I hold a Bordeaux

I hold a Bordeaux

The glass tapered so the wine ignores the tongue
worms down the throat into the brain’s meaty pit.
In the browning edge she says something I miss.
The glass crumbles like an eggshell. A few drops bleed
into the table’s grain. Disappear. I hold
the glass, a broken bird that slapped a window,
still aloft so she could see. Or like a peony
slumped on the asphalt defeated by the morning dew.
Did grief constrict my grip? Is wine preserved
like the yoke in a broken belly? But my palm
is washed. Red drains down my wrist, sticks my jeans
against a leg. Make the anger run more rampant.
More glasses would survive and I could feel the shard.

Ode to a Pillow

Ode to a Pillow

You slept nights in 300 count cotton.
Maybe towards the end,
Denise shrouded you in 500.

Only today I noticed you missing.
In some police locker, obviously,
with the knife and GameCube.

I have to admit some jealousy.
You were the last to bruise his cheeks,
to taste vomit on his lips.

When you smothered his cries,
did you feel his tears soak through your slip
and stain you where you blinded him?

There was an instant, wasn’t there--
when he fought through the drugged sleep,
to feel his arms pinned between her legs?

You didn’t answer him, did you.
You thought you’d shelter him
from the precise nature of her betrayal.

I know you lay awake always
searching for his head to cushion—
to atone for his eternal rest.

If I can’t praise you, dear pillow,
if I don’t petition your release,
where will I find my place to sleep?

Scientists try to stop schizophrenia in its tracks

On Sunday, this article was posted on MSNBC.  I read an article like this completely differently than I would have a few years ago.  This idea that psychosis is a distinct phase in some illnesses like schizophrenia and manic-depression was news to me. And that mental illness is a progressive disease.  I thought back then that crazy just meant crazy. (I don't know if it is true for schizophrenia, but Kramer in his book Against Depression, demonstrates that depression, untreated, deepens over time and becomes more frequent.)

I'm then very keen on what are the early warning signs that hint that psychosis is coming.

Then I look for the bottom line ... does the new treatment or program have proven results?  In this case not yet, but the article gives anecdotal evidence that PIER is helpful.

Subtle, early signs Researchers have known about this warning phase [or prodrome] for decades, but they're still working on how to treat it. Now they're calling in tools like brain scans, DNA studies and hormone research to dig into its biology. They hope that will reveal new ways to detect who's on the road to psychosis and to stop that progression.

In the prodrome, people can see and hear imaginary things or have odd thoughts. But significantly, they understand these experiences are just illusions, or they have a reasonable explanation. In contrast, people with psychosis firmly cling to unreasonable explanations instead.

PIER emphasizes non-drug therapies for its patients, ages 12 to 25, although about three-quarters of them take anti-psychotic medication.

The treatment regimen includes group meetings in which patients and families brainstorm about handling the condition's day-to-day stresses. It also focuses on keeping patients in school and in touch with their families and social networks.

When it comes to treating the prodrome, scientists say they have some promising approaches but no firmly proven treatments to prevent psychosis from appearing.

On Cha: an Asian Literary Journal

http://www.asiancha.com/index.php?option=com_content&task=view&id=193&Itemid=112

New Yorker article of Psychopathy

Psychopathy is not my favorite subject.  But I find myself reading a cross section of articles on mental health, and letting the ideas pollinate across the various subjects.  In this article I do sense distance between the author John Seabrook and the researchers, Dr. Kiehl and his mentor Dr. Hare.  For example when Seabrook was interviewing Dr. Hare, he commented, "Hare was friendly but wary of me."  I share that sense of distance with the author.  I know the subject is important, but I'm not sure I want to get too close to it.

I've excerpted some quotes below just to give a bit of the background on Hare and Kiehl.

At thirty-eight, Kiehl is one of the world’s leading younger investigators in psychopathy, the condition of moral emptiness that affects between fifteen to twenty-five per cent of the North American prison population, and is believed by some psychologists to exist in one per cent of the general adult male population.

In order to distinguish psychopaths from non-psychopaths among the Western volunteers, Kiehl and his students use the revised version of the Psychopathy Checklist, or PCL-R, a twenty-item diagnostic instrument created by Robert Hare, a Canadian psychologist, based on his long experience in working with psychopaths in prisons. Kiehl was taught to use the checklist by Hare himself, under whom he earned his doctorate, at the University of British Columbia.

Today, Kiehl and Hare have a complementary but complicated relationship. Kiehl claims Hare as a mentor, and sees his own work as validating Hare’s checklist, by advancing a neurological mechanism for psychopathy. Hare is less gung ho about using fMRI as a diagnostic tool. “Some claim, in a sense, this is the new phrenology,” Hare said, referring to the discredited nineteenth-century practice of reading the bumps on people’s heads, “only this time the bumps are on the inside.” (Hare himself is a “strong proponent” of brain-imaging technology, but he noted that scans in isolation will always be insufficient.) Hare sees himself as a generalist, and Kiehl as “more of a data-driven guy.” Hare added that, while Kiehl’s brashness sometimes puts people off, “that’s why Kent gets things done.

