This latest fake news cycle started on Thursday, apparently with the release of a Reuters news story from Kate Kelland. Kelland notes the newest concern comes from “Liverpool University’s Institute of Psychology at a briefing in London about widespread concerns over the manual.” There’s no link to the briefing. And I’m not sure what a “briefing” is — a press conference? (And since when is a press conference a news item? It’s not really equivalent to a new research study, is it?)

Kelland fails to note that Europe and the U.K. don’t actually use the DSM to diagnose mental disorders — it’s a U.S. reference manual for mental disorders diagnosis. So while it’s nice that some Europeans are expressing concern about this reference text, their concern isn’t exactly much relevant. Context is everything, and Reuters failed to provide any useful context in that article.

Sadly, Reuters is a brand name. And once you write an article under that brand name, it cascades down an entire news cycle. Let’s follow it for fun!

Reuters begins with:

Millions of healthy people – including shy or defiant children, grieving relatives and people with fetishes – may be wrongly labeled mentally ill by a new international diagnostic manual, specialists said on Thursday.

In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and other experts said new categories of mental illness identified in the book were at best “silly” and at worst “worrying and dangerous.”

Wow, glad there’s no fear-mongering going on there. A nice, balanced approach to the news.

These are the same “experts” who have been beating their drum all fall and winter, but who decided to convene a press conference in the UK last week to generate more press. And more press they did generate.

The Kelland article again regurgitates half-truths about the issue, such as this beauty:

More than 11,000 health professionals have already signed a petition [...] calling for the development of the fifth edition of the manual to be halted and re-thought.

Apparently Reuters doesn’t do any fact checking any longer. As we discussed more than a month ago, not all of the “signatures” are mental health professionals — only approximately 88 percent self-reported they were. Sloppy reporting from Reuters.

The rest of the “briefing” was simply rehashing all of the same old arguments that both we and many, many others have already covered. It’s silly and a little demeaning to try and argue these things in the press, over and over again, because it comes down to one set of professional opinions against another. Whose set is “better” or more legitimate? Nobody can tell, because nobody has access to the future.

Oh. Except for Allen Frances, M.D. He has apparently left his position as a doctor and taken up residency as a psychic, because he told the U.K.’s Telegraph,

“DSM5 will radically and recklessly expand the boundaries of psychiatry. Many millions will receive inaccurate diagnosis and inappropriate treatment.,” said Allen Frances of Duke University, North Carolina.

Wow, really? You always seem to miss mentioning how the current DSM-IV — overseen by the same Allen Frances — has done exactly the same thing (according to its critics).

Because this press conference — uh, I mean “briefing” — was conducted in the U.K. by U.K. organizations, it was picked up in the U.K. media. (Here’s a nice summary of the coverage.)

Now, in order to capitalize on this new news cycle in the U.S., American outlets needs to bring their own sexy angle to the story.

A day after the UK press conference, ABC News took the bait and Katie Moisse wrote it up as though the petition was a new thing (it was started in October 2011 and had 10,000 signatures two months later, in December 2011). Our knight in shining armor against the DSM-5, Allen Frances, again is liberally quoted:

“You can’t have one professional organization, like the American Psychiatric Association, responsible for something so important,” he said.

The change of heart is amazing. When the APA was signing checks to Frances, he had no problem supporting them. Now that he’s out of the process, he suggests the APA shouldn’t be the one publishing the reference text.

Keep in mind, the use and adoption of the DSM is completely a market-driven, voluntary choice. Nobody is demanding professionals use the DSM to diagnose mental disorders in the U.S. Another international system already exists called the ICD-10, and is used throughout the rest of the world. All the 600,000+ U.S. mental health professionals need do is agree to start using that instead of the DSM. It doesn’t require government intervention, and it doesn’t require endless hand-wringing.

The NY Daily News ran with the latest news cycle today with their own unique spin. This newspaper initially claimed that “DSM-5 lists Internet addiction among mental illnesses.” The headline was later changed to, “DSM-5, the new mental illness ‘bible,’ may list Internet addiction among illnesses.” Note that “may” was slipped in, and of course, typical of Internet news articles, no mention was made of the edit to the headline to reflect that absolutely nothing has changed about the status of Internet addiction in the new DSM-5. It will still likely not appear except in a general “behavioral addiction” disorder category — something we’ve known for about 2 years now.

Probably mostly unnoticed in this latest blip in the DSM-5 news cycle is this thoughtful article over at Medscape about the bereavement exception for depression. Well worth a read, as it actually is a nicely balanced piece of actual journalism. It’s thoughtful, examines both sides of the issue without bias, and presents a wealth of data to let the reader draw their own conclusion.

A refreshing change from the dribble passing for journalism from Reuters and others these days.

So a quick recap — no new news has occurred with the DSM-5. Some professionals who started a petition back in October 2011 held a press conference, and some news media attended it, and decided to write up these professionals opinions. These opinions are in opposition to other professionals’ opinions.

I will make a prediction right here and now, much like the psychic Allen Frances: When the DSM-5 is published next year, the world will not end. We will not face a new epidemic of diagnoses of any of the disorders listed therein. And mental health professionals will adapt to the new changes with little effort on their part.

For further reading…

Read the Reuters story: New mental health manual is “dangerous” say experts

Read NY Daily News story: DSM-5 lists Internet addiction among mental illnesses

Read the ABC News story: American Psychiatric Association Under Fire for New Disorders

Read the Fierce Pharma story (with links to UK coverage): Psychologists petition against DSM-5 revisions

So we’re putting out a call for any and all psychotherapy stories — from therapists, psychologists, psychiatrists, counselors, clients and patients. If you have a story you want to tell and can do so in under 1,400 words, we’re interested.

We’re not looking (just) for salacious stories. We’re looking for stories that show the personal nature of therapy, and how it can help people.

Read on for details…

We are looking, first and foremost, for your psychotherapy story (or that of a loved one; or if you’re a professional, one involving your psychotherapy session with a client). We don’t want fictional stories. We also don’t want you to tell your story in public if you’re not ready to share it and have it be read by thousands of people.

