The board of directors wishes a Happy Birthday today to Dr. William Van Ornum—and many more.

As readers of this blog know, Dr. Van Ornum contributes selflessly to the organization. His intelligence, culture, and wit grace these pages and all endeavors of the Foundation. As director of research and development, and the publishing program, in addition to being one of the directors of the Foundation, Dr. Van Ornum extends the legacy of Dr. Stefan de Schill while taking the Foundation into the brave new world of another century.

Dr. Van Ornum's idealism, keen understanding of the psyche, professionalism, "people skills" as professor and wise counsel, and the sensitive care he gives son William are recognized and to be honored.

Dr. Van Ornum is held in the highest esteem by his colleagues, who thank him for his nonpareil contributions to the mission of The American Mental Health Foundation: to create a more compassionate, humane society.

All best wishes, dear friend!

Antipsychotic medications have an interesting history. In the early 20th century, Thorazine was used as an anesthetic during surgery. In the 1940s, a patient with schizophrenia found that after surgery that the delusions and hallucinations had disappeared. Within a few short years this medication was being used for treatment of schizophrenia and two decades later it had worked so effectively with many (but sadly--not all) persons with schizophrenia that many psychiatric hospitals were closing or on their way to that end.

Faculty of the Harvard Medical School note that Patient Outcomes Research Team (PORT) Treatment Recommendations for Schizophrenia have been updated:

"The Schizophrenia Patient Outcomes Research Team (PORT) has issued updated treatment recommendations that not only include detailed advice about medication and psychosocial treatments but also address, for the first time, common problems in this population such as smoking cessation, substance abuse treatment, and weight loss. The authors note that the goal is not only to help clinicians and patients understand how to increase chances of schizophrenia recovery (albeit modest in scope), but also how to reduce the risk of additional life-threatening medical problems such as diabetes and cardiovascular disease.

"The PORT recommendations, issued in 1998 and first updated in 2003, were funded by the Agency for Healthcare Research and Quality and the National Institute of Mental Health. Researchers at the University of Maryland wrote the latest update after consulting with leading schizophrenia experts. In contrast to efforts like the American Psychiatric Association practice guidelines for schizophrenia and the Texas Medication Algorithm Project, which attempt to address the full range of situations clinicians encounter, the PORT review is more conservative in scope. The PORT authors limit their recommendations to those interventions that have been tested in randomized controlled trials."

The recommendations are highly detailed and specific and can be read in further detail here.

Here are some new books on counseling by members of the American Counseling Association, as described in the February 2012 edition of Counseling Today:

Married to the Enemy: A Guide to Overcoming the Obstacles to Intimacy When We are Raised in a Culture that Uses Stereotyping and Sexism to Divide Us

By Dawn Kozarian and Mark James; Author House

"The co-authors expose how gender roles create barriers in relationships and reveal tips to overcoming them in this new self-help book. This resource goes beyond understanding to empower readers to unearth their own destructive and limiting gender beliefs."

By all accounts Mary Todd Lincoln led a difficult and tragic life despite her early upbringing with material comforts and blessings. She married Abraham Lincoln when she was twenty three and was often alone rearing four sons while Lincoln embarked upon his upward political climb. Of her four sons, one died in 1850, another during the Civil War, and still another after the war during Reconstruction.

Some suggest that even prior to the death of her second son and her husband's assassination that she may have suffered from depression or bipolar disorder. (Yet how does one untangle all these threads of behavior and sadness in the life of a person none of us has ever met?)

One of the saddest elements in her life was the estrangement between herself and her oldest son, Robert Todd Lincoln, who had her certified as "insane" and involuntarily committed to an asylum. The Chicago Sun-Times reports on a historical re-enaction of Mary Todd Lincoln's insanity trial, beginning this Spring and continuing into September, 2012.

Slapstick humor can do wonders for mental health. Norman Cousins retreated to a place where he could watch videotaped comedies when he was suffering from a serious illness. Carol Tavris recommends the same approach when confronted with the inescapable frustrations of life. In National Review Online, AMHF Board Chair Jack Fowler offers a neat slideshow on the history of the Three Stooges. This comes just as the new movie on this trio of lovable laugh-mates makes its premier weekend.

