The Ethan Watters Phenomenon
Physicians and therapists are going to have to read Ethan Watters’s new book Crazy Like Us, if only to respond to friends and patients who have read it.
Watters is attracting attention across the press spectrum, from NY Times to Psychology Today, as well as international press stories. We have already pointed to some of this press in two earlier posts: Exporting Mental Illness and Is the U.S. Exporting Mental Illness?.
The latest article is “Crazy Like Us” in Psychology Today (9 February 2010). The author summarizes Watters’s study:
“Crazy Like Us’’ is both groundbreaking and shocking. By focusing on four countries and four disorders – anorexia in Hong Kong; post traumatic stress disorder in post-tsunami Sri Lanka; schizophrenia in Zanzibar, Tanzania; and depression in Japan – Watters shows how American mental health professionals and pharmaceutical companies, sometimes accidentally, sometimes insidiously, have actually hastened the spread of some Western disorders.
Despite this praise, the article finds fault with Watters’s style and command of the scholarship. Further, Watters is faulted for not investing his writing and argument with enough passion: “the book is thoughtful, contextualized reportage of a disturbing if not entirely surprising trend.”
Crazy Like Us’s approachable prose, engaging style, and authoritative tone guarantees that many people will read it and accept its conclusions as a valid critique of the mental health profession.
More Press Coverage of the DSM-V
Time magazine has weighed in with it’s analysis of both the DSM-V and the APA’s efforts to address the criticisms of earlier versions. Obviously, the biggest step has been to publish the draft of the new DSM, available at the new dsm5.org website. In addition, Time lists five additional stepts:
- Contain the definition of a mental illness within sensible borders.
- Define mental disorders along a continuum rather than as bianaries.
- Address the problem of including some minor addictions (e.g., caffeine intoxication) while excluding others (e.g., compulsive gambling).
- Overhauls the strange grouping of personality disorders.
- Rethink the definitions of sexual and gender identity disorders.
As the Time points out, these approaches don’t prevent controversy. For example, the autism spectrum of disorders had drawn criticism because it groups high-functioning people with Asperger’s disorder with people who suffer from extreme cases of autism. This is surely just one of the many controversies that will erupt over the new definitions of disorders. No amount of public airing will prevent such discussions, and indeed shouldn’t prevent such discussions.
See John Cloud, “The DSM: How Psychiatrists Redeined ‘Disorder’,” Time (13 February 2010).
More Desvenlafaxine Research
Desvenlafaxine has been attracting considerable attention lately. We pointed to two recent studies that seemed to present contrasting results about DVS (see this post). Yet another study, published in the current issue of Primary Psychiatry examined DVS’s safety and effectiveness for older patients suffering from major depressive disorder (MDD). Focusing on patients over 65, the study found that the most frequently reported adverse events were moderate nausea followed by dizziness and headache. There were few clinically important changes in vital signs.
The study concludes that DVS is safe, well tolerated, and effective for elderly patients with MDD.
S. Ferguson et al., “An Evaluation of the Efficacy, Safety, and Tolerability of Desvenlafaxine in the Long-term Treatment of Elderly Outpatients With Major Depressive Disorder,” Primary Psychiatry 17, no. 1 (2010): 66–73.
The DSM-V in the News
The proposed emendations to the DSM-V have been attracting considerable attention the past few days. Following the official launch of the new DSM-V website, articles (with oddly similar titles) have appeared in the NY Times, the LA Times, and the Washington Post, as well as in other newspapers.
In many ways, the new DSM will reduce the number of distinct diagnoses, folding related disorders into single, broader categories, e.g., autism spectrum disorders covers autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and persuasive developmental disorder. Not only will these changes spark debate from people who suffer from these various individual disorders, but such reclassifying will both open and close (financial) opportunities for pharmaceutical companies, insurance companies, and research dollars.
To have your say in the on-going debate, visit the official DSM-V site:
APA DSM-V. See also:
B. Carey, “Revising Book on Disorders of the Mind,” NY Times (10 Feb. 2010)
R. Stein, “Revision to the Bible of Psychiatry, DSM, Could Introduce New Mental Disorders,” Washington Post (10 Feb. 2010)
S. Roan, “Revising the Book on Mental Illness,” LA Times (10 Feb. 2010)
A recent article in Psychiatric Times reviews some basic marketing strategies for increasing your practice’s success. While the individual points are important, the most important lesson to take from the article is: You should spend time and money marketing your practice.
Many physicians fail to invest time and money in marketing and promoting their practice. However, marketing their practice is a wise investment that helps ensure financial stability and allows them to reach short- and long-term goals
Some basic checkpoints:
- Marketing your practice is a wise investment that helps ensure financial stability and allows you to reach your short- and long-term goals. Efficient and effective operations of your practice are prerequisites to successful marketing.