We are also looking for submissions that meet our editorial guidelines. These include:

• Good English grammar.
• Simple formatting — no indenting, but please use paragraphs and spaces between your paragraphs.
• Spell-checking before you send.
• Make the details anonymous. We don’t want you to be too personal with your details, to ensure no one recognizes you (or your client) from the story.
• Taking 5 minutes to proof-read your submission before sending it to us, making sure it reads well and makes sense.

All entries will be published anonymously, unless you specify otherwise.

There may be a small stipend involved if your submission meets our editorial guidelines and is a story we end up publishing. If this is the case, we will contact you for your billing details. (We’re not guaranteeing any stipend or giving details about it, because we prefer people do this for sharing their story, not for the money.)

Submit Your Psychotherapy Story

Ready to go? So are we! So go ahead and send us your best story about psychotherapy to:

(We can take any format you care to send it in.)

The Fine Print:
Any submission to Psych Central grants us a royalty-free, perpetual, irrevocable, non-exclusive right and license to use, reproduce, modify, adapt, publish, translate and distribute such material (in whole or in part) worldwide and/or to incorporate it in other works in any form, media or technology now known or hereafter developed for the full term of any copyright that may exist in such material. Authors may retain their original copyrights if they so desire. Psych Central has the option, but not the obligation, to publish any material it receives at this email address.

This, of course, is a Big Deal, since one of the major stumbling blocks of the thousands upon thousands of health apps are their need for something or someone to input personal health data. Without personal health data, health and mental health apps are generally pretty useless.

The method to measure one’s psychological well-being (or, as we more commonly refer to it, one’s happiness) passively is to use whatever metrics are available through the phone. Since phones generally only have a limited amount of inputs — voice, video, geo-positioning (GPS), and an accelerometer — your choices as a researcher interested in personal health data are pretty limiting.

Using only these four physical measurements, is it really possible to accurately and reliably measure a person’s well-being? Let’s find out.

In the research I’ve read on this issue, the researchers focused on three components: social interaction, as measured solely by the amount of talking done (through the phone’s microphone); sleep/wake patterns (through the accelerometer); and physical activity (through the accelerometer and geo-positioning).

Let’s look at each one of these characteristics in turn.

1. Social Interaction as Measured by Talkativeness.

Slowed speech or a reduction in the amount of speech (from whatever the person’s original baseline was) can be one part of one symptom (of the 9 symptoms) of depression. It is, however, also a symptom of many, many other disorders. Slowed speech, or a reduction in the amount of speech is part of a larger symptom cluster in depression, called “psychomotor agitation or retardation.” The DSM-IV makes clear that this slowed speech or reduction in the amount of speech can’t just be a subjective feeling — it has to be severe enough to be observable by others.

It’s also important to note that since people vary widely in terms of their social outgoing-ness (extroversion) and talkativeness, anything that seeks to measure how much a person is talking throughout the day is going to have to understand that individual’s personal talkativeness baseline level.

For instance, if I usually say about 20 sentences a day, and then I go down to 10, that might be an important change. But the app would have to know my baseline first. If it just assumes that I’m like an average person who says 200 sentences a day (or whatever the real number is) and sees I’m not meeting that average, it’s going to be wildly inaccurate.

Last, the most obvious problem with trying to measure social interaction or isolation through sound alone is the reality of how we conduct ourselves through technology. Much social interaction done today is done silently, through our smartphones and keyboards. It also assumes that simply sitting in the same room quietly with another person is the same as sitting alone in your own room. Being together with others, but not necessarily talking, is the New Togetherness.

Researchers can also look at “stress levels” in one’s speech. I suppose that could indeed give you an immediate, real-time reaction to things happening in the world around you. But good mental health isn’t based upon simply your levels of stress — it’s based on how resilient you are and what you do with such stress later on. These are vital components a smartphone or iPhone simply can’t measure.

2. Sleep/wake patterns.

Problems with sleeping aren’t going to be detected by the app, since it can’t tell when you’re sleeping or not (unless you pick up your smartphone every time you wake up). What it can do right now within 1 and 1/2 hours of waking is to determine if you’re awake or not (because you start using your phone). An hour and a half is a huge degree of error, and can easily be the difference between you getting a normal night’s sleep (8 hours, say) and not (6 1/2 hours).

The sleep/wake cycle is also impacted by dozens of other variables that may have nothing to do with your overall well-being or happiness. These include things such as a change of season, change of working times, change in relationship status, change of child rearing duties, change in physical health, and about a half dozen other mental health concerns.

It could also include a new exercise routine, getting married, or moving into a new house — all things that most people would think of as positives and increase happiness. Yet the app would see them as negatives, since they all might impact your normal sleep schedule.

An impact in your sleep schedule is not really a sufficient indicator of much of anything — other than you have trouble sleeping. It could be caused by so many different things as tying it to just one thing is simply not very reliable — or scientific.

3. Physical activity.

Physical activity is correlated positively with increase happiness, as well as greater overall health. People who engage in regular physical activity indeed may feel better about themselves and have a better mood.

In fact, if there’s one thing you want to do today — right now! — to make yourself feel better, go take a walk.

But a lot of people’s physical activity is pre-determined by the type of work they do and the lifestyle they lead. So if you’re tied to a desk all day, chances are your physical activity measurements are always going to be worse than someone who works outdoors all day. Even if you work-out on a regular basis.

Physical activity alone is not really a good measurement of mood. And while someone who engages in more physical activity should be at lesser risk — population-wise — for depression or other mental health issues, it can’t speak at all to an individual’s risk. After all, a professional athlete who is engaged in physical activity almost every day can still become depressed.

Can an iPhone Measure Your Mood?

Which brings us back to the original question… In reviewing what we know about mental disorders, depression and happiness, is any smartphone or iPhone app really going to be an accurate measure of those things?

