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Archive for May, 2011

This is just a note to let you all know that the May Blog Carnival of Mental Health, themed patients and professionals is up at The Madosphere. It is a nice collection of posts, so check it out.

The June carnival will be hosted by Pandora from Confessions of a Serial Insomniac, and the theme will be hope or despair. Please submit your post by midnight British summer time on June 29, and check back the next day for the carnival.

Also, I want to let you all know that the Blog Carnival of Mental Health has slots open for hosts starting the month of August – I seem to remember Mental Fool wanted to host in August, so please let me know if you read this if this is still the case. Otherwise, anyone who has a blog that has at least some content on mental health is free to host the carnival. You will choose the theme, deadline within your destined month, and how bloggers can submit their posts. If you are willing to host the carnival in an upcoming month, please leave a comment here.

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Welcome to May’s Disability Blog Carnival, on the theme of care. I’m two days early, but I was finished compiling the posts already. We have a very small carnival, but it is beuaitful nonetheless. Most people have written about interactions with professionals, but there is a good post on self-care, too.

Carl Thompson of Working at Perfect writes Dear Surgeon, I Have a Name:

Surgeons and specialists are extremely important in society, they save lives and make people feel better. They also usually drive swanky cars. Qualities such as persistence, enthusiasm and intelligence are common amongst these medical practitioners. What is not common however, and entirely absent in a large proportion of cases is emotional intelligence. But who am I to cast aspersions on, and make generalisations to an entire group of diverse individuals?

Cara of Butterfly Dreams writes Self-Care Is a B*tch:

I never thought too much about self care before I went to college.  Sure, some aspects of self care were more difficult for me, but I had been completely independent in all my self-care activities since my mid teens. Surely self care wouldn’t be difficult for me in college, after all, I took care of myself every day. I didn’t need a personal assistant like some of my friends, I could do everything on my own. Taking care of myself in college would be a breeze;
in fact, I barely thought about it before I left.

Lastly, Sharon Wachsler of After Gadget submitted two posts on the same encounter with a docotor. The first is Waspish Wednesday: Yes, I DO Know How to Operate My Power Chair. The second is Waspish Wednesday: Yes, Lyme Did Cause This.

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Tomorrow, the Ugandan Parliament will vote on a gay death penalty bill. This is horrible. Gay people are already in danger of the death penalty, but this bill could make it even worse. AVAAZ has created a
petition
to sign against this bill. The site is not very accessible, so don’t blame me for not having signed it myself. I am just passing this on for everyone who is opposed to homophobia like I am.

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In South Africa, a 13-year-old girl is the latest victim of “corrective” rape. “Corrective” rape involves the raping of lesbians in order to “cure” them of their sexual orientation. The goveornment condemns this crime, but I wonder whether they will genuinely act upon it. It is obviously at least as serious a crime as other forms of rape. Probably more so, because a hate crime is involved, too. Maybe I’m too cynical, but my inclination is that the police won’t do much with this presumed epidemic of “corrective” rape. Gay rights may be human and constitutional rights according to the government spokesperson, but there are probably more important things on the police’s mind.

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In DSM-IV, if you hear voices, you can be diagnosed with schizophrenia even if this is the only “psychotic” symptom. This has been controversial for a while, because many people hear voices without being actually psychotic. Not only other conditions – such as dissociative identity disorder – are characterized by voice-hearing, but voice-hearing may be a normal symptom related to stress.

Thankfully, the DSM-V workgroup is recommending that someone must have two or more characteristic symptoms of schizophrenia for a substantial period of time in order to be diagnosed. These two symptoms must include at least one core symptom, which are determined to be delusions, hallucinations and disorganized speech. In addition, people must display a significant deterioration in their social or occupational functioning. This criterion was considered for elimination, but the workgroup thankfully decided against this. Again, this protects functioning voice-hearers from a false diagnosis.

Of course, there is the newly considered diagnosis of attenuated psychosis syndrome, which includes symptoms suggesting a person is at risk of a psychotic disorder. This diagnosis may cause voice-hearers to be pathologized after all, which is a very sad thing.

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I have been told a few times that I fake being dissociative. Faking is often assumed to be a behavior problem, sometimes even an offense, rather than a mental illness. In fact, factitious disorder, popularly known as Münchhausen Syndrome, is a real mental health condition.

In DSM-IV, factitious disorder is characterized by intentional feigning or creating of symptoms or signs of illness, which is present even without obvious external reward, and which is not due to another mental disorder (eg. delusional disorder). Furthermore, the person must present themself to others as ill or impaired.

In the current proposal for DSM-V, slight modifications have been made to the wording. The part about intent has been replaced with wording about a pattern of falsification of signs or symptoms. It is added that the faking of symptoms or signs must be associated with deception. This change of wording was made in order to clarify that intent or motivation must be objectified, rather than inferred.

The DSM-V workgroup is still uncertain as to how to classify severity. It is proposed that level one is diagnosed when a person only reports faked symptoms, level two when lab tests were modified, level three when a person makes themself sick, and level four when one’s faking leads to life-threatening illness. Of course, here, it seems there is an overemphasis on physical symptoms, because psychological symptoms do not present themselves on lab tests or the like. I do not know how the faking of psychological symptoms would be graded.

Obviously, of course, I do not have factitious disorder. Imagining of symptoms – even assuming my DID symptoms are indeed not real, which I do not believe – is not the same as intentionally falsifying them. There is, however, no category in the DSM for people who unintentionally imagine a (psychological) disease.

