The power of words: What the Wall Street Journal didn’t tell you

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Note: For those of you reading this post for the first time as a part of Friday Update, 7-10-15, know that the original post was written 4-17-14. We are featuring the original post again, as we have received a number of requests for some of the more popular background posts written about HR 3717 that are still relevant to current discussions about H.R. 2646.

Two weeks ago there was an editorial in the Wall Street Journal that basically eviscerated the Substance Abuse and Mental Health Services Agency (SAMHSA) while at the same time calling for support of HR 3717 – The Helping Families in Mental Health Crisis Act.

Last week we featured a Morning Zen post by Jonathan Delman, who provided a perspective on the article from both a consumer and researcher of mental health services point of view.

Over the past few months we have written extensively on HR 3717 and the challenge the proposed bill presents in its current state. It has elements that we agree with as well as elements we don’t. In addition, there are elements that are just plain confusing to us. If you haven’t already, I encourage you to read the Morning Zen post where we went through the bill page by page, identifying areas that raised red flags for us. We will be posting an updated more-detailed review next week.

Since the introduction of the proposed bill we have read with great interest articles in the press, personal communication, and written testimony from past Energy and Commerce Subcommittee on Health hearings on HR 3717. Much of what has been written is definitely passionate and unfortunately sometimes vitriolic. In this Morning Zen post I want to address three of the most popular sound bites (two of which found their way into the WSJ editorial) that continue to come up again and again. It is interesting to note that these three provocative sound bites seem to have gone unquestioned in the popular press all these months, taken at face value for fact, creating an impression that might not be accurate. The other interesting aspect is that all three sound bites reference the Alternatives Conference. Some day I'm gonna have to go to that conference to see what all the fuss is about. 
Note to readers: I have no monetary investment in the Alternatives Conference, nor have I ever participated in the Alternatives Conference.

Here are the three juicy morsels that keep making their way into the press:

In the most recent hearing on HR 3717 one of the expert witnesses was asked if he thought SAMHSA offering a workshop titled Dance Your Way to Wellness and Recovery was a good use of federal funds. I remember at the time thinking how I would answer. It would be something like “It depends on the context.” Realizing that I did not know the context I did some digging. In true Morning Zen fashion, here now is some background on each of them.

Let’s start with “Dance Your Way to Wellness and Recovery.”
It turns out that this “session” was actually part of the morning wellness activities offered to conference participants from the hours of 7 am – 8 am before any general session started. In addition to this offering, there was a yoga session as well as a silent meditation session. Like most Network faithful, I have been to many conferences that offered early riser exercise or centering sessions to prepare conference participants for a long day of sitting in sessions. I would be hard pressed to imagine any physician arguing against the benefit of exercise or centering activities before a long day of workshops. Think Zumba – one of the biggest conference crazes currently around. And why do conferences offer sessions like this? Because increasingly conference participants demand wellness activities so that they can get their workout or quiet time in before the workshops begin. But let’s peel the onion a bit more and look at the description of this session as printed in the conference agenda:

The description makes clear that the focus is on free-form movement – no dance experience necessary and also references the importance of dance to tribal nations, presenting an opportunity for some cultural learning as well.

With this important context, the accusation that offering this wellness activity is a poor use of money gets complicated real quick. It should be noted that the conference also conducted mini-health screenings where people could get their blood pressure checked, get a reading on their blood sugar levels, and get some ideas on getting and staying healthy. Sounds pretty reasonable to me.

Hearing Voices Network
Okay, on to the next oft-used phrase in this increasingly vitriolic dialogue, also referencing the Alternatives conference – “a presentation from the “Hearing Voices Network,” which believes that hearing voices is a natural part of human experience.”

Here is the workshop description:

It turns out that the Hearing Voices approach has been developed over the last 25 years in Europe and is now practiced in 23 countries across the world. Essentially it involves engaging the voice hearer about their experience and determining the meaning the voices have for them in relation to their lived experience, with the objective of developing long term coping strategies.

One of the tenets of Intervoice, which is the international umbrella of the Hearing Voices Network, is to develop a close and respectful partnership between voice hearers – who are experts by experience and mental health workers, academics and activists – who are experts by profession. The group stresses the importance of both voice hearers and professionals engaging in respectful dialogue.

In context, this seems like a perfectly reasonable session to offer at a recovery conference. I get the fear amongst the psychiatric community that this suggests that there is never a role for psychiatric intervention but from what I read that appears not to be the case. This is undeniably a controversial discussion point from the medical community perspective but this is also a movement that is not going away. If anything it is picking up steam. Instead of shouting it down, it seems to me that the more fruitful approach would be to engage in respectful dialogue.

