What I'm reading this week: Confidentiality in mental health

Cordless, C. (Ed.). (2001). Confidentiality in mental health. London. Jessica Kingsley Publishers.

One thing of note when reviewing an edited volume is that each article is not equally good or equally relevant to one’s interests.  This book for example had some articles which related more to psychiatry or hospital based care than to the community based work I’m involved in. 

An ongoing theme throughout the book is the shift from a psychiatry/hospital oriented model of mental health care to a community based one and it’s implications confidentiality.  While in the past, patients may have engaged in individual psychoanalysis with one professional, many clients today are involved with interdisciplinary or interagency teams and their personal information may be shared with all members of the team.  Also, in the modern context we place emphasis on supervision, debriefing and consultation with colleagues.  While most of us as professionals would not perceive this as a breach of confidentiality, clients might. 

Another theme in the book is client expectations of confidentiality, informed consent, and whether clients really know what they are getting into.  While a client may be informed that their social worker works as part of a team, do they understand that this may mean common record keeping, or in the case of Assertive Community Treatment, a daily review of their file by the entire team. 

Finally, the book discusses the legal aspects of confidentiality and what constitutes a breach.  When does the threat of harm to others outweigh a clinician’s responsibility to keep confidentiality?  For many, it can be a “damned if you do, damned if you don’t” scenario as they face threat of litigation from both sides. 

I actually liked this book.  I didn’t read all of the legal chapters, but the chapter about social work was particularly good (or perhaps particularly relevant). The only draw back to the book was that it was British not Canadian and so all laws sighted were British.  I’d love to see Canadian authors pull together something similar.

 

What I'm reading this week: Understanding Personality Disorders: An introduction

Dobbert, D. L. (2007).  Understanding personality disorders: An introduction. Westport, CT.: Praeger.  

The stated intent of Duane L. Dobbert when writing this book was to provide a non-clinical explanation and exploration of personality disorders, and he does.  Dobbert approaches the subject from an “us verses them” mentality.  In contrast to much psychological literature of the time, Dobbert sees the individuals affected by other people’s disorders as being “victims” and the personal with a personality disorder as being the antagonist.  The preface states “if nothing else, this book will help you realize that you are the victim, not the person with the problem”. 

Dobbert starts his book with case studies illustrating his position that people are victims of those with personality disorders.  The introduction goes through the DSM-IV-TR definition of Personality Disorders and their associated criteria and characteristics.  Dobbert’s definitions are clear and his explanations straight forwards.  However, Dobbert uses a lot of black and white language and gives a very negative outlook using statements like “they [those with a personality disorder] are not capable of viewing the world from the perspective of another…consequently, it is an egocentric view, albeit inaccurate.” (page 3). 

Chapters two through twelve of Dobbert’s book go through the DSM criteria for each of the ten personality disorders (Paranoid, Schizoid, Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependent, Obsessive Compulsive and Conduct Disorder).  For each, he provides at least one case study.  He then discusses expected outcomes and therapies.  An appendix at the end of the book outlines major theoretic perspectives of personality disorder. 

I’ll be honest, and say that I didn’t like the book.  For starters, I found Dobbert to be arrogant, and I can’t stand arrogant authors.  Secondly, I found it boring.  He literally takes the DSM and explains each sentence.  However, I can see that this book could be useful for family and friends of someone with a personality disorder.  I still wouldn’t recommend it though except as a last resort, because I think it has a very negative perspective.  Unfortunately, I haven’t had a great experience with any books I’ve read about personality disorders, so I’m not sure what I would recommend instead (suggestions are always welcome). 

 

What I'm Reading this Week: Beyond the Razor's Edge

Redheffer, J. and Brecht, S. (2005).  Beyond the razor’s edge: Journey of healing and hope beyond self injury.  New York: iUniverse Inc.

I don’ t usually publish book review of books I don’t like, but this one, well, there was something about it that made me want write about it anyway.  Being a former self injurer (or whatever the popular slang for that is now a days), I’m often drawn to books about self injury, this one being no exception. 