Probably not. While researchers may find some weak correlations with some of these things and mood, I have my doubts about whether such an app can be robust and personalized enough to actually give most of us meaningful information.

So do we need an app to tell us we’re depressed? Most of us are already quite well enough aware of when we’re feeling down, socially isolate, or don’t feel like talking to others.

And an app is especially ironic, given the active initiative you would have to take in order to use it. You would need to download and install the app first — suggesting you already have a certain amount of insight into your own mood or psychological needs.

For further reading…

• Get Some Therapy From An App That Reads Your Feelings Through Your Voice

• Web-based counseling — Telepsychiatry — is taking off

Of all companies you’d think might be smart enough to “get it,” Google would be at the top of my list.

But in a demonstration that apparently some companies don’t really give much thought to such things, Google decided to shut down the popular SuperPoke Pets game, after buying the company that owned it. (Which begs the question — why buy a company only to shutter its popular products?)

The real problem for users of SuperPoke! Pets (SPP) is that the game featured a virtual economy full of virtual goods. Virtual goods that people paid real money for. And of course with pets, one can become emotionally attached to them (yes, even virtual pets).

A new lawsuit just announced features a group who are suing Google over the game’s shutdown — and the loss of meaningful interaction with their virtual pets.

Google made the announcement of the shutdown back in August 2011, and now as the March 6, 2012 shutdown date approaches, users have had enough of the company’s tactics. They are suing Google to recover the money spent in the online social game. A lot of people still play Superpoke Pets, including a substantial handicapped population that are limited to playing only games that are adopted for their use.

But I suspect another strong motivating factor behind the suit is because of the specific makeup of the game. That is, the creation and enhancement of emotional objects — in this case, pets.

Apart from being upset about lost money, and having been misled about how long the game would continue, SPP users are sad and angry about the loss of a valued community and the social aspects of a game that appealed to children as well as adults and was accessible to and enjoyed by handicapped users.

Surprise, surprise. Develop a game that encourages you to bond emotionally with objects you create in the game, and a lot of users will develop a strong emotional bond with those objects. This is a core component of game dynamics in modern gaming, making games “addictive” (in the sense that a person wants to play frequently and for longer periods of time). Mess with that emotional bond and you’re messing with people’s emotions.

Google does allow you to download your virtual objects and interact with them on your computer, but that’s not really the same thing, is it? The game is a social game, and it’s not very social to interact with virtual objects by yourself. (To add insult to injury, the software that allows this interaction is apparently buggy as well.)

This isn’t the first time Google has said, “Eh, we’re not interested in this product or service after all. Take your data elsewhere.” Google Health users were stuck with a set of health data that they could download but no longer interact with. (Others did even worse, offering PHR users only a PDF download).

This event offers a few pieces of wisdom for the rest of us:

1. Don’t buy virtual goods in a social game expecting it to last forever — there’s no guarantee the company backing up that virtual economy will be around in a year (much less 5 or 10 years) from now

2. When you offer your users something that encourages an emotional attachment, don’t be surprised when your users form an emotional attachment to that object (virtual or otherwise)
3. Think twice about selling your company to Google if you want your products or services to have a bright and successful future

RIP SuperPoke! Pets.

Read the full article: Social Game Players Sue Google.

So how does a relationship recover from cheating? How do you make amends with it personally?

I’m pleased to introduce the second in a series of interviews and conversations with two of our resident therapists about a wealth of mental health topics. In this installment, Marie Hartwell-Walker, Ed.D. and Daniel J. Tomasulo, Ph.D., TEP, MFA answer the question of how to recover from cheating in this latest video from Psych Central.

Can your relationship survive cheating? What about the forbidden fruit in relationships? When does flirting turn into cheating?

Dr. Marie and Dr. Dan will be hosting many future videos on relationship and mental health topics in the weeks to come. We will post them here as we publish them, or you can check them out on our new YouTube channel. Want to learn more about Dr. Marie and Dr. Dan?

What do you think about their advice? Please leave your thoughts in our comments section.

He starts off the op-ed, “As a psychologist who has been studying the development of troubled children for more than 40 years, I believe we should be asking why we rely so heavily on these drugs.”

Like most professionals who are trying to boil down decades worth of research into a layperson-friendly length, Dr. Sroufe unfortunately glosses over the psychological literature and what we know (and don’t know) about ADHD medications.

I will say this before we begin… most children would benefit not just from being prescribed an ADHD medication, but also getting specific psychological treatment as well. Few child psychologists and child specialists would be happy if their patients were only getting the benefits of one type of treatment, and many would agree that parents are too quick to medicate before trying non-medication options.

Which isn’t to say they would agree that ADHD medications have no place in the treatment regiment. Dr. Sroufe cites a 2009 study to prop up his anti-medication argument (oddly, the only modern research study he cites in the entire article):

But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.

What Dr. Sroufe fails to mention is that this was an “uncontrolled naturalistic follow-up study” that, after 14 months of treatment in one of the four treatment groups, the subjects were welcomed to continue treatment, seek other treatment, or discontinue treatment as they saw fit. This hardly qualifies as a demonstration of treatment effects that “faded” over time.

What it does demonstrate, to me anyways, is someone who will cherry-pick the vast ADHD research literature to find something that supports his point of view, and then suggest this one study characterizes the vast majority of ADHD research. There are a dozen longitudinal studies measuring how ADHD progresses into early adulthood, and many other studies — some that are far more methodologically rigorous — that demonstrate just the opposite of Dr. Sroufe’s claims.

Alan Sroufe than carries into a tangential rant about brain imaging studies, suggesting they demonstrate little about causative factors. So if the brain isn’t to blame for ADHD behaviors, what is? Dr. Sroufe points to the child’s family environment:

It is certainly true that large numbers of children have problems with attention, self-regulation and behavior. But are these problems because of some aspect present at birth? Or are they caused by experiences in early childhood? [...]

Putting children on drugs does nothing to change the conditions that derail their development in the first place. Yet those conditions are receiving scant attention.

