Tuesday, October 14, 2014

A new tool to help fight against mental illness?

The history of addressing mental illness has been a tumultuous one in the United States. In the past behaving against the norm commonly landed an individual in jail or an asylum, both which existed on the periphery of society, a location that potentially reduced the ability to produce effective treatment. The location was typically not the only element that reduced the viability of effective treatment as a number of asylums were poorly funded and staffed by a number of individuals who appeared to quickly tire of continuous interaction with “non-normal” individuals reducing their vigor for proper treatment both physically and mentally.

In more modern times a “so-called” enlightenment regarding mental illness was born from deinstitutionalization. The “noble” or liberalized story of deinstitutionalization involves the belief that the development of both Medicare and Medicaid as well as various psychotropic medications allows mentally ill patients to function “normally” and live among the community reducing the stigma of having a mental illness, thereby increasing their ability to assimilate and manage their condition(s). However, the more dirtied history of deinstitutionalization is that after the Supreme Court ruling in Souder v. Brennan prohibited mental hospitals from exchanging patient labor for room and board, forcing these institutions to pay for patient labor at minimum wage levels, there was little opposition to implementing the principles of the Community Mental Health Act of 1963 regardless of execution viability. Unfortunately despite the public’s apparent “zest” to integrate mental patients into society, the networked infrastructure that was to support these patients never materialized in a vast majority of places.

Sadly this early failure in the 60s and 70s has yet to be significantly rectified for while the proportion of individuals in public mental hospitals has dropped from 0.338% (558,000/165 million) in 1955 to 0.016% (50,000/313 million) in 2010,1 the Department of Justice estimated in 2006 that at least 24% of inmates in state prisons and 14% of inmates in federal prisons have mental illness and an additional 15% of state inmates and 24% of local/city inmates meet criteria for psychotic disorders.2,3 It stands to reason based on how mental illness is currently treated that this number has only increased into 2014. In addition at least 50% of a number of ex-cons with significant mental illness are rearrested typically through violations of their parole (these individuals have come to be known as “frequent fliers”).1 Incarceration has its own societal stigmas, imagine how difficult successful community treatment could be with both a criminal record and a mental illness.

Deinstitutionalization has also failed to live up to the idealistic diverse and “normal” environment pictured by its supporters in the associated residential “communities”. To most these “communities” have become a de facto urban asylum that again cares little for the recovery or treatment of the patients reducing the probability of any return to genuine normalcy. Some hold out hope that the focus of the Affordable Care Act on result-based outcomes will be an effective panacea to the squalor conditions of a number of these mental illness communities, but whether or not that reality will emerge is difficult to predict due to numerous unknowns and at the moment seems more unlikely than likely.

These environmental factors notwithstanding, one aspect of treatment that is not typically discussed is the idea of an individual focal add-on treatment where an individual that suffers from mental illness attempts to “commandeer” their brain in effort to regain control. Basically one wonders if too much emphasis has been placed on pharmaceutical, talk therapy and, now in modern times, assertive community treatment resulting in the omission of more personal options? Such abandonment is perplexing because these potential methods have almost no side effects and very little financial cost. With this intention to add an extra tool to the toolbox it must be mentioned that general result-based analysis of treatments for mental illness is almost non-existent. Despite advancements in the ability to treat mental illness almost no one actually studies which of these treatments work, both on an absolute (does treatment A work) and relative (does treatment A work better than treatment B) level.4,5 Therefore, these methods would have to be studied and compared against and in cooperation with existing methods.

One example of an individually driven treatment would be an attempt to control the multiple network firing of schizophrenia by engaging in a task requiring overpowering focus to reduce the firing of the other more spontaneous neuronal elements. For example when a schizophrenic begins to hear voices he/she would begin to play a game of chess, start a logic puzzle, a sudoku puzzle, i.e. a task that requires significant focus in order to be successful. One of the keys to this strategy is to identify a simple task/game that requires focus, but also makes an individual content (not necessarily happy). The necessity of contentment is to ensure a lack of frustration thus affording the ability to maintain focus.

Contentment is an element that seems to be pushed to the side when discussing mental illness, with focus instead placed on happiness and unhappiness. Contentment is important because it is less vulnerable to the negative impacts of more extreme emotional states, which can rapidly cascade into opposing elements (i.e. happiness can quickly become unhappiness and visa-versa), but is still emotionally positive enough to spark focus and enjoyment.

Another option could be producing an overpowering focus through visualization. By focusing on a single place of reference an individual would create a positive non-violent altered reality that could control spontaneously produced changes in mood or sensory information. The complexity of elements assigned to enriching and maintaining the visualization could mute the action potentials associated with the spontaneous firings that create symptoms of mental illness.