The book is a collection of stories and poems written by the patients and staff of SAFE Alternatives treatment program.  SAFE stands for Self Abuse Finally Ends and is associated with a hospital in Chicago.  They are a one-month “cold turkey” program and provide after care for those living in the Chicago area. 

For those who’ve been through the program at SAFE and found healing through it, I imagine this book is a nice way of remembering those times.  I however found the book to be very narrow minded and very focused on how wonderful the program is.  It would be sort of like a book written by recovering alcoholics all of whom found sobriety in the exact same way.  In many ways SAFE resembles AA and the story repeated over and over again is “once I submitted to the process I began to heal”.  And maybe that’s true, but I’m a firm believer that there is more then one way of healing. 

I suppose I need to take the book for what it’s written for though.   The self-described goal of the book is, “to empower individuals to make healthier choices by sharing what has worked for others” (p.ix).  Well, they do share what has worked for others, but I really don’t think that the book is all that empowering.  If anything, I find that it could be frustrating in the way it promotes a very specific program, which is not all that accessible. 

Recommendations… well, I’d have to say don’t bother reading it.  Maybe if you want to go work for SAFE, or if your thinking of starting your own program and want to read about people’s successes in this one. 

The stories are good though.  It takes courage to share your story and each and every woman whose account is in this book had the courage to stand up and say, “this is me”. 

 

What I'm Reading this Week: Bad Therapy

Kottler, J.A. and Carlson, J. (2003). Bad therapy: Master therapists share their worst failures.  New York: Brunner – Routledge.

When I saw the title of this book staring out at me from the shelf I was immediately intrigued.  Bad Therapy?  Who writes about that?  I’ve read many books in which therapists share cases, both good and bad, many stories of those who survived bad therapy, and of course books that bash the entire idea of therapy at all.  Thinking it would be a collection of short stories, I stuck it in my bag for work the next day ready to jump in. 

While it many ways it was a collection of short stories, in other ways it wasn’t.  Kottler and Carlson put together a set of interview questions which they sent to participants ahead of time and conducted a study of sorts, so things didn’t flow quite as well as I’d hoped they would. 

The authors spoke to twenty-two different therapists, and while their biographies were impressive, I have to admit the only one I was familiar with was William Glasser the founder of Reality Therapy.  The therapists had a variety of backgrounds and worked with a variety of theories, which is something, I appreciated about the book.  Further, it was refreshing to hear therapists be honest about the mistakes they have made or were perceived to have made.  Although, I have to admit, most frontline workers I know are readily willing to admit they’re not perfect!

In terms of recommendations, it’s definitely worth checking out if you have any interest in therapy.  At only one hundred and ninety-nine pages it’s a short read, and due to the format, it’s good for reading when you only have a little bit of time.  It’s probably not a great read if you’re looking for something entertaining (which I usually am).  Finally, as I mentioned before it’s presented in interview format rather then as short stories and sometimes the flow seems just a little bit off, so if that’s important to you, probably not a book you’re going to want to open up. 

 

What I'm reading this week: Cracked

Pinksy, D with Gold, T. (2003). Cracked: Putting broken lives together again, a doctor's story.  New York: Regan Books.

I'll be honest, I liked this book until I realized who wrote it.  Not being up on popular culture, I didn't realize that the author Drew Pinsky was the doctor on the shows Celebrity Rehab and Sober House.  I find those shows disgusting, as in they disgust me, not that they have gross content.  So pretend with me for a moment, that I don't strongly dislike the author's professional image and we'll talk about the book.

Pinksy writes about his time spent working as on a doctor on the chemical dependency unit of a hospital.  Unlike the model in my city, the unit seems to function as both detox and addictions treatment, with clients moving directly from hospital to sober living facilities.  The book takes us through average days in Pinksy's life following the lives of patients and their efforts to gain and maintain sobriety.