The answer is, of course, that everything and anything could be to blame. We simply don’t know what the cause of most mental disorders are — including ADHD. Many ADHD researchers believe, for instance, that genetics contributes approximately three-quarters of the causative factors to attention deficit disorder, yet we have yet to identify how this expresses itself in any combination of specific genes. Perhaps genes are a necessary but not sufficient component — that something has to happen to trigger ADHD from one’s environment or development.

But rather than detail all the problems with Dr. Sroufe’s claims, I’ll point you instead to Dr. Harold Koplewicz’s rebuttal, that describes why the slam on ADHD medications is misleading at best.

In my reading of the research, it suggests to me that few children should be on ADHD medications alone. Adding a psychotherapy treatment to medications helps a child learn to augment and supplement the work of the medications, to prepare them for a time when medications can be reduced or discontinued altogether. And I firmly believe psychosocial interventions should be tried first, before ADHD medications, in most cases.

Finally, I wanted to point to an interesting blog post over at the Boston Globe from blogger Claudia M. Gold, M.D. that argues that prescribing medications to children with ADHD threatens to remove the motivation to work on its related problems:

The point of this story is that there are serious long-term consequences to prescribing stimulant medication to large numbers of children. In addition to the above dilemma, by controlling symptoms with medication, the motivation to provide more comprehensive treatment is lost. [...]

Careful examination of the school setting and accommodations to decrease over-stimulation are similarly necessary. But if the drug makes the symptom go away, there is no motivation to devote effort and resources to make these kinds of changes.

I agree with her — right up to the point when she mentions a scare-mongering tidbit linking suicidal ideation and Focalin, a stimulant medication used for ADHD. Because the FDA has received 8 reports — only 4 of which they link to the medication — in the past 6 years. Odds ratios suggest these are not significant numbers compared to prescriptions, and probably do little to help inform the larger debate about how much we should be medicating children for ADHD.

Has Ritalin Really Gone Wrong?

So I end up wanting to provide some sort of answer to Alan Sroufe’s original question — why do we rely so heavily on drugs to treat mental health and behavioral health problems, especially in children? Has Ritalin “gone wrong?”

The short answer is that people have increasingly come to expect that there’s a quick fix for any problem, and that quick fix is often in the form of a pill and medical science. It is far easier for most parents to ensure their child is taking a daily medication than it is to take them to once or twice weekly psychotherapy sessions, sessions where they may also have to participate and help the child with learning new cognitive skills to help with their inattention and related problems.

This is the same reason antidepressants are far more popular among adults than psychotherapy. Psychotherapy requires not only that weekly time commitment, but also the commitment to change and willingness to try something different in your life. It requires actual work, effort and focus, week after week — something a lot of people just won’t commit to.

We can lament the popularity of psychiatric medications all we want, but ease-of-use and lower costs are two powerful factors that make the decision easy for many, many people.

Cited Articles:

Read the original New York Times op ed: Ritalin Gone Wrong

Read Harold S. Koplewicz, MD, President of the Child Mind Institute’s response: Righting the Record on Ritalin

Meds for ADHD: They Work, But Is That the Right Question?

But unlike most Sundays, when you drive this Sunday coming home from your Super Bowl Party, be especially careful. Why?

Because unlike other Sundays when a football game is televised, researchers found that both non-fatal and fatal car accidents increase 41 percent on average. The risk is highest within an hour of the game’s end, when most people are driving home.

What causes this rise in automobile accidents? Not surprising, alcohol was involved in most fatal injury accidents, as well as a majority of non-fatal accidents. Inattention and fatigue are two additional factors implicated.

Researchers (Redelmeier & Stewart, 2003) examined 27 consecutive Super Bowl games from 1975 to 2001, and then looked at motor vehicle crash data for those same years. They examined accident rates before, during, and after the Super Bowl game, as well as a sample of control Sundays earlier in the year to see if the effect also carried over to normal football games.

Their findings?

We observed a 41 percent relative increase in the average number of fatalities after the telecast. In contrast, we observed no significant difference between Super Bowl Sundays and control Sundays in fatalities before the telecast. [...]

The increase in fatalities after the telecast was evident for 21 of 27 years and amounted to about seven added deaths on the average Super Bowl Sunday as compared with the average control Sunday.

Fatal injuries were largest in states who had a losing team, versus those who had a winning team or had no team in the Super Bowl.

And the results are larger than those for other popular holidays where large amounts of alcohol may be consumed:

The 41 percent relative increase in fatalities after the Super Bowl telecast exceeds the relative increase in fatalities on New Year’s Eve that has prevailed for the past two decades in the United States.

The upshot?

Be careful and especially attentive driving home this Super Bowl Sunday if you’re attending a Super Bowl party, or just watching the game with some friends or family members. Especially if you’re in the losing team’s state. Designate a driver beforehand, and drive defensively.

And of course, enjoy the game. Go Pats!

Reference:

Redelmeier, D.A. & Stewart, C.L. (2003). Driving Fatalities on Super Bowl Sunday. New England Journal of Medicine.

For instance, in its post on its website titled, “STUDY: Manic Symptoms Linked to Specific Criminal Acts,” the unattributed and undated article suggests that a new study was released that demonstrated a causal link between manic symptoms, and well, specific criminal acts.

But when I read the study, and compared it with what was in the article on the TAC website, I saw a complete misunderstanding (or misrepresentation, whether intentional or not) of the new study.

It now makes me question the validity of any information published by the Treatment Advocacy Center on their website, because it appears their bias — to drive home the mistaken idea that mental illness = increased risk of violence — affects their ability to even deliver research news objectively.

It’s pretty clear whoever authored this post is not a researcher and probably shouldn’t be trying to interpret and disseminate research results. The post begins with the mistaken suggestion that the new study (Christopher et al, 2012) found:

Individuals with bipolar disorder are “more than twice as likely as the general population to commit violent crimes and nearly five times as likely to be arrested, jailed or convicted of an offense other than drunk driving,” authors of a new study on the association between manic symptoms and criminal acts report.