Here are two examples to illustrate further what the Hearing Voices Network is. The first is a Ted Talk by Eleanor Longden and the second is an interview by Allen Frances, MD with Eleanor Longden. The sub-title of the interview is appropriately titled “Reconciling psychiatry and recovery.”

Eleanor Longden, Hearing Voices Network
Eleanor Longden spent many years in the psychiatric system before earning a BSc and an MSc in psychology at the University of Leeds. She argues that schizophrenia is a "creative and ingenious survival strategy" that should be seen "as a complex, significant, and meaningful experience to be explored." Longden is studying for her PhD and lectures and writes about recovery-oriented approaches to psychosis, dissociation and complex trauma.  

Psychiatry & Hearing Voices: A Dialogue With Eleanor Longden
In this interview, Dr. Allen Frances and Eleanor Longden have a dialogue attempting to find common ground between psychiatry and the Hearing Voices Movement. Read the interview. And then, come back to this post – we still have more to cover. Dialogue is key, folks. 

Okay Network faithful, hopefully you have some better context around this second sound bite as well.

Unleash the Beast
On to the final sound bite, not in the WSJ article, but worthy of inclusion here in case you are asked about it. This is from the Opening Statement of the Honorable Tim Murphy Subcommittee on Oversight and Investigations Hearing on “Examining SAMHSA’s Role in Delivering Services to the Severely Mentally Ill” May 22, 2013:

"If SAMHSA were to use an evidence-based approach to identifying how to prioritize its resources – like other federal agencies do – would their record, not to mention their strategic initiatives going forward, look the same as they do now? For example, in 2012, an annual conference that has been funded by SAMHSA for many years – and at which the SAMHSA administrator regularly delivers a keynote – Alternatives, an hour and a half workshop was held, described as follows:

Without the proper context one could draw the same conclusion. Unleash the Beast is such a provocative title I had to investigate this one. It turns out that the presenter grew up alongside an older brother with autism. At the age of 12 he was in a serious car accident and suffered a severe Traumatic Brain Injury. He spent three months in the hospital, relearning how to walk, talk and think. The next 15 years of his life were spent riding a roller coaster of success and setback dealing with severe physical, mental and social difficulties. Fast forward to today, he is a certified Life Coach, peer support specialist and works with individuals discharging from the psychiatric ward at a local hospital. His specialties include working with individuals who have brain injury, trauma/PTSD, bipolar, Autism spectrum/Asperger disorder. 

Okay, he passes my test for a credible presenter. But what about the subject matter? I didn’t attend the session so I certainly can't speak to that but it did get me thinking about mind body work and the question of scientific merit. Network faithful should be aware that the National Institute of Health established the National Center for Complementary and Alternative Medicine (NCCAM) in 1999. Since that time they have been looking at alternative forms of treatment (meditation, forms of movement therapy such as yoga, etc.) and are taking a refreshingly open view towards the efficacy of complementary and alternative practices that may not yet be considered evidence based. Much of what has been discussed in this post most likely falls into the practice-based evidence camp instead of the evidence-based practice camp. It is encouraging to see that NIH is keeping an open mind about alternative practices, as we all should.

Watch this brief video announcement from Josephine P. Briggs, M.D. Director, National Center for Complementary and Alternative Medicine

One thing we know for sure, the Veterans Administration has embraced body movement practices with returning servicemen and veterans who are experiencing PTSD. At the Washington VA Medical Center, both Yoga and meditation are used to help veterans recover from trauma. Many treatment programs for veterans with PTSD as well as individuals with diagnosed severe mental illness offer mind/body therapies, equine therapy (remember the first sound bite - Spirit of the Horse?) and other expressive arts therapy, including the healing power of dance. For a fascinating read on how dance/movement therapy approaches were used to foster resilience and recovery among child soldiers in Sierra Leone who had experienced significant trauma, read the paper by David Alan Harris.

The next time you read a sound bite... 
The next time you are discussing HR 3717 with colleagues and one or more of these sound bites are referenced, hopefully you will be able to avoid the visceral reaction (pro or con), thoughtfully consider the context and will be able to engage in meaningful dialogue about this proposed bill.

Look for our updated analysis of HR 3717 next week!