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Abortion is, of course, a vjery controversial but relatively common means of fertity planning. A lot of research has been done on various aspects of it, such as mental health and medical consequences of abortions as compared to completed pregnancies. However, little research has been done on the consequences of completing an unwanted pregnancy for the resulting child. In the American Journal of Orthopsychiatry, april 2011, there is a very interesting study on this topic.

The study compared mental health and developmental outcomes for children whose mothers were denied abortion to those born from accepted pregnancies. In Prague in the 1960s, abortion had to be approved by a local abortion commission, and, if denied, could be approved anyway by a regional commission. Unwantedness was defined for the purposes of this study as an abortion having been denied twice. This is a very strict definition of unwantedness, because, of course, not all unwantedly pregnant women go through the bureaucratic process of twice requesting abortion.

There were 220 unwanted pregnancy children found eligible for the study. Each was pair-matched to a child from an accepted pregnancy (mother’s name did not appear on the abortion record) similar in age, gender, birth order and school, while mothers were matched on age and socio-economic status. Children were followed up at age 9, 14-16, 21-23, 28-31 and 32-35. In addition, a substudy was done on married people at age 26-28.

Children born out of unwanted pregnancies had similar birth weights and lenghts, a similar chance of having congenital abnormalities, and a similar score on signs of minimal brain dysfunction (a condition most like current ADHD) to the accepted pregnancy children. At age 9, the two groups also scored similar on overall IQ. However, the unwanted pregnancy children, particularly boys or only children, were significantly less sociable and well-adjusted than the controls.

In adolescence and young adulthood, problems for the unwanted pregnancy group became more significant as compared to the controls. In adolescence, unwanted pregnancy children had dropped out of school more and had obtained lower scores in school (that is, much fewer scored above-average). Social problems also continued. In young adulthood, fewer unwanted pregnancy people were satisfied with their jobs, relationships and overall mental well-being than accepted pregnancy people. Mothers were also less satsified about their unwanted pregnancy children’s developmental and educational outcomes. More unwanted pregnancy children than accepted pregnancy children had been or were still in treatment for mental health conditions, and also more unwanted pregnancy children had been sent to prison.

By about age 30, there was still a difference in psychosocial adjustment between people born from unwanted pregnancies and accepted pregnancies. However, this gap had narrowed. By this follow up, women’s outcomes were less favorable as compared to controls than men’s. There was a significant difference between unwanted pregnancy women and control women in terms of unemployment, unmarried status, and parenting difficulties that requered authority attention, to the disfavor of the unwanted pregnancy women. Such a difference could not be found among men. Unwanted pregnancy women were also less socially integrated and emotionally stable than controls. These effects were due to unwantedness. This can be seen, because, by this stage in follow up, siblings were used as an additional comparison group, and they did not show these problems.

Lastly, by age 32-35, those unwanted pregnancy and accepted pregnancy people still living in Prague and their siblings were given an extensive face-to-face interview. Mental health outcomes were compared. People born from unwanted pregnancies had significantly more problems, as indicated by nine out of ten measures of mental health – ranging from inpatient treatment to sexual satisfaction – than their siblings. This difference was not found among the accepted pregnancy people. The unwanted pregnancy people were significantly more likely to have received inpatient and outpatient mental health treatment than the accepted pregnancy people. They were also significantly more likely to suffer from anxiety and depression. By this age, however, poor social adjustment was not merely attributable to unwantedness, since siblings of unwanted pregnancy people also had poorer social outcomes than the accepted pregnancy controls’ siblings.

The substudy on married unwanted and accepted pregnancy people found some interesting things. In many ways, the female partners of unwanted pregnancy men and the male partners of unwanted pregnancy women were comparable to unwanted pregnancy women and men, respectively. Female partners of unwanted pregnancy males had more abortions (both one-time and repeat) and were more dissatisfied with their jobs and mental well-being than the famele partners of male controls. Similarly, male partners of female unwanted pregnancy people encountered more relationship difficulties than the male partners of control females. Lastly, unwanted pregnancy women who had at least one child, felt less prepared for and less happy about the pregnancy and parenthood than control females.

This study, the author concludes, shows that unwanted pregnancy and denial of abortion lays the foundation for an environment in which children are poorly reared, which subsequently leads to mental health and psychosocial problems for the unwanted child. An alternative hypothesis, whereby mothers of unwanted pregnancy children are simply emotionally unavailable mothers, is rejected.

The last wave of the Prague study was conducted in 1996/1997. The results of earlier waves of this study, in part, led the Czech government to abolish abortion commissions in 1986. The author of course advocates legal abortion and other means of fertlity regulation. It is interesting that this is argued from the point of view of the unwanted child, who is at significant risk of mental health and psychosocial problems if born. Of course, it remains to be debated, from an anti-abortion standpoint, whether these problems are worse than not to be born.

Reference

David HP (2011), Born Unwanted: Mental Health Costs and Consequences. American Journal of Orthopsychiatry, 81(2): 184-192. DOI: 10.1111/j.1939-0025.2011.01087.x.

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First, the April Blog Carnival of Mental Health, themed self-care, is now up at Nyx’s Journal. The May carnival will be hosted at The Madosphere, on the theme of patients and professionals. Submit your post in a comment there by May 25 and check back to see the posts a while later.

Second, I am hosting the Disability Blog Carnival this month. The theme for this month’s carnival is care. This could be health or social care, but also the care family members provide each other or self-care, of course. Please submit your posts in a comment here or E-mail me by May 25. I will post the carnival on May 29.

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