- Mental health patients probably will not promote your expertise with friends and colleagues. This lack of personal referrals from current patient to potential patient means you will have to promote your services on your own.
- A Web site for your practice is the most valuable marketing tool you can have. It is worth the investment.
- Retaining your existing patients for already-scheduled appointments is one of the most critical aspects of internal marketing.
Read the full article (it’s not long) for explanations of these different points.
See M. Brachler, “Marketing Your Private Practice Successfully Useful Tools to Improve Your Bottom Line,” Psychiatric Times
Two recent studies present varying cases for Desvenlafaxine Succinate (DVS). DVS is a relatively recent antidepressant (approved by the U.S. FDA in early 2008) and joins a group of serotonin-norepinephrine reuptake inhibitors (SNRIs) for the treatment of major depressive disorder. Trials show definite efficacy over placebo-controlled studies. However, efficacy over existing antidepressants has not been clearly demonstrated.
See:
C.-U. Pae, “Desvenlafaxine: A New Antidepressant or Just Another One?,” Expert Opinion on Pharmacotherapy 10, no. 5 (2009): 875–87.
H.-J. Seo et al., “Desvelafaxine Succinate: A Newer Antidepressant for the Treatment of Depression and Somatic Symptoms,” Postgraduate Medicine 121, no. 1 (2010)
In a recent study researchers survey the various pharmacological options for Treatment-Resistant Depression (TRD). While TRD is poorly defined, they claim TRD represents an area of unmet medical need. The researchers dismiss non-pharmacological therapies because of their experimental nature or lack of long-term benefits. Instead, they point to various “experimental pharmaceutical” alternatives in combination with or instead of traditional antidepressants, e.g., pindolol, inositol, hormones, herbal supplements, omega-3 fatty acids, etc.
They conclude:
In summary, despite an increasing variety of choices for the treatment of TRD, this condition remains universally undefined and represents an area of unmet medical need. There are few known approved pharmacological agents for TRD (aripiprazole and OFC) and overall outcomes remain poor. This might be an indication that depression itself is a heterogeneous condition with a great diversity of pathologies, highlighting the need for careful evaluation of individuals with depressive symptoms who are unresponsive to treatment. Clearly, more research is needed to provide clinicians with better guidance in making those treatment decisions – especially in light of accumulating evidence that the longer patients are unsuccessfully treated, the worse their long-term prognosis tends to be.
See R.C. Shelton et al., “Therapeutic Options for Treatment-Resistant Depression,” CNS Drugs 24, no. 2 (2010): 131–61.
Citalopram and Late-Life Depression
A study published in American Journal of Geriatric Psychiatry found that older patients suffering from late-life depression and deficient response inhibition (DRI) responded poorly to SSRI antidepressants such as citalopram.
This double-blind study followed patients aged 75 years and older who were suffering from depression with and without DRI. The patients were treated with citalopram or a placebo. Citalopram-treated patients with DRI did significantly worse than placebo-treated patients with DRI. Conversely, citalopram-treated patients without DRI did significantly better than placebo-treated patients without DRI.
See J.R. Sneed et al., “Antidepressant medication and executive dysfunction: a deleterious interaction in late-life depression,” American Journal of Geriatric Psychiatry 18, no. 2 (2010): 128–35.
Mental Health Parity—Looking Forward
In an article published today, in Psychology Today, Dr. David Sherm points out that the recent passage of the mental health parity act is only the first step. Behavioral health professionals need to engage in educating the public about the benefits this law provides, especially with respect to reducing the stigma associated with seeking mental health treatments. Moreover, businesses need to be educated about the benefits for them if they provide mental health benefits to their employees. In fact, Sherm points out that most businesses actually save money when they include mental health coverage in their health plans.
See David Sherm, “Minding the Nation’s Health: What’s Next for Parity-Part I” Psychology Today
A new study explores the ways that psychiatrists might, unconsciously and unintentionally, perpetuate racial-ethnic disparities in mental health care. Psychiatrists responded to a survey that asked about their awareness of racial inequalities in psychiatric care, their beliefs about those inequalities, and their interest in educational programs about them.
Approximately half (51%) of the respondents were unfamiliar with literature on racial inequalities in psychiatric care. When asked, they thought conditions were improving. About one quarter had participated in educational programs to raise awareness of racial/ethnic disparities and another two-thirds expressed interest in participating in such programs.
Authors of the study focus on the percentage of respondents who expressed ignorance of racial/ethnic disparities. They offer a range of approaches to ameliorate the situation, including top-down educational programs initiated by the APA.
Despite the negative tone of the article, the profession seems to be making some positive steps.
See the complete study: J. B. Mallinger et al., “Psychiatrists’ Attitudes Toward and Awareness About Racial Disparities in Mental Health Care” Psychiatric Services 61 (2010): 173–79.