Dr. Pinksy addresses some of the common causes of addiction although he tends to take a somewhat narrow approach.  He is a doctor, so perhaps it makes sense that he pays a great deal of attention to the medical model and
the theory that addiction is a disease.  The book is clear that the way to maintain sobriety is to detox, start the twelve steps, find a sponsor, and stay in a sober living facility.  The author acknowledges no other paths and does not discuss other models of addiction.  He is clear that all addicts come from extremely dysfunctional families and were abused as children. While I don't have any studies contradicting this on hand, it "irks" me that there is nothing else presented.

Dr. Pinksy shows a great deal of self awareness in his writing, spending time discussing what many would term as "countertransferance" (although he does not use that word) and his reactions to patients.  I appreciated that fact that he acknowledged that he had these reactions and they played a part in treatment.  It takes confidence to talk about your awareness that a patient is trying to sexually seduce you and your reactions to this situation.

As for whether I would recommend this book, I'm not sure.  I might, especially if the person I was recommending it to likes Dr. Drew, but my dislike of his TV shows doesn't make me want to.  But, books are what they are.  If you're interested in a basic overview of one model of addictions and treatment it might be a good place to start.  The patients are interesting, and the story is well told.

What I'm reading this week: The culture of our disconent

Small, M (2006).  The culture of our discontent: Beyond the medical model of mental illness.  Washington, DC: Joseph Henry Press.

To start off with, let me say I really liked this book.  Meredith Small is an anthropologist who sets out to look at models of understanding mental illness in both Western Society and around them world.  I've never read much anthropology, so I'm not sure how things hold up from an anthropological stand point, but from a Social Work perspective the book was well written, concise and easy to understand.  To be honest, my favourite part about it was the length; not too long and not too short!

The stage is set in the introduction which describes the American Psychiatric Association's annual conference.  Small is surrounded by drug advertisements and drug representatives and says, "the ads addressed a cornucopia of negative human behaviors, and every symptom, syndrome or condition called for pharmaceutical treatment" (page 2).

The first chapter of the book looks at the impact of the medical model on mental illness, while the second chapter explores alternative models already present in Western Culture.  Third, Small looks at the biological basis for mental illness citing a variety of studies on monkeys (or non-human primates as the book describes them).  Moving on the book looks at how diet contributes to mental illness and how the slow change in diet of a country exposed to Western styles of eating can have mental illness increase in prevalence.

The middle of the book begins to look at things from the perspective of cultural anthropology.  Small discusses how mental illness is viewed in different cultures and the impact this has.  Next she discusses how some mental illnesses appear to be "culture bound" appearing only in certain populations living in more isolated parts of the world.  Small further discuss different treatments considered to be the norm in different parts of the world, placing importance on the link between the believed cause and the selected treatment (i.e. if possession causes mental illness then an exorcism is necessary).

The book ends without coming to a conclusion about which model is best, which is something I appreciated.  Small believes that what is universal, is that in all cultures treatment of mental illness is tied to hope.  "Sadness and despair might be the hallmarks of mental illness, but quite remarkably, every culture believes that something can always be done to bring relief" (page 4).

All in all, the book was a good read.  I learned a surprising amount from it without feeling that I was being overwhelmed by difficult to understand information.  The content flows together nicely with good transitions from one chapter to the next.  While I would recommend this book to anyone interested in learning more about Western thinking, I would especially recommend it to professionals who deal with a diverse population on a regular basis or with recent immigrants.  I would not however recommend this book to people who are looking for books about a very "anti" medical model of mental illness.  The book presents each view equally and it in no way raises one model above any other.

What I'm reading this week: Prozac Diary

Slater, L. (1999).  Prozac diary. New York, NY. Random House. 

I realize this makes two book reviews in a row about medication, and I promise the next one won’t be (although it is about healthcare, and then comes suicide, it is a social work blog after all).  I tend to have many books on the go at once, and I happened to finish 4 almost at the same time. 

 

I liked Prozac Diary.  I enjoy reading memoirs about people who have dealt with mental illness, disease, disability, abuse etc... I find that I learn a lot more from people’s stories then from any text book I’ve ever read or lecture I’ve attended.  That being  said, Prozac Diary was almost a little too “booky” for my liking.  I don’t tend to consider myself a linear thinker, but I’m beginning to think I like my books that way.  My main complaint about the book was that it jumped from past to distant past to present, and had some sections which seemed to be a bit metaphorical. 

The book talks about the author, Lauren Slater’s life as a child and then as an adult as she begins taking Prozac before Prozac became a “thing”.  After spending time in hospitals and trying a variety of the other medications out there, Slater finds that Prozac is her “answer”.  Almost immediately after starting Prozac, the author begins to find relief from her overwhelming OCD symptoms.  She no longer has to wash her hands multiple times or perform rituals simply to get out of bed.  Despite her doctor’s assurance that Prozac could not be working so quickly, Slater knows it has changed her life forever. 

 

By exploring Slater’s childhood, the reader learns that Slater’s issues began at a young age and were not precipitated by any one event.  However, it is easy to see how the author’s family constellation had an effect on her emotional wellbeing.  Through 10 years of Prozac we see Slater experience drug poop out, the party scene, a PhD and meeting the man of her dreams. 

 

While the book isn’t exciting exactly, it provides a nice middle ground, an “average” experience on anti-depressants one might say.  At the end of the book, Slater isn’t cured, and she still takes those little pills while struggling with the ups and downs of life and mental illness.  While it wasn’t my favourite, it’s definitely worth looking into if you or a client is struggling with the idea of taking medication long term. 

  

What I'm Reading this Week

I decided that since I read a lot I should start writing about what I'm reading if for no other reason then making me process what I read.  I often pick non fiction from the new non-fiction books at the local library and this book stood out to me because of the giant title.  The fact that entire cover is words should have given me an idea of what the book would be like... And so, my completely non academic review.  

Breggin, P.R. (2008). Medication madness: A psychiatrist exposes the dangers of mood altering medication. New York, NY: St. Martin's Press.  

This book made me laugh.  Not because of the subject matter, but because the author thinks he knows everything.  The book's subject matter, and indeed the intended tone of the book is infact very serious.  The psychiatrist who wrote it is completely against psychiatric drugs... completely.  Infact, his entire practice is about taking people off psychiatric medications.  Breggin also has a side business testifying in cases about what he calls medication spellbinding.  

Breggin shares case studies from his experience in which people have done crazy violent things while under the influence of psychiatrict medication.  He then, if they were still alive, took them off their medication and they became imediately remorseful and wondered how they could ever do such a thing.  I don't doubt these case studies existed and that Breggin has seen people do horrible things while on psych meds.  What I don't like is his black and white attitude.  

On the positive side however, it's nice to hear a psychiatrist talk about the over prescribing of psych meds.  Medications seem to be the answer to everything in this day and age and it's nice to hear a different perspective... especially from a medical practioner.  I do believe that medications are over prescribed and that psych meds can be seen as a fix all for everything.  I think it's awesome that Breggin has a practice which encourages people to try and come off medications and supports them while they do so.  Breggin also makes it very clear that he doesn't want his readers to cold turkey their meds unsupervised after reading the book, something that's very important.  

What i find lacking from the book is the discussion of schizophrenia.  I'm not sure he mentions the word once and it's not in the index.  I'd really like to know what he has to say about this confusing and frustrating disease.  I'd love to see what he would do with my client's from Assertive Community Treatment, and I mean that in all seriousness, not sarcastically.  I'm interested to know if he advocates that people who have been able to function in society because of their meds should be taken off them if they wind up sinking to a place where they sit catatonically and rock.  

So all and all, if you're looking to read something really anti medication or need to balance out a paper, this is a good book.  If you're looking for a discussion of pros and cons, head somewhere else.  

the end.