While indeed the current authors write that, that’s actually just background information in the study — it does not refer to any new data.

But rather than just take what a researcher says at face value, we do something here other websites don’t provide — a critical analysis. Let’s look at those two statements first, since they set the stage (both for TAC’s and the current researchers’ article).

The current authors (Christopher et al, 2012) write in the introduction to their study:

Persons with bipolar disorder, in particular, are more than twice as likely as the general population to commit violent crimes…

The reference for this statement comes from a single study (Fazel et al., 2010), that examined “violent crime” (which also included crimes such as simply threatening another person), and bipolar disorder in Sweden. (Whether Sweden is like the rest of the world’s population of people with bipolar disorder or who commit violent crimes is an exercise I leave to the reader). Here’s what they actually found:

During follow-up, 314 individuals with bipolar disorder (8.4%) committed violent crime compared with 1312 general population controls (3.5%). The risk was mostly confined to patients with substance abuse comorbidity. [Emphasis added]

That means that the vast majority of the increased doubling of the risk is not from bipolar disorder alone, but rather from someone who has a drug abuse or alcohol problem, who also happens to have bipolar disorder. That’s a big difference, and one conveniently overlooked by the current study’s authors (and duly reported by TAC).

And the second part of the statement:

… and nearly five times as likely to be arrested, jailed, or convicted of an offense other than drunk driving.

This comes from Calabrese and colleagues’ (2003) study of 1,167 subjects from an epidemiologic study of bipolar prevalence using the Mood Disorder Questionnaire (MDQ) to assess for bipolar symptoms. This is an important distinction to note — these were not individuals actually diagnosed with bipolar disorder, but rather were simply assessed with a self-report screening measure they filled out on their own. Whether a person was arrested, jailed or convicted for offenses (of any nature or severity, except for DUIs) was also based upon self-report, not actual jail or court records.

The researchers reported that “MDQ-positive women reported more disruption in social and family life, while MDQ-positive men reported being jailed, arrested, and convicted for crimes.”

But here’s the catch — the researchers never specifically asked about substance or alcohol abuse. Since we know that such abuse is the primary determinant of violent crime and criminal behavior when combined with certain kinds of mental illness, that oversight is significant. It is a confound that means we cannot draw any meaningful conclusions from their findings regarding criminality and bipolar disorder. (Furthermore, it’s unclear why the researchers arbitrarily removed driving while under the influence of alcohol from their results, given its serious nature. They provided no rationale for doing so.)

So both statements that the researchers simply repeated in the current study (without any qualifications) are less than accurate, when you delve into their research support.

But let’s get on with the actual study, shall we?

Prevalence of Involvement in the Criminal Justice System During Severe Mania and Associated Symptomatology

The current study used the NESARC, “the largest U.S. epidemiologic survey to assess psychiatric disorders according to the DSM-IV criteria.” The study used a structured diagnostic interview to generate DSM-IV diagnoses for major axis I and axis II (personality) disorders, a reliable method used by researchers to diagnose disorders in large groups of people.

Here’s what they found:

Among NESARC wave 1 respondents (N=43,093), a total of 42,079 (97.7%) had valid responses to the questions in the mania section and, of these, 1,044 (2.5%) met specified criteria for having experienced at least one episode of mania.

Of these, 135 persons (13.0%) had legal involvement during the episode that they identified as the most severe in their lifetime.

What is “legal involvement”? Is that the same thing as committing a crime or going to jail? Is it the same thing as committing “specific criminal acts,” or a violent crime?

Well, no. It’s one of those fuzzy terms that researchers use when they want to make something seem like a bigger problem that it is. Here’s how they defined it:

Legal involvement was defined as being arrested, held at the police station, or put in jail, during the manic episode that the respondent identified as the most severe in his or her lifetime.

So in America, where you are innocent until proven guilty, researchers who are pursuing their own agenda define things a little differently. These aren’t people who actually were found guilty of committing a crime — they were simply people who may have had a run-in with the police.

The data the researchers do not provide are data that would put that 13 percent into some sort of context. How many people who did not have a manic episode also had “legal involvement?”

Sadly, the researchers do not report that number. An inquiry asking the researchers about this missing data was not returned.

While it’s interesting to see that 13 percent of people who report manic symptoms had some sort of legal involvement — serious or not — it’s a number that exists in a vacuum. It also demonstrates once again that the vast majority of individuals with bipolar disorder and mania had no legal problems.

Other demographic statistics, while not significant, also point in the direction of existing data. For instance, if you’re Black, you’re 35 percent more likely in this study to have reported legal involvement in the study. (Being African-American puts you at greater risk in general for incarceration in America.) If you have less than a high school education, you’re at 45 percent greater risk of having legal involvement.

But when all was said and done, and demographics were taken into account, this is what the researchers ultimately found that had the strongest statistical power (e.g., the most robust results):

When adjusted for demographic and clinical variables not in potential temporal conflict with the most severe lifetime manic episode, being male and having a first manic episode at age 23 or younger were associated with a higher risk of legal involvement.

Surprise! Being a young man — who have an incarceration rate 9 to 11 times that of women — is the strongest predictor of legal involvement. Also have social indiscretions and having both social and occupational impairment are strong risk factors for legal involvement, according the researchers’ data. Again, neither of which are surprising.

And being manic? Well, given the definition of mania (which is different than actually being diagnosed with bipolar disorder, an important distinction blurred by the researchers), it’s little surprise people with more energy, inflated self-esteem, flight of ideas and distractibility might find themselves at occasional odds with societal norms and laws. It’s like noting that you’re more likely to be pulled over for a DUI after you’ve drank too much and then try and drive.

I can’t really answer why TAC misrepresents the psychological research, and doesn’t bother to delve into it more deeply to examine the conclusions drawn by researchers. While I suspect it may be related to their own advocacy agenda, it could also just be due to sloppy reporting on their part.

What the study clearly shows is that manic symptoms are not linked to any specific criminal acts.