And it was this paragraph below, that made me want to excerpt the article for this blog.  It illustrates much of the misinformation out there which we have to deal with regarding mental health awareness.  And this misinformation or distortion (I'm searching for the right word ... casualness?) is coming straight from the mouth of Dr. Kiehl, a PHD, doing fundamental research, an expert in the field.  1. The DSM definitions are subjective, cover a broad, continuous range of symptoms, and are mutable.  You cannot take a blood test and get a definitive diagnosis.  When Dr. Kiehl says "so much" it almost implies too much.  2. He mentions the famous drug companies that fund research, and profit from treatment.  Quotes like this make the general public suspicious of what is happening.  When you read commentary in the MSM you always run into this.  3.  The categorization of the disorder is influenced on whether it treatable or not.  (I have added the blue for emphasis.)

If a biological basis for psychopathy could be established and pharmacological treatments developed, the idea that many people have at least a little of the psychopath in them could well become accepted. As Kiehl points out, “It used to be the case that it was very hard to meet clinical criteria for depression in the fifties and sixties. However, the definition of depression has been broadened so much with DSM-IV that nearly every person will meet the criteria at some point in their lives. One reason for this is that drug companies have lobbied to change the criteria—because they have a treatment, a drug, that can help people even with moderate levels of depression. It’s a completely different issue whether this is appropriate.” He added that “even moderate levels of psychopathy may someday be considered a disorder—especially if we can treat it.”

"Mental Health awareness raised in campaign"

The Bernardsville News posted my letter to the editor Thursday.  I’ve made progress this week.

I met today with Pam Mastro, the Somerset County Mental Health Administrator.  Pam has an open door policy and will take phone calls from anyone with a question or need about mental health.  She is eager to help roll out a education and awareness program in our town.  Her email is mastro@co.somerset.nj.us.

Earlier this week I met with Mary Lynn Bradshaw and Barbara Barklay.  They are coordinators for the Stephens Ministers program at the Liberty Corner Presbyterian Church.  The program is non-denominational, and is open to anyone in the community.  The Basking Ridge Presbyterian Church has this program as well.  A quote from their brochure:

Our congregation’s Stephen Ministry equips lay people to provide confidential, one-to-one, Christian care to individuals in our congregation and community who are experiencing difficulty in their lives.

One of the things I am focused on is how does someone make that first phone call for help.  Because of the many obstacles to seeking care, I think the Stephen Ministers are a good model of lay people, in the community, that are available and can help refer the person to the right place for care.  Each volunteer has 50 hours of training.  The have a list of doctors and therapists within the community, who are all credentialed, and have been endorsed by the local program.

I see the benefit of a group like this, and am wondering if a more secular version of this could also be created for people perhaps not comfortable with a Christian oriented ministry.

More discussion will be coming.

Against Depression

Dr. Peter Kramer’s 2005 book, Against Depression, blows me away. I have read a lot of books in the last couple of years, but this is a rare one, that has me jotting notes on every page.

His chapter 12, “Magnitude,” answers the question: how bad is depression:

“Depression is the most devastating disease known to human kind.” (Researchers measure this statistically in terms of “good days” lost.)

In 1996, the most extensive global-burden-of-disease study, conducted by the WHO, the World Bank, and Harvard, concluded that “depression will be second only to ischemic heart disease–in terms of disability caused.”

“Estimates put the annual workplace cost in … America at over forty billion dollars.”

“The best studies show that over 16 percent of Americans suffer major depression in the course of a lifetime.”

“Depression often begins in adolescence. A recent study looked at children between the ages of twelve and seventeen, a stage of life when illness is rare. In the prior six months, 7 percent of boys and almost 14 percent of girls had met the full criteria for major depression.”

Impact on the elderly, “researchers evaluated more than 5000 mean and women age sixty-five and older … over a six year period. Those with high depression scores were over 40 percent more likely to die than those with low depression scores.”

In a cardiac study: after controlling for variables like social class, health risk factors (such as smoking), and other concurrent disease, depression still accounted for a 24 percent increase in deaths–from such causes as heart attack and pneumonia. “Think of it: a cardiac study that finds depression as deadly as congestive heart failure.”

These statements all relate to major depression. Earlier in the book, on page 69, Kramer writes:

“Depression is characterized less by acuity than duration. Depression is what settles in to stay.” 

In these excerpts, I feel like I’ve done the book a disservice. I’m an engineer. Facts are my friends. So I start with the numbers. But Kramer’s writing is clear, convincing, artful. As I make my way through the book I see myself shifting seamlessly from one role to the next: patient, father, child, husband.