majority of people who screen positively do not have bipolar disorder.

Zimmerman specifically brings up the Mood Disorders Questionnaire (MDQ) that I discussed in the previous post. Get this: in one study by Frye and others in the journal Psychiatric Services in 2005, the authors found that one half of the patients who were positive for bipolar disorder on the MDQ were not diagnosed with bipolar disorder by the treating clinician.  

Their conclusion? They said the clinicians "failed to detect" or "misdiagnosed" bipolar disorder in these patients! Actually, the exact opposite is far more likely: it sounds like the clinicians' judgments tended to be correct.

Frye and others then went on to state that these patients were "inappropriately treated because they were given antidepressants instead of mood stabilizers." Again, exactly the wrong conclusion to draw from the authors' own data. Yet they went on to say that this completely false conclusion was "worrisome." Some of us would call this real chutzpah.

Bipolar, my ass researchers love to talk about the bipolar "spectrum," based on the crazy logic that if a given symptom appears slightly similarly in two people, they must both have a version of the same syndromic psychiatric disorder. Zimmerman asks why no one talks of a borderline spectrum, when clinically, many patients are diagnosed as having borderline traits. This means that out of the nine criteria, of which you are required to meet any 5,6,7, 8, or all nine to qualify for the diagnosis, the patients may only have three or four. 

In fact, as reported in the July issue of the American Journal of Psychiatry (Vol. 173, pp. 688-694), Zanarini and others followed 290 patients with BPD closely over 2 years. They found that "...the symptoms of borderline personality disorder are quite fluid..." This means that they come and go over time. This was particularly true for acute symptoms like self-mutilation. Therefore, people with the disorder may frequently go from 5 symptoms to 4, and suddenly they don't "have" it anymore - unless and until the 5th symptom recurs!

In actual reality, he said redundantly, those people who exhibit three or four of the nine symptoms look a lot more like those folks who have five or more than they do like those folks who have none of them. Now that sounds like a "spectrum" to me.

Tuesday, August 2, 2016

Guest Post: What Happens When Mental Health Care Is Unavailable?

Adam Lanza, Sandy Hook Elementary School Shooter

Today’s guest post is by Audrey Willis.

It's a sad fact that mental health care in the United States is becoming increasingly unattainable.

From 2009 to 2012 the mental health care industry saw a $5 billion drop in funds across the country, primarily stemming from national budget cuts. While one in four adults---nearly 62 million individuals--experiences some type of mental illness in a given year, a staggering 4,500 public psychiatric hospital beds were eliminated during the same period. New York, Kentucky, California, and Illinois were among the top cutting states. Additionally, 13 states closed at least 25 percent of their state hospital beds. Unsurprisingly, this has resulted in a steep increase in patients visiting emergency rooms across the country in search of mental health care assistance. States that closed the highest number of mental health care beds also experienced an increase in violent crime over the same time period.

Aside from these budget cuts, there is another concerning issue, as the global mental health care industry is experiencing a shortage in working professionals. Globally, nearly one in ten people has a mental health issue. Who will take care of these people if only one percent of the universal health care workforce is dedicated to mental health?

Some real life examples may help to illustrate the serious nature of this ongoing issue:

-A 19 year old from New Hampshire recently spent 10 days in the common area of a Maine emergency room waiting for a bed to open in the mental health facility.

-A man who allegedly stole the equivalent of $5 in snacks died in jail as he waited for space to open up in a mental health center.

-A woman visited an Illinois emergency room 750 times over the course of 10 years searching for mental health assistance. The cost was a sobering $2.5 million.

These are problems that could be easily eliminated by integrating mental health care professionals into the emergency room staff of every major hospital.

With examples like this, it is easy to see why deep budget cuts have negatively impacted the quality of treatment for those who suffer from chronic mental illness. A recent heartbreaking report from the Treatment Advocacy Center found that at least one in four fatal police encounters involved the death of an individual suffering from a severe mental illness.

Individuals suffering from various mental illnesses who do not receive proper treatment often find themselves in the country's criminal justice system. Aside from the very real concern that these people will fail to recover without treatment, this also results in a significantly higher cost to taxpayers and makes for a more dangerous landscape, both for patients and law enforcement professionals.

While a tragic event can often increase public attention to mental health needs, the passion is rarely sustained after the news media cameras stop rolling.

A solution to this healthcare problem is to staff hospitals with mental health professionals, and find a way to open additional beds in treatment facilities---places that are specially trained on how to handle the vast spectrum of mental illness. Until that occurs, tragedies, much like the gut wrenching 2012 Sandy Hook Elementary School shooting---that claimed the lives of 20 children and six adults---may continue to happen. The perpetrator of this specific incident is known to have suffered from various mental illnesses, and was not able to obtain successful help.

Here is an infographic from the Cummings Institute ( that goes into more detail. Please Zoom in to see: