Go here to listen to an archived interview on the Sasha Show about stress, depression, the media, and modern times. It is WGCU SW Florida public radio. Friend the show on fb by looking for ‘Sasha Show’ or friend me here ‘Doug Bremner’.

NYU has acquired the archives of so-called “artist” Larry Rivers who filmed his daughters naked while they were growing up, including the time when they developed breasts. When they complained he told them that they were bad daughters and uptight. This douchebag was apparently big on the beat artist and NYC circuit. Her mother said it “wasn’t a big deal at the time, but now NYU was making it a big deal by not giving up the films.” Now New York University (NYU) has acquired his archives, including the films, which are essentially child pornography. His daughter, Emma, states that the filming caused her to have anorexia, and drove her into therapy. She wants the films back.
But a spokesperson for the archive said he didn’t have the “authority” to go back and figure out which parts of the archive are innappropriate. I say someone from NYU should use a little bit of f-ing sense and get rid of their child porn collection. What do you think?

I have written before about the DSM-5 process, including criticisms that the process is not transparent and that it is dominated by psychiatrists with histories of consulting to pharmaceutical companies, and that the process of revising DSM is driven by the royalties that the American Psychiatric Association depends on selling new copies to pay for its expenses.

Now the proposed criteria are out, but the link did not work for gender identity disorders or dissociative disorders, although this is the last day for comments. The PTSD criteria were present and I had the following critiques which I posted there.

There are no plans to do a field trial to compare prevalence of PTSD under the new criteria compared to DSM-IV-TR. We will unleash a diagnostic classification system with no idea about the impact it will make on diagnosis. This will increase overnight the number of people who meet criteria for the disorder, with the associated stigma and risk of adverse effects of treatment. The new “Criteria A” expands the number exposed from half the population to probably all of the population (although we don’t know for sure, as there are no studies). Anyone who has witnessed death or threatened death, or threatened sexual violation, or heard about it from a close friend or relative, or heard about aversive details. It doesn’t matter how they reacted, as the stipulation “associated with intense fear, horror or helplessness” has been removed. Some symptoms like “I’ve lost my soul forever” are grounded in JudeoChristian beliefs (this last one makes me wonder if the lights are on in there).
Did you know that you don’t have to use the DSM or buy it? Yep. All you need is the ICD-9 codes for insurance or billing purposes.That’s the APA’s dirty little secret.

Here are the proposed criteria for PTSD

Posttraumatic Stress Disorder*

A. The person was exposed to the following event(s): death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways:**

1.Experiencing the event(s) him/herself2.Witnessing the event(s) as they occurred to others
3.Learning that the event(s) occurred to a close relative or close friend
4.Experiencing repeated or extreme exposure to aversive details of the event(s) (e.g., first responders collecting body parts; police officers repeatedly exposed to details of child abuse)NOTE: Witnessing or exposure to aversive details does not include events that are witnessed only in electronic media, television, movies or pictures, unless this is part of a person’s vocational role. Exposure to aversive details of death applies only to unnatural death.

B. Intrusion symptoms that are associated with the traumatic event(s) (that began after the traumatic event(s)), as evidenced by 1 or more of the following:

1.Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
2.Recurrent distressing dreams in which the content and/or affect of the dream is related to the event(s). Note: In children, there may be frightening dreams without recognizable content. ***
3.Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
4.Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
5.Marked physiological reactions to reminders of the traumatic event(s)
C. Persistent avoidance of stimuli associated with the traumatic event(s) (that began after the traumatic event(s)), as evidenced by efforts to avoid 1 or more of the following:

1.Thoughts, feelings, or physical sensations that arouse recollections of the traumatic event(s)
2.Activities, places, physical reminders, or times (e.g., anniversary reactions) that arouse recollections of the traumatic event(s)
3.People, conversations, or interpersonal situations that arouse recollections of the traumatic event(s)
D. Negative alterations in cognitions and mood that are associated with the traumatic event(s) (that began or worsened after the traumatic event(s)), as evidenced by 3 or more of the following: Note: In children, as evidenced by 2 or more of the following:****

1.Inability to remember an important aspect of the traumatic event(s) (typically dissociative amnesia; not due to head injury, alcohol, or drugs).
2.Persistent and exaggerated negative expectations about one’s self, others, or the world (e.g., “I am bad,” “no one can be trusted,” “I’ve lost my soul forever,” “my whole nervous system is permanently ruined,” “the world is completely dangerous”).
3.Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)
4.Pervasive negative emotional state — for example: fear, horror, anger, guilt, or shame
5.Markedly diminished interest or participation in significant activities.
6.Feeling of detachment or estrangement from others.
7.Persistent inability to experience positive emotions (e.g., unable to have loving feelings, psychic numbing)
E. Alterations in arousal and reactivity that are associated with the traumatic event(s) (that began or worsened after the traumatic event(s)), as evidenced by 3 or more of the following: Note: In children, as evidenced by 2 or more of the following:****

1.Irritable, angry, or aggressive behavior2.Reckless or self-destructive behavior
3.Hypervigilance
4.Exaggerated startle response
5.Problems with concentration
6.Sleep disturbance — for example, difficulty falling or staying asleep, or restless sleep.
F. Duration of the disturbance (symptoms in Criteria B, C, D and E) is more than one month.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:

With Delayed Onset: if diagnostic threshold is not exceeded until 6 months or more after the event(s) (although onset of some symptoms may occur sooner than this).
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=165

Back in 1999 I was asked to write an editorial for the American Journal of Psychiatry about a group of articles in the journal on Acute Stress Disorder (ASD). Prior versions of the Diagnostic and Statistical Manual (DSM) had a PTSD, acute (less than one month) and chronic types. The DSM-IV dropped the acute type and added AS, which was like actue PTSD but with some dissociative symptoms (feeling out of your body, feeling like you are in a dream, and so on). The editorial introduced the concept of trauma-related disorders, and proposed taking posttraumatic stress disorder (PTSD) our of the category of the anxiety disorders and creating a new category of disorders related to trauma, that would include acute and chronic PTSD, with and without a dissociative subtype.

I further elaborated this idea in my book Does Stress Damage the Brain : Understanding Trauma-related Disorders from a Mind-Body Perspective (WW Norton, 2002) where on page 36 I introduce the term “Trauma Spectrum Disorders (TSD),” based on the concept that there are a group of disorders linked to trauma that have a great deal of overalp in terms of symptomatology, as well as in brain findings from imaging studies. These disorders include acute and chronic PTSD, Dissociative Identity Disorders (DID), borderline personality disorder (BPD), conversion disorder, traumatic grief (currently a “research” diagnosis in DSM-IV), and the adjustment disorders. I further pointed out that there is a subtype of depression that is linked to early childhood abuse, and that other disorders had a strong connection with trauma, including somatization disorders, alcohol and substance abuse, and eating disorders. Since then I have given a number of lectures on the imaging findings from our group and others (smaller hippocampal volume, depressed frontal lobe function) that characterize these disorders and suggest a common link, and we published a book chapter and an article with Trauma Spectrum Disorders as the title in 2006.

Others have had similar ideas. In 2002 Moreau and Zisook also wrote about a Posttraumatic Stress Spectrum Disorder, which looked similar to mine, and Bessel van der Kolk has long talked about complex PTSD, which is an extension of the more restrictive PTSD. It looks like the TSD tag has stuck, but interestingly the DOD and VA are now putting mild traumatic brain injury (TBI) into the mix. I don’t know if I agree with that, since TBI and psychiatric disorders are related to different traumas (one physical, the other psychological). I also get the feeling that the term has been passed around as being useful from a treatment and policy point of view, but that people may not know the background, which is why I wrote this post.

Today I got a call from a reporter who attended a conference on Trauma Spectrum Disorders last year conducted by the DOD, VA and NIH, so I guess the term and the ideas behind it have taken off over the years. He said there didn’t seem to be a clear idea of what disorders were included, so he was looking for clarification

I couldn’t believe it when I opened the New York Times this morning and read the rather shoddy article about the case of convicted Boston pedophile priest Paul R. Shanley, who was convicted after one of his victims had a recall of being abused by him after hearing about another case. Shanley is now appealing his conviction based on an argument against the validity of repressed memory. What gets me is that the chowder headed reporters on this article quoted a certain Harrison G. Pope, Jr, a professor of Psychiatry at Harvard, as saying “My impression is there continues to be a few scientists who honestly believe that it is actually possible for someone to be involved in a traumatic event and not be able to remember it at all. But you cannot argue that it is generally accepted” (which is the legal standard for admission of evidence).

Helloooo?

Other than one article which was cited in a chowder-headed review paper on PTSD which I previously picked apart here, Pope really hasn’t done much research on PTSD. My guess is that he has profited handsomely from working as an expert witness in PTSD cases, something which was not disclosed in the NYT article.

Pope was actually one of the signers of the “Bogus Letter to Remove Dissociative Disorders from DSM“, along with my friends the monacle, the evil leprachaun, and other pedophile apologists. Let’s watch them dance around the maypole “one more time” (this time with feeling).

 

There is no evidence presented that gaps in memory for traumatic events do not exist because, frankly, there is none. I have already extensively debunked arguments agains the validity of amnesia for traumatic events here, for those interested. Dissociative amnesia is a recognized diagnosis in the DSM, referring to gaps in memory not related to ordinary forgetfulness. It’s link to trauma is established by ample research studies which I reviewed in the prior post.

And now we are saying DSM does not represent consensus of opinion in the psychiatry field? Hey guys you are starting to sound a bit like me! But you can’t have your cake and eat it too.

This rather chowder-headed article (”PTSD has Unreliable Diagnostic Criteria“) by David Wilson and Peter Barglow has several weak points that I thought I would address. First of all the use of the term “Unreliable”. Reliability in science doesn’t refer to whether or not you can count on your brother-in-law to return the lawn mower he borrowed. It means whether two clinicians will come up with the same diagnosis (Inter-rater reliability) or whether the same diagnosis will come up when the person is assessed at two different time points (test-retest reliability). The authors use the term in neither of these senses, but rather just throw it out there and hope that it sticks to something.

Their first critique is that the diagnosis is based on human judgment and the criteria have changed several times in different versions of the DSM.

Like so what? And isn’t that true for other diagnoses?

The next set up the straw man that there is a high degree of overlap with other mental disorders in terms of symptomatology. As I have written in my book Does Stress Damage the Brain? it shouldn’t be surprising that mental disorders, including depression, borderline personality disorder, dissociative disorders, and depression, that have in common a link to psychological trauma, shouldn’t have overlapping symptomatology. That is why I call them trauma spectrum disorders.

The authors refer to a study of patients being treated with medication for depression where those with and without a history of trauma had similar rates of co-morbid PTSD at 78%. Given the overlap of symptoms between PTSD and depression and the strong link between depression and trauma this really isn’t all that surprising. They cite another study in which healthy college students were divided into those with a DSM defined trauma and those without. The ones in the group without trauma had higher levels of PTSD. A traumatic event is defined in DSM as a threat to self or or personal integrity, or the sudden death or injury of someone close to you, experienced with intense fear, horror or helplessness. Obviously an event like a death of a parent can be very traumatic for a child, even if it doesn’t happen suddenly. In fact, in this second study, 2/3 of the students noted death of a parent or someone close to them as a ‘non-congruent’ trauma. Furthermore the paper did not specify whether the required “fear, horror or helplessness” was assessed, so we have to assume that it wasn’t. These papers were in an issue of the Journal of Anxiety which ran a series of troll-ish articles which I have previously taken on here.

The authors go on to tackle some other non-issues, like the fact that a re-analysis of data from the Vietnam War showed lower rates of PTSD than previous estimates. So what? This was largely because DSMIII did not require functional disability for the diagnosis. There are still 236,000 veterans with PTSD, as we wrote in a letter to the Editor of Science in 2007.

The authors go on to set up the straw man that not all veterans with PTSD can be confirmed to have been in combat. So what? There are other possible traumatic events that occurred in Vietnam, and some may have experienced PTSD from other events. It stands to reason that this could happen in some instances.

The authors go on to claim that cases of PTSD are related to searching for financial gain. To state that all veterans are faking their symptoms to make money is ridiculous. If they don’t like psychiatry, why don’t they go work in a different field?

I have been following the death of Michael Jackson, and not only it [possibly] illustrates the death of another celebrity from prescription medications, but it also shows the importance of childhood abuse and neglect, and how the jerks who perpetuate it get off scott free.

Michael’s father, Joe Jackson, used to watch them rehearse and beat them with a belt if they did something wrong. He would trip them and push them into walls. One time he picked up Michael by one leg and beat him on the buttocks and legs. He took the proceeds of the Jackson 5 for himself. Just looking at Michael’s behavior as an adult it is obvious that he was a victim of childhood abuse.

But then, just in case you were unsure about this jerk, when interviewed by CNN after his son’s death, he said “we’re fine” and then went on to glibly promote his own new record company, taking advantage of the opportunity to be on the camera to promote his own business!

If this man doesn’t crawl under a rock, someone should suggest it to him strongly.

Here is Joe Jackon with the Rev. Jesse Jackon (no relation?) after Michael’s death outside his home. I always thought that Rev Jackson was a twit. What is he a Reverend of anyway? The religion of his own ego?

There is an article in this week’s JAMA on the evidence that much of adult physical illness could be prevented through the elimination of childhood abuse. The article cites one I was a co-author on with Robert Anda MD (”The enduring effect of abuse and related adverse experiencess in childhood: A converging of evidence from neurobiology and epidemiology“) , whose career has been at the Centers for Disease and Control in Atlanta, GA.  (where he incidentally is almost unique in understanding the importance of abuse for health). He has been conducting the Adverse Childhood Experiences (ACE) study with Vince Felitti MD for many years, documenting the increased risk of smoking, heart disease, asthma, obesity, intravenous drug use, anxiety, depression, and other conditions with early abuse. Skonkoff and the authors of this week’s paper make the point that preventing abuse would go a long way toward improving health outcomes.

Probably will be more important than more more expensive imaging centers.

See other comment here.

Last week I was in Nashville and flew back on my birthday and reflected on that experience, and got some feedback from others. At the time I was reflecting on some memories from my childhood that weren’t that great, and at the time I simply allowed myself to feel sorry for myself and feel the feelings that were associated with the experiences I had had, as I perceived them. Now I am not going around blaming others or looking for a fight. I just think sometimes you should allow yourself to feel sorry for yourself. I mean if something bad happened to you, and you don’t allow yourself to be honest about it, then you aren’t practicing emotional integrity, are you?

A while back I started a cause on Facebook called “Virtual Fishtrap“. It refers to a place on Puget Sound in Washington State where myself and others lived before bad things started happening like people dying or getting divorced. Anyhoo the principles of our “cause” are:

• We believe in emotional integrity/honesty
• We like to walk on the beach
• We like sheep

Anyone is welcome to join.

We were thinking of making Fishtrap the site of the new University of Emotional Integrity.

Lolcat is ready to enroll.

 And we’ve already gotten going on Board of Trustees, which will be headed by Milvina Dean, last survivor of the Titanic, whom I mentioned in my lecture last week on the tendency of trauma survivors to want to gather together on the anniversary of the traumatic event they experienced in common.

She died a few weeks ago, but it doesn’t matter, since we’ll mostly be using primary process thinking at the University. And after all, time is relative, right?

See you at the U.

This week I am in Nashville TN for the Frontiers in Biomedical Imaging Sciences hosted by theVanderbilt Institute of Imaging Sciences in Nashville TN. We learned about how white matter in the brain gradually increases with age but that grey matter increase up until the teenage years and then decreases as a process of pruning of neurons up until the age of 25.

The conference is sponsored by John Gore PhD who was the former Director of MR Research at the Yale University School of Medicine in New Haven CT where I was a faculty member up until 2000. I was at Vanderbilt two years ago and I felt like I was having a flashback when I rounded a corner in their MR imaging center and heard the British accents of the group that came from the original Yale MR research group.

There were a number of other former Yale Psychiatry at the conference including Brad Peterson and Anissa Abi-Dargham, as well as Jay Giedd from the NIMH. This was the first slide of my presentation “Neuroimaging in PTSD”:

“This is the last survivor of the Titanic, who died last week. She was lowered in a mail sack off of the Titanic into a boat to her mother, but her father never got off the boat and died. It was said that because he was in the steerage class that the first class passengers got priority over him (as well as the women and children).

“Years later she was discovered as a survivor of the Titanic and was contacted. She started attending reunions of the survivors of the Titanic. As a researcher of trauma I have always been interested in the fact that survivors of traumas like to gather together and remember, like the survivors of the Oklahoma bombing.”

 And then the next slide was this.

And then the question to the audience was, “Does anyone know what this building is?”

No response.

“It is the Yale University School of Medicine. You might have noticed from the program that many of the speakers, as well as the sponsor of the conference, formerly came from the Yale University School of Medicine. Many of us spent over a decade in that awful place. I think this conference is an example of who survivors of a trauma like to come together to remember.”

(laughter from the audience).

Last night we heard some good music at The Station in “The Gulch” neighborhood of Nashville. I showed the guys a picture from my Treo of the piece of ground where my mother was buried along with 50 other anonymous urns in Tumwater WA.

We have since put a tombstone over the site but we of course don’t know exactly where she is in that 4 x 10 or so square foot space.

I have been overwhelmed with the many responses I have gotten to my prior posts “Brief History of My Mom” which I wrote in three parts since I wrote it last month. I wouldn’t be able to reproduce all of the stories here even if I thought that people were willing to make them public. This adds to the stories I gleaned from the children of my mother’s friends after I contacted them for the first time last year (I was cut off from all contact with my mother’s friends and family after she died).

I cried a lot last year after I found my mom and went through the process of grieving for her that I was denied when I was a child.

I have always had trouble remembering birthdays and I think I never liked my own birthday that much. Today I found myself feeling sad and on reflection remembered that it was my birthday. My father married my step mother three months after the death of my mother, on June 4, 1966, one day before my birthday (which is today) and on my sister Anne’s birthday.

As kids we never had real birthdays. Some years we got a cake with a line through the middle and my sister’s name on one side and my name on the other. We got to have parties only every other year since my step mother said she didn’t have time to do back to back parties. And then we had to organize our own parties anyway. I remember one year I had my much awaited party and put out clues in the yard for a treasure hunt but then the wind came up and blew away all the clues and ruined my party

Of course my parents focusing on their anniversary detracted from our birthdays. I think some years they must have gone away for the weekend but I don’t really remember.

I sent flowers to my sister on her birthday this year. First time ever. I figure after all this time she should get some recognition without having to compete with others.

Have a good day and happy birthday to myself. And in honor of my birthday I give permission to all of you who were left as a sack of bones for curbside pickup to give yourself a break and stop trying to cover up for those who hurt or oppressed you and let yourself feel your own feelings (they are yours, even if “negative”). Oh and I am growing a beard now in protest against those who ask how you are but don’t want to know the answer. And thanks to those who said happy birthday to me on FB. Bye ya’ll.