Growing mental health problems in military.

Tragedy.

Mental illness at the movies.

Psychflix.com is the creation of Robert Atkinson, professor of psychiatry at the Oregon Health & Science University in Portland, who claims to see 200 films per year and does reviews from psychological and psychiatric perspective for professional publications like Clinical Psychiatry News. (If you visit Portland on a clear day, I recommend taking the aerial tram up to OHSU from the waterfront; you'll get some nice views.)

On the site, Atkinson reviews and rates of a wide range of films dealing with mental health-related issues, from Taxi Driver and The Deer Hunter to High Anxiety and What About Bob?

(For the heck of it, here's a little a-propos-to-the-anxious taste from that last title:)



("I get dizzy spells. Nausea. Cold sweats. Hot sweats. Fever blisters. Difficulty breathing. Difficulty swallowing. Blurred vision. Involuntary trembling. Dead hands. Numb lips. Fingernail sensitivity. Pelvic discomfort." I love Bill Murray. And Richard Dreyfuss is no slouch.)

There are notable gaps -- where are Pyscho and Vertigo? -- and you may not always agree with Atkinson's overall assessment of a film's quality, but if you want to know if the filmic depiction of a given dysfunction or disorder is accurate, this is the place to check.

Panic in the air!

The recent passing of Leslie Nielsen made me think of Airplane!, a film which when I first saw it made me laugh so hard I thought I was going to lose control of my bowels. So I went online and found this scene, of great and humorous relevance to those of us who know what it is to panic. (Go ahead, laugh at yourself. Trust me, it feels good.)

Then I started looking around YouTube a bit and found this:



I admire this guy. He's pushing himself to face his fear, and he's taking a lighthearted approach to his effort. (Well, until the very end of the clip -- we're with you, dude!)

A portrait of Aaron Beck, inventor of CBT.

This is a longish look at the life and work of Aaron Beck, who invented cognitive-behavioral therapy (CBT) after studying more traditional psychotherapeutic practices in the 1950s. In a nutshell, his transformation from proponent of Freudian analysis to CBT founder went like this:

At the close of a typical session one afternoon, Beck asked his patient, in classic analytic style, “How do you feel?”

“Very anxious, doctor,” she replied.

Of course, Beck told her. That was because she was being forced to confront her deepest sexual impulses. When these impulses rose to her consciousness, breaking through her ego’s defense systems, they caused anxiety.

“You’re right,” she said. “That’s brilliant.” But she sounded tentative. Beck told her so.

“Actually,” she said, “I was afraid I was boring you.”

Beck was surprised. Fear of boring one’s analyst is not uncommon, but this patient had never mentioned it before. He asked her how often she thought she was boring.

“Oh, all the time,” she said. “I think it when I’m here with you, and I think it when I’m with everyone else.”

This was nothing short of revelatory. As engaging as his patients’ monologues could be, and as much emphasis as analytic doctrine placed on them, it was their mundane, reflexive, almost forgotten thoughts that now seemed to hold the true explanatory power. In this patient, for instance, the insidious belief “I am boring” explained why she slept around (afraid that she had nothing else to offer, she jumped into bed), why she wove dramatic stories in session (anything else might seem tedious), and why she was anxious. Once Beck realized this, he began to uncover similar thoughts in all his patients, as well as in his friends, his family, and himself. Our daily lives, he concluded, unwind to the accompaniment of a quiet but constant self-talk, through which all external events are filtered.

When Beck pieced together his experimental and clinical findings, in the early 1960s, he drew two conclusions about psychoanalysis. The first was that it was cruelly glacial. Psychoanalysis takes years, at the end of which the analysand typically feels much wiser about the roots of her misery but no less miserable. By homing in on his patients’ self-defeating thoughts, Beck found that he could alleviate symptoms in as few as 10 sessions. And the progress stuck. The second conclusion he drew was that psychoanalysis was a theory built on sand. Beck had been duped. “I concluded that psychoanalysis was a faith-based therapy,” he has said, “and that if I was going to practice or teach therapy, it had to be empirically driven.”

While favorable to Beck's creation on the whole, the piece benefits from its acknowledgment of gaps and weaknesses in the CBT story; to wit:

... the problem with ruthless empiricism, as opposed to charismatic boosterism, is that if you live by data you can die by data. In studying the effects of psychotherapy on depression the variables are after all vast, even endless, and the tiniest alteration in study design or slip-up in delivery can fundamentally alter the outcome.

Beck learned this lesson well in 1985, when the first results of a multi-site, multi-million-dollar trial of CBT for depression, organized and funded by the National Institute of Mental Health, began to trickle out. That the NIMH would even be interested in such a study was a testament to the growing prominence of Beck’s ideas. But he was skeptical. He felt that there were not enough experienced therapists to perform so large an experiment, and he withdrew his support. “It reminded me of the song of the Valkyrie,” he told me. “You can hear the drum beats, you know there’s gonna be disaster.” When the numbers were crunched, CBT was shown to be no better than drugs for mild depression, worse than drugs for severe depression, and without any real lasting effect.

And:

There is mounting interest ... in how psychopathology can be mitigated by targeting the experience of emotion, a “low road” approach stemming from basic neuroscience research that contrasts with Beck’s cognitive “high road.” And in 2006, the results of a randomized controlled trial suggested that in CBT it is not the evaluation of thoughts but the changing of behavior that is doing the real therapeutic work.

In other words, it may be the behavioral part of the therapy that's more important, not the cognitive part. Which feels right to me. Exposing myself to the situations I fear has always been the quickest way to being able to cope with them.

In the end, I'm not sure why folks make psychoanalysis vs. CBT into such an either/or battle. Both have their place; the two can be complementary tools. While CBT's call to challenge your "automatic thoughts" is of real value in making it through difficult moments, tranforming the way you think probably takes a whole lot longer than the 10 or 20 sessions comprising the typical course of CBT.

Muppet panic!

"9 Easy Steps to Simulate the Sensation of Panic." Grover rules.