Irvin D. Yalom, one of the most accomplished group therapists of his generation, recently offered the opening keynote at the recent 2012 American Counseling Association Convention, held March 21-25 in San Francisco, California. Yalom is well-known for his many books, including The Theory and Practice of Group Psychotherapy, cited by the Journal of the American Psychiatric Association as one of the most influential books of the 1970-80 decade. This book is now in its fifth edition, and it offers strategies and approaches for group therapists.

John Sommers-Flanagan, blogging for the American Counseling Association, gave this reaction to Yalom's presentation

“Are you sure?” He hadn’t slept well last night. “Of course, I’m sure. You know the secret and they want you dead. Don’t you see? It’s a plot to kill you. You must get them first.” "My knowing the hidden secret of Peterbus has been such a burden. No one believes me.” “Wrong. They all believe you, which is why they want you dead. The secret gives you power over them. Get them first. It’s kill or be killed.” With that Henry lurched forward onto the back of the nurse and began assaulting her. The voices were right. The nurse was in on the plot to kill him. He had to strike first.

This episode of assault was precipitated in a patient with paranoid schizophrenia where voices in his head (auditory hallucinations) were telling him to harm others. Research (1, 2) has demonstrated patient assaults on staff on both psychiatric and medical wards to be a worldwide occupation health hazard. Health-care providers are not the only victims of this form of workplace violence. Police, emergency medical services, paramedics, teachers, and others are victims of assault by suspects, patients, students, customers, domestic batterers, and disgruntled employees. This victimization is true for both genders, all races, all creeds, and all socioeconomic classes. Level of education and length of experience do not preclude being victimized. This violence results in the obvious costs of possible death, disability, medical expense, sick leave utilization, industrial accident claims, legal costs, lost productivity, and poor morale. It also results in the not so obvious cost of psychological distress, including the severe stress of psychological trauma.

There are many helpful strategies to reduce the risk of this violence (3). Skills used (singly or in combination) in self-defense, scene surveillance, awareness of the early warning signs of loss of control, nonverbal communication skills, verbal communication and de-escalation strategies, use of restraints, and alternatives to restraint can enhance workplace safety. However, they will not prevent all workplace assaults from erupting. When violence occurs, most individuals and organizations know how to implement the necessary medical and legal tasks to restore some semblance of normality to the staff victim(s) and the worksite. Unfortunately, many organizations either do not address or do not address adequately the not so obvious issue of the employee victim’s psychological distress, anxiety, fear, and even terror.

The purpose of this essay is to review both the issue of the employee victim’s psychological trauma and to present a detailed discussion of a psychological counseling program for victims of violence to address that psychological trauma. Known as the Assaulted Staff Action Program (ASAP), ASAP is the most widely researched crisis intervention program in the published literature for assisting with the psychological aftermath of trauma and has been efficaciously assisting employee victims of assault for twenty-two continuous years of service (2).

Today on Easter Sunday Erich Fromm's The Revolution of Hope offers us a discussion on the paradox and need for hope in human affairs, Resurrection, as well as psycho-spiritual renewal. In this optimistic work, the noted humanist draws upon religious traditions to help everyone in our secular world.

Controversy swirls around the Motion Picture Association of America "R" rating of Bully. AMHF has earlier blogged on the epidemic of bullying. In principle and logically, AMHF underscores that Cinematherapy begins with the prudent liberty to watch. Currently forbidden by the M.P.A.A. rating, young people—victims and those who target their peers—need to absorb this sensitive-sounding documentary.

An article in the March 23, 2012 Chicago Sun Times reported that 19-year-old Allison C. Zak, a student at Illinois State University, was found dead in her dorm room. Preliminary autopsy reports "showed that Zak may have died from a seizure or stroke caused by a previously undiagnosed seizure condition or a known condition that causes brain and skull abnormalities," the newspaper reports.

Our condolences to the family and to the students and others at Illinois State University who are grieving.

The Merck Manual provides helpful and detailed information about these conditions. In seizure disorders, the normal electrical activity of the brain is periodically disturbed, resulting in some degree of temporary brain dysfunction. In many persons, there are premonitory cues or auras which alert the person to an impending seizure. Some seizures (grand mal) result in uncontrollable shaking and a loss of consciousness, but many times people simply stop moving and become unaware of their environment.

Although physicians can often speculate closely the reason for the seizure based on symptoms, blood test and an electroencephalogram (EEG), which records brains activity, can identify the specific cause. Sometimes medications are needed, and these can often control the seizures. However, for many other people, managing seizure disorders is much more complicated, and the condition may seriously disrupt their own life and their family's.