Scott Bryant-Comstock
President & CEO
Children's Mental Health Network 

Comments

  1. Tom Grinley's avatar
    Tom Grinley
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    Bravo! Having just come from the Alternatives 2014 conference I can speak from first hand experience about the value of the workshops despite the occasional attention-grabbibng provocative title.
  2. George Patrin's avatar
    George Patrin
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    The piece by Eleanor Longden is particularly important. While it speaks specifically about schizophrenia, the subject matter looks to the transformative principles of person-centerdness (vs business or research-centered), inclusion of the patient on their own health care team, and integration of ideas (specialties) to achieve the best results for the client and the economy (outcomes). In our society, "hearing voices" at a very superficial level is not "normal," but thank Goodness many enlightened thinkers do listen to their voices, whether their own, others, or from the Spiritual realm, as they guide us to transforming our world into a place where respect for diversity and individuality is a cherished and valued commodity. I choose to keep an open mind and listen, always. Thanks for this reality check morning zen piece.
  3. Dennis D. Embry's avatar
    Dennis D. Embry
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    Letter to the Wall Street Journal Signed by 23 Leading Prevention Scientists

    Dear Editor:

    Mental, Emotional, and Behavioral Disorders Are Preventable.

    The Wall Street Journal editorial of April 1, 2014 (The Definition of Insanity) stated, “...there is no known way to prevent severe mental illness.” This statement is scientifically and verifiably false, easily established by the scores of gold-standard, randomized control studies indexed in the US National Library of Medicine (www.pubmed.gov). These are studies funded by the National Institutes of Health, the Centers for Disease Control and Prevention, private foundations, or comparable entities in OECD countries. Many of these prevention studies include long-term, randomized control follow-up from five to twenty years later, much longer than any preserved randomized psychotropic medication study published at pubmed.gov.

    Further, the highest independent entities for such issues in the United States - the National Research Council and the Institute of Medicine (both chartered by Congress in 1863) - issued a significant and influential report in 2009, Preventing Mental, Emotional, and Behavioral Disorders Among Young People.(1) Page 1 of that report, which is based on an extensive review of the scientific literature, concludes unequivocally that several evidence-based practices are available now to prevent or delay mental illnesses among children and adolescents. The report then reviews the relevant literature for each developmental phase and setting (e.g., family, school, community) of the nation’s young people.

    The signatories of this letter are among the scientists whose work has shown in gold-standard, randomized longitudinal control studies to prevent, avert, or reduce one or more than one mental illness, including members of the IOM Committee issuing the finding that mental illnesses are preventable. We note that one of the witnesses at Congressman Murphy’s hearings was Dr. E. Fuller Torrey, who is the Executive Director of the Stanley Medical Research Institute that funded the first randomized, longitudinal trial to prevent first episode psychosis(2)—the proximal condition that triggered the events in Tucson, Virginia Tech, and Aurora. That study was published in the Archives of General Psychiatry, an official publication of the American Medical Association. There are replications already happening. Other gold-standard studies protect against or prevent the much earlier predictors of serious mental illness and, then in turn, can prevent serious conditions in later life.

    The editorial misses the verifiable fact that scores of strategies on the National Registry of Evidence-Based Programs and Practices (operated by the Substance Abuse and Mental Health Services Administration) are proven to prevent, reduce, treat, and even help people recover from serious mental, emotional, or behavioral disorders. Many of the same practices can be found on the list of the non-partisan, independent Coalition for Evidence Based Policy. Sadly, members of Congress, Governors, state legislators, mayors and families across America have scant awareness any of these rigorously proven preventive strategies, which are well documented to collectively save local, state, and the federal governments billions by the independent analyses from the Washington State Institute for Public Policy.

    Other countries have lower prevalence rates of mental, emotional, and behavioral disorders, perhaps because they are using the prevention science that United States citizens developed, U.S. taxpayers and foundations funded. A front-page article in the WSJ on December 28, 2010(3) pointed out that 40 million out of 75 million young people in the US had at least one prescription for a psychotropic medication, suggesting we cannot treat our way out of the epidemic. We cordially invite the Wall Street Journal to have its excellent reporters create a series of articles based on the world-class, gold-standard science that can prevent, reduce, or avert mental, emotional, and behavioral disorders that are now epidemic in the United States.

    Signatories:

    Abigail Gewirtz, Ph.D., L.P., Associate Professor, Institute of Child Development, University of Minnesota, St. Paul, MN
    Anthony Biglan, Ph.D., Senior Scientist, Oregon Research Institute, Eugene, OR
    Aysenil Belger, Ph.D., Professor and Director, Neuroimaging Research, Department of Psychiatry, University of North Carolina, Chapel Hill, NC
    Bill Beardslee, M.D., Director, Baer Prevention Initiatives, Department of Psychiatry, Boston Children’s Hospital, Boston, MA
    Daniel Shaw, Ph.D., Chair/Professor, Department of Psychology, University of Pittsburgh, Pittsburg, PA
    David Shern, Ph.D., President/CEO, Mental Health America, Alexandria, VA
    Dennis D. Embry, Ph.D., President/Senior Scientist, PAXIS Institute, Tucson, AZ
    Diana Fishbein, Ph.D., Director/Professor, Center for Translational Research on Adversity, Neurodevelopment and Substance abuse (C-TRANS), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
    Emilie Phillips Smith, Ph.D., Professor, Human Development and Family Studies, Pennsylvania State University, University Park, PA
    Faith Elizabeth Fuller MBA, President of Financial, Analytic, and Strategic Services for Nonprofit and Government Agencies, Berkeley CA
    Hanno Petras, Ph.D., Chief Methodologist, JBS International, North Bethesda, MD
    Holly C. Wilcox, Ph.D. Associate Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
    Irwin Sandler, Ph.D., Professor, Department of Clinical Psychology, Arizona State University, Tempe, AZ
    Liepa Boberiene, Ph.D., Washington Liaison, American Orthopsychiatric Association, Washington, DC
    Linda A. Randolph, MD, MPH, President and CEO, Developing Families Center, Inc., Washington, DC
    Mark T. Greenberg, Ph.D. Director, Prevention Research Center, Penn State University, University Park, PA
    Mimi M. Kim, Ph.D., Research Investigator, Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
    Nicholas Ialongo, Ph.D., Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
    Ricardo F. Muñoz, Ph.D., Professor, Department of Psychology & Psychiatry, University of California, San Francisco, CA
    Ron Prinz, Ph.D., Carolina Distinguished Professor, Psychology Department, University of South Carolina, Columbia, SC
    Teresa LaFromboise, Ph.D., Professor, Development and Psychological Sciences, Graduate School of Education, Stanford University, Stanford, CA
    Ty Ridenour, Ph.D., M.P.E., Research Associate, Division of Behavioral Health and Criminal Justice Research, Research Triangle Institute International
    Yi-Yuan Tang, Ph.D., Professor/Director, Texas Tech Neuroimaging Institute, Department of Psychology, Texas Tech University, Lubbock, TX

    References Cited

    1. National Research Council & Institute of Medicine (2009). Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: National Academies of Science, pp. 576.
    2. Amminger, G. P., Schäfer, M. R., Papageorgiou, K., Klier, C. M., Cotton, S. M., Harrigan, S. M., ... & Berger, G. E. (2010). Long-chain ω-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Archives of General Psychiatry, 67, 146-154.
    3. Mathews, A. W. (2010, December 28). So young and so many pills: More than 25% of kids and teens in the U.S. take prescriptions on a regular basis, Wall Street Journal.
  4. Frank Rider's avatar
    Frank Rider
    | Permalink
    Truly, Scott, you are the Paul Harvey of children's mental health, and that is a great thing. Now we can all know THE REST OF THE STORY! Thank you.

    Frank Rider (a.k.a. the Mick Jagger of systems of care :) ~~
  5. Amanda Thompson's avatar
    Amanda Thompson
    | Permalink
    Thank you for providing this intelligent, well-researched and rational response to the editorial in the Wall Street Journal and other misleading comments made about the Alternatives conference.

    I have attended the conference for the past three consecutive years and have not only had a chance to learn about innovative approaches to mental health recovery, but have met a number of people who have truly inspirational recovery stories and are using their lived experience to passionately promote innovative treatment options.

    It is unfortunate that these sound bites, taken out of context and without proper explanation are being used to promote political agendas and mislead readers.

    The mental health system in the United States is in need of transformation and the perspective of people who have received mental health treatment is crucial in systems reform and developing alternative programs that are not only effective and evidence based, but promote self-determination, empowerment and informed choice in recovery.

    Amanda Thompson
    Executive Director
    Empowerment Services
    Salt Lake City, Utah
  6. Alisha's avatar
    Alisha
    | Permalink
    Thanks, Scott, for doing the legwork on this. I remember a similar occasion a number of years back where the NSF took heat for funding a project that the media referred to as "a study of why the shower curtain sticks to your legs when you turn the water on." After alarming the public with this description, FINALLY someone looked at the whole grant proposal- and though the researchers used the shower curtain to illustrate the phenomenon, the study was on the physics of how airplane wings are designed to get air lift, in the interest of building more efficient planes. Context is always important.
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