Another technique, one more recognizable by many for its ability to assist in mental control, is meditation. In recent years meditation has become an interesting subject of contemplation regarding its potential to manage the negative symptoms of mental disease. For the purpose of this brief discussion meditation is regarded as a physiological state invoking physical and mental relaxation with a reduced metabolic activity.6

The state of meditation is achieved through the reduction of thought processes to a single focused internal dialogue in the mind eliminating mental clutter and spontaneous thoughts. Unsurprisingly the elimination of this mental clutter enhances pure awareness and clarity on the single internal dialogue, usually calm central breathing tethered by the single focal word. Theoretically a meditative state could block the occurrence of negative symptoms from mental illness. This possibility is supported by the reported long-term effects seen in meditation practitioners such as: enhanced concentration attention skills, improved self-control and self-monitoring, increased ability to inhibit irrelevant external and internal stimuli, increased positive mood, emotional stability and improved resilience of stress.7 One issue with meditation is that most of the research has been conducted in small groups with few meaningful controls; therefore, outside of very long term practitioners it is difficult to determine when the advantages of consistent meditation will take hold.

However, meditation does have its share of more serious potential concerns as there is past evidence that during meditation an individual with a mental illness can have an increased probability of exacerbating short-term (non-permanent) psychosis.8 This increased risk for temporary psychosis could be drawn from the increased anxiousness that is common among individuals with mental illness, which makes meditation in general more difficult, but could also make it more beneficial in the long run. Another concern is that individuals with mental illnesses have motivational issues or even defects, which may make inspiring the discipline for routine focal tasks like meditation more difficult.

Note that these above personal add-on strategies differ from cognitive behavioral therapy because they do not seek to change the long-term thinking paradigms held by a particular individual. Instead these techniques are theoretically thought to act as an acute deterrent to be applied upon the onset of a significant negative aspect of a given mental illness.

On a side note numerous individuals think that education is an important aspect to limiting, or even eliminating, stigmas associated with mental illness, which is a reasonable and accurate assessment. However, no one really seems to suggest a means of applying a mandatory aspect to this education element, which would significantly increase its effectiveness. For example one effective means to addressing public education of mental illness would be for all high school students to take a psychology class that would be required for graduation that covers various mental illnesses in depth. Through this class all high school students would learn rudimentary means to identify symptoms of mental illness, manage it, and how to effectively interact with those who have a mental illness limiting uncomfortable and/or inappropriate moments.

Overall many have professed a concern that mental illness will increase in the future due to increases in population and proportion of occurrence.9 This increase is buffered by the concern that most traditional talk therapy treatment will remain centralized in high population affluent areas of the country. Unfortunately there is no evidence that this unequal distribution of certain psychological services will change, thus placing additional pressure on community environmental therapy and pharmaceuticals. To alleviate this pressure new techniques need to be developed. Understand that these techniques are acute immediate response deterrents and are not meant to replace other therapies; it is to say that one should not say that Johnny no longer needs his anti-psychotics because he plays chess. The above strategies appear to be theoretically viable and worthy of further study to determine whether or not they are empirically viable. If so these individual acute strategies could be important elements in reducing the more severe negative attributes associated with mental illness.

Citations –

1. Edmondson, B. “Crazy enough to care.” The American Scholar. Spring 2012. 46-55.

2. Clayton, A, et Al. “The citizenship project part II: impact of a citizenship intervention on clinical and community outcomes for persons with mental illness and criminal justice involvement.” Am. J. Community Psychol. DOI 10.1007/s10464-012-9549.

3. Department of Justice. Mental health problems of prison and jail inmates. Bureau of Justice Statistics Special Report. (2006). NCJ 213600.

4. Morgan, R, et Al. “Treating offenders with mental illness: a research synthesis.” Law Hum Behav. 2012. 36(1): 37–50.

5. Rice, M, and Harris, G. “The treatment of mentally disordered offenders.” Psychology, Public Policy, and Law. 1997. 3:126–183.

6. Young, J, and Taylor, E. “Meditation as a voluntary hypometabolic state of biological estivation.” News in Physiological Sciences. 2001. 13:149–153.

7. Rubia, K. “The neurobiology of meditation and its clinical effectiveness in psychiatric disorders.” Biological Psychology. 2009. 82:1-11.

8. Walsh, R, and Roche, L. “Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia.” Am J Psychiatry. 1979. 136:1085–6.

9. Mathers, C. and Loncar, D. “Updated projections of global mortality and burden of disease, 2002–2030 data sources, methods and results.” Evidence and Information for Policy. 2005.

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