Monday, March 26, 2012, is Purple Day—a time to reflect upon epilepsy and its devastating effects on millions of people and families.

Click the link above to learn why purple has been chosen as the color to represent this day.

Learn more about epilepsy at the Web site of the Epilepsy Foundation.

We've looked at Elaine Aron's research on Highly Sensitive People (HSP) and how this is related to introversion.

Susan Cain, author and speaker, offers more thoughts on this topic in March 26, 2012 cnn.com Introverts Run the World Quietly.

BY LAWS OF AMERICAN MENTAL HEALTH FOUNDATION, INC.

ARTICLE I

Section 1. The name of the Association is American Mental Health Foundation, Inc.

Going out to see a movie on the big screen is a great way to spend an evening. Almost as nice is ordering up a movie on the computer and watching right at home. There's such a great interest in mental-health themes in movies that AMHF is writing about all this on its blog.

Can movies be actual therapy? Some, most unequivocally, say "yes!"

There's something about the Deep South that inspires the writing of great literature (think William Faulkner, Tennessee Williams, Truman Capote) more than, for example, North Dakota. Likewise, we think of "the grand diagnoses" in psychiatry more than we do, say, about Generalized Anxiety Disorder. Prince of Tides is a 1991 movie capturing the lowland beauty of South Carolina and the despairing depths of psychotic depression. Based on the 1986 novel by Pat Conroy, it also has a happy ending.

Sometimes when we feel strongly about something we throw all our energies into one passionate viewpoint. The often perceived overuse of anti-psychotic medication in an "off-label" use in nursing homes is one such example. "Off-label" use means that a drug is being used for purposes other than what is was originally intended. Anti-psychotic drugs are used to treat psychoses: hallucinations, delusions, and the symptoms of schizophrenia. In nursing homes, agitated and violent behavior can occur among residents. An off-label use of anti-psychotic drugs is their sedating effect. (I have heard that one of these drugs is used, in large doses, to tranquilize animals such as lions and tigers when they escape from captivity.)

There are too many cases where residents in nursing homes become agitated--and it's due to lack of external stimulation, boredom, loneliness, and feeling trapped or hopeless. When this occurs, staff may have to restrain them. There are too many injuries that happen to staff in nursing homes. These individuals care for some of our most vulnerable citizens and their profession, I believe, has a much higher injury rate than for police officers. And when they are injured for life, they don't receive a disability pension to fall back on. A recent letter, written by Meghan Lee of Auburn University, to the editor in the Monitor of The American Psychological Association brings this issue to us in clear focus.

This is the fifth of twenty-one films in the AMHF series of blogs. Charly is a controversial film, about mental retardation and psychiatry. The central controversy revolves around the question, "What is a human being?" Are individuals challenged by developmental delays "to be cured?" Are they not soulful, "whole individuals"? What would be the role of psychiatry in such a scenario?

The title character, Charlie Gordon, is sensitively played by the late Cliff Robertson, who won an Oscar for this role. Charlie works at a low-level job in a bakery and lives alone in a run-down room somewhere in Boston. He is the object of pranks at the bakery, and the only good thing in his life is his caseworker, likewise compassionately portrayed by Claire Bloom. The caseworker is earning her Ph.D. in conjunction with a young man, whom we never meet, set to be her husband.

The Individuals with Disabilities Act (IDEA) lists conditions present in a child that can qualify him or her for special services in the educational system in preschool. These are:

*Chromosomal Abnormalities (e.g., Down syndrome)

*Syndromes (e.g., fetal alcohol syndrome)

*Neuromuscular Disorder (e.g., cerebral palsy, spina bifida)

*Central nervous system (CNS) abnormality (e.g., caused by bacterial/viral infections of the brain or head/spinal trauma)

*Hearing impairment (not correctable with surgery)

*Visual impairment (not correctable with glasses, contact lenses, or surgery)

*Diagnosed psychiatric conditions (e.g., reactive-attachment disorder)

*Emotional/behavioral disorder (i.e., not achieving expected milestones including lack of interest in others, inability to communicate emotional needs, self-injurious or other persistent stereotypical behaviors)

*Diagnosis of autism

*Orthopedic impairment

*Other health impairments (e.g., heart condition, tuberculosis, sickle cell anemia, asthma)

*Traumatic Brain Injury