Read the blog post yourself: STUDY: Manic Symptoms Linked to Specific Criminal Acts

References:

Calabrese, Joseph R.; Hirschfeld, Robert M. A.; Reed, Michael; Davies, Marilyn A.; Frye, Mark A.; Keck, Paul E., Jr.; Lewis, Lydia; McElroy, Susan L.; McNulty, James P.; Wagner, Karen D. (2003). Impact of bipolar disorder on a U.S community sample. Journal of Clinical Psychiatry, 64, 425-432.

Christopher, P.P, McCabe, P.J., Fisher, W.H. (2012). Prevalence of Involvement in the Criminal Justice System During Severe Mania and Associated Symptomatology. Psychiatric Services, doi: 10.1176/appi.ps.201100174

Fazel, Seena; Lichtenstein, Paul; Grann, Martin; Goodwin, Guy M.; Långström, Niklas; (2010). Bipolar disorder and violent crime: New evidence from population-based longitudinal studies and systematic review. Archives of General Psychiatry, 67, 931-938.

Sheldon, CT, Aubry, TD, Arboleda-Florez, J., Wasylenki, D., & Goering, PN. (2006). Social disadvantage, mental illness and predictors of legal involvement. International Journal of Law and Psychiatry, 29, 249-256.

But what do you do when you face cheating in your relationship?

I’m pleased to introduce the first of a series of interviews and conversations with two of our resident therapists about a wealth of mental health topics. In this installment, Marie Hartwell-Walker, Ed.D. and Daniel J. Tomasulo, Ph.D., TEP, MFA answer the question about cheating and explore the various aspects of cheating — including how different people define cheating differently — in this latest video from Psych Central.

It may help to read this article about cheating from Dr. Marie as well.

Can your relationship survive cheating? What about the forbidden fruit in relationships? When does flirting turn into cheating?

Dr. Marie and Dr. Dan will be hosting many future videos on relationship and mental health topics in the weeks to come. We will post them here as we publish them, or you can check them out on our new YouTube channel. Want to learn more about Dr. Marie and Dr. Dan?

What do you think about their advice? Please leave your thoughts in our comments section.

Many years ago, when ADHD was first proposed as a diagnosis, you would’ve been right — few people would’ve bothered faking the diagnosis because it brought you little reward to do so.

But as ADHD diagnoses bloomed over the past two decades, so did special accommodations in the school systems for children and teenagers diagnosed with the disorder. And one of the primary treatments for attention deficit disorder is stimulant medication, something that can be used for less-than-legitimate reasons.

Could teens today really be faking ADHD to get into college?

Welcome to the world of unintended secondary gains and rewards.

Secondary gains are when you get something unintended or secondary to the primary objective. For instance, let’s say you need to get good grades in school in order to get to the next grade or keep your GPA up. But when you bring home a report card with mostly As on it, your parents are so excited they treat you to a special dinner out or a gift certificate. You didn’t get good grades just to get the dinner or gift certificate — those are secondary to the real reason.

Psychologists have long understood the power of secondary gains as rewarding to people, sometimes in very unintended ways. So when some well-meaning people give those disabled by a mental illness such as ADHD special treatment (such as unlimited time to take a test or the SATs), others see the benefits and take advantage of the situation.

Heidi Mitchell has the story over at The Daily Beast about an anonymous student named “Steven” who decided to fake ADHD in order to get into a college in upstate New York (not Harvard, as the article’s headline mistakenly claims).

Steven decided to dupe his doctor when he returned from his elite boarding school exhausted by the intense competition there. He needed an edge to help him, he felt. So through written evaluations from teachers and his parents, and by deliberately failing tests, he succeeded in getting himself diagnosed with attention-deficit/hyperactivity disorder (ADHD), and was given both his in-school tests and his SATs untimed. Eventually Steven, which is not his real name, was accepted to a top college in upstate New York, although he no longer takes medication, nor does he consider himself ADHD. The ADHD diagnosis, and the benefits that came with it, he acknowledges, helped him beat the competition. [...]

Faking the test that diagnoses ADHD is easy, shows a recent study by Prof. David Berry at the University of Kentucky. His group of fakers was assessed on the ADHA Rating Scale (ARS) developed by Barkley and Murphy and on the Conners Adult ADHD Rating Scale. The test givers could not distinguish between the fakers, who had spent five minutes on Google learning what signs to display in order to trick assessors, and the real ADHD group.

Nobody knows the exact numbers of students who are doing this, but it appears to be enough of a problem that researchers are finally trying to better detect malingering, the technical term for faking.

I’d argue that rating and screening scales for ADHD, like those for most mental disorders, aren’t there to make a definitive diagnosis — that’s the mental health professional’s job. They are there to act as a rough screening measure to give a person or a professional an idea of the likelihood of ADHD.

The problem is that most symptom criteria for nearly all mental disorders are subjective behavioral symptoms arrived at, most usually, be self-report by the patient. It’s really hard to tell a person is lying when they say all the right things that a person with actual ADHD might say.

Luckily, researchers are on it. A study published in The Clinical Neuropsychologist in December 2011 by Lindsey Jasinski and colleagues suggests that the administration of a battery of neuropsychological tests can pick up on ADHD malingering:

Similar to Sollman et al. (2010) and other recent research on feigned ADHD, several symptom validity tests, including the Test of Memory Malingering (TOMM), Letter Memory Test (LMT), Digit Memory Test (DMT), Nonverbal Medical Symptom Validity Test (NV-MSVT), and the b Test were reasonably successful at discriminating feigned and genuine ADHD.

I’d also suggest that if someone wants special academic accommodations for their mental illness, it’s required they see a specialist in that area who is most qualified to render an accurate and objective diagnosis. A neuropsychologist, for instance, is the most qualified professional to render an accurate ADHD diagnosis, since they are the only professionals trained and qualified to administer neuropsychological testing.

Unfortunately, such consultations don’t come cheaply. But it’s one solution to this potentially burgeoning problem.

Read the full article: Faking ADHD Gets You Into Harvard

They just got dinged with a $158 million settlement in a Medicaid fraud case in Texas for “making false or misleading statements about the safety, cost and effectiveness of the expensive anti-psychotic medication Risperdal, and improperly influencing officials and doctors to push the drug.”

But we won’t feel too badly, because Janssen got off easy with this one. They don’t have to admit to any liability with the settlement, and Johnson & Johnson — who made billions off of the sale of Risperdal — will barely blink their corporate eyeballs as they make out the check.

This is the third state settlement for Johnson & Johnson in connection to their promotion and marketing of Risperdal, an atypical antipsychotic medication that was touted to be a drug better than sliced bread — and with far less side effects. (Too bad corporations don’t eat, my friend.) They’ve been ordered to pay $327 million in South Carolina, and $258 million in Louisiana in similar state lawsuits.

That brings the grand total to $743 million the company will pay for allegedly fraudulently marketing the drug Risperdal. That’s a pretty crazy number for a company claims that it’s done nothing wrong.

The really sad part of it for me is that our fellow person, Janssen, is either is in denial about what it’s done wrong with regards to marketing of Risperdal, or simply lying:

At the start of the trial, lawyers for New Brunswick, N.J.-based Johnson & Johnson had insisted the company did nothing improper in marketing the drug.

“Janssen is committed to ethical business practices and had policies in place to ensure its products are only promoted for their FDA-approved indications,” the company said in its settlement statement

Maybe we should sign-up Mr. Janssen for some Freudian psychoanalysis.

Nothing improper? Then why have two states already found you guilty of doing activities you consider “proper,” and why are you so willing to pay out three-quarters of a billion dollars so far?? Innocent parties rarely would be willing to pay out such enormous sums of money unless they knew there was something more to all of this.

You should also check out the interview Pharmalot has just published with Allen Jones, the whistleblower on the Risperdal cases (without his standing up for what’s right and ethical, the states probably would’ve never had a case to make). It’s sad to see the end result is a much more cynical man:

Pharmalot: What have you learned from all this?

Jones: I live in a world that seems very different to me than the one I stumbled into since this began. There were so many layers of disillusionment after seeing what I thought were supposed to be good intentions of the pharmaceutical industry and government. I see greed and cynicism and bureaucrats protecting their fat bellies and fat pensions. But I’ve acquired more skills to live in a cynical world in which I see I live in. I lost of a heck of a lot of innocence along the way.

But maybe that’s the inevitable result of pharmaceutical companies who put profit ahead of all else — even ethical marketing of their products.

Hence my continued skepticism about any new psychiatric medication to hit the market. Over the past decade, we’ve seen virtually all the psychiatric pharmaceutical companies be indicted or pay settlements or fines for their unethical behavior when it comes to marketing and selling such medications.

We can only hope these kinds of settlements make them think twice for behaving badly in the future. But when it comes to shareholder profits versus a possible future fine and a slap on the wrist, my gut tells me to trust companies will continue to pursue shareholder profits at all expenses… Even when what it appears they are doing is illegal and unethical, and appears to cause very real health complications to millions of people.

Read the full interview with Allen Jones at Pharmalot: Risperdal Whistleblower: J&J Credo Is ‘Empty Words’

Read the news story on the settlement: Johnson & Johnson settles Texas lawsuit for $158M

The latest upset? The fact that the new DSM-5 suggests that depression could co-occur with grief. Critics see the changes as suggesting the DSM is trying to “medicalize” normal grieving. Anyone who experiences grief after a tragic or significant loss will now be at risk for receiving — heaven forbid — mental health treatment and a diagnosis.

We’ve covered this ground here on more than one occasion, but it appears time to talk about whether depression can occur at the same time as grief or not. My first reaction was — grief is grief, depression is depression, and the two never really co-occur. But a few years ago, I read a piece here on World of Psychology by Dr. Ron Pies which completely changed my perspective.

Benedict Carey over at the New York Times is covering the story this week, pointing out the debate that’s heated over onto the web, into an online petition, and more.

In blogs, letters, and editorials, experts and advocates have been busy dissecting the implications of this and scores of other proposed revisions, now available online, including new diagnoses that include “binge eating disorder,” “premenstrual dysphoric disorder” and “attenuated psychosis syndrome.” The clashes typically revolve around subtle distinctions that are often not readily apparent to those unfamiliar with the revision process.

If a person does not meet precise criteria, then the diagnosis does not apply and treatment is not covered, so the stakes are high.

Well, not really.

In the real world of clinicians, they use the DSM more as a rough guide to diagnosis, not an absolute, black-and-white scientific manual (researchers do more of that). Clinicians know the real world is a messy, complex place, and so a person who presents with all the signs of a disorder, but who may not meet the specific number of symptoms for its diagnosis, are unlikely to withhold the diagnosis (and therefore, treatment) from them.

In the real world, clinicians already apply the DSM criteria in any way they see fit, by and large. And, I’d argue, there is a large swath of professionals — family physicians and primary care doctors — who may not even be familiar enough with the specific criteria for every disorder in order to diagnose them reliably right now.

But should we try and short-circuit our normal healing process by introducing anti-depressants or other treatments? How would such mood-elevating medications help us better understand and put into perspective another human being’s life?

Dr. Ron Pies had a few words to say on this topic more than 2 years ago, pointing out that sometimes grief can indeed turn into depression:

I recently had an essay published in the New York Times (9/16/08), in which I argued that the line between profound grief and clinical depression is sometimes very faint. I also argued against a popular thesis that says, in effect, “If we can identify a very recent loss that explains the person’s depressive symptoms — even if they are very severe — it’s not really depression. It’s just normal sadness.” [...]

There are, of course, no “bright lines” that demarcate normal grief; complicated or “corrosive” grief; and major depression. And, as I argued in my New York Times piece, a recent loss does not “immunize” the grieving person against developing a major depression. Sometimes, it may be in the patient’s best interest if the physician initially “over-calls” the problem, hypothesizing that someone like Jim or Pete is entering the early stages of a major depression, rather than experiencing “productive grief.” This at least allows the person to receive professional help. The clinician can always revise the diagnosis and “pull back” on treatment, if the patient begins to recover rapidly. [...]

But in cases where major depressive symptoms are present — even if they appear to be “explained” by a recent loss — some form of professional treatment is usually necessary.

You can read his full entry about the potential of grief turning into depression here. His point is well-taken — sometimes grief can indeed turn into depression.

More recently, Dr. Pies helped to clarify how this might fit into the DSM-5 specifically:

Since they are distinct conditions, grief and major depression can occur together, and there is clinical evidence that concurrent depression may delay or impair the resolution of grief. Contrary to widespread claims in the media, the DSM-5 framers do not want to limit “normal grief” to a two-week period — which would be foolish, indeed. [...]

What are the implications of all this for the DSM-5? I believe that symptom check lists alone provide only a narrow window into the patient’s inner world. The DSM-5 should provide clinicians with a richer picture of how grief and bereavement differ from major depression — not just from the observer’s perspective, but from that of the grieving or depressed person. Otherwise, clinicians will continue to have difficulty distinguishing depression from what Thomas a Kempis called, “the proper sorrows of the soul.”

I’d encourage checking out his entire essay, The Two Worlds of Grief and Depression. (And, for the record, you should also read Dr. Pies’ latest entry on the DSM-5, Why Psychiatry Needs to Scrap the DSM System: An Immodest Proposal).

As for me, I remain somewhere in the middle.

I still remain largely unconvinced depression should be regularly or routinely diagnosed during the grief process. And I’m not sure anyone is arguing for that. But the current DSM doesn’t even make that an option, since it only offers an un-reimbursable “V-code” diagnosis for bereavement. If you have grief and depression co-occurring, today the DSM acts as though you don’t exist.

Critics of the proposed DSM-5 changes would like that situation to continue, apparently, putting their heads in the sand about the messy realities of the world — that depression can and indeed does co-occur with grief. Therefore I believe that ultimately the proposed changes to the DSM-5 in this matter are reflective of the reality of patients’ worlds.

Read the full article: Depression’s Criteria May Be Changed to Include Grieving

Read my previous entry on the DSM-5: Some of the Empty Arguments Against the DSM-5

Drug and alcohol addiction remain a serious problem in this country, as well as many others. Surprisingly, nearly 75 percent of all adult illicit drug users are employed, as are most binge and heavy alcohol users, according to the National Institute on Drug Abuse. In the United States, it’s estimated that companies and organizations lose up to $100 billion a year due to employee alcohol and drug abuse, according to the The National Clearinghouse for Alcohol and Drug Information. The destruction to a person’s private life, relationships, friends and family is often immeasurable.

Substance abuse and alcohol abuse treatments are effective and do work. Not only does it help the abuser, it also begins the recovery process to help them repair their relationships with others.

So learning more about how addictions work and what methods are used in their treatment seems like a good idea. That’s why I’m happy to welcome our newest blog, Addiction Recovery by Dr. David Sack, a board-certified addiction psychiatrist and CEO of Elements Behavioral Health. He’ll be blogging here on the topic of addiction and addiction recovery. You can learn more about him here.

Please give a warm Psych Central welcome to Dr. Sack over at Addiction Recovery now!

So even though schizophrenia can often be treated fairly effectively with medications and psychotherapy, it often is not because medication compliance becomes a significant ongoing issue.

This results in many people with schizophrenia going in and out of inpatient care. Because inpatient psychiatric care is virtually non-existent in most states any longer, this means a primary treatment point for people with chronic, serious mental illness defaults to the local hospital emergency room (ER).

While most ERs are setup to handle people with a serious mental illness fairly well, ERs aren’t exactly known for their warm-fuzzy, emotionally-supportive environments. So people slip through the cracks.

In this case, the woman with schizophrenia who slipped through one hospital ER’s cracks was Cindy Ciarafoni, a mother of two, who died when she apparently wandered out of the ER and tried crossing a busy highway. She was struck by a car and later died from her injuries. Now her family wants to know what happened, but the hospital is being tight-lipped.

Cindy’s story is that she had a history in the past three years of deteriorating behavior. In the past 6 months alone, she had been hospitalized about once a month, according to her family.

On New Year’s Day, she was acting strangely in a local Toronto coffee house. Police were called, who then called paramedics to take her to the hospital when it was apparent Cindy was suffering from a mental illness and needed treatment.

She was dropped off at the hospital just before 5:00 pm, and signed in by the triage nurse to the emergency room at Humber River Regional Hospital’s Church St. campus.

Her family was notified by the police of her hospital admission, but since it had become a commonplace occurrence, her family was not concerned for her safety or well-being. They knew she’d be kept under observation for at least 72 hours.

A day later, they got another phone call from the police. This was not as good a call, because Cindy had been hit by a car 10 kilometers north of the hospital.

Here’s the kicker. The hospital has refused to answer questions about the incident, citing “patient confidentiality.” But when the family has tried to get answers, all they’ve gotten is a stone wall:

Danny said he never received a call to tell him his wife had left the emergency department without being assessed or admitted. The family said the hospital has been uncooperative about telling them what happened that night.

“They’re not even calling us back, so it’s frustrating,” Ciarafoni-McGrath said.

Why is the Humber River Regional Hospital stonewalling? What have they got to hide, except for the fact that a patient was dropped off in their ER, and they didn’t notice when she left on her own long before being seen by a doctor.

But the hospital emergency record obtained by the family shows that when a physician attempted to begin a preliminary assessment six hours later, at 11:36 p.m., there was no answer — indicated by a slashed zero and the word “answer.”

This is the problem when hospital ERs become dumping grounds for people with serious mental illness who need special attention and care. Some hospitals are just ill-equipped and their staff aren’t properly trained to help such people.

This tragedy could’ve been prevented had the hospital had a procedure in place to ensure that people with special mental health needs are properly taken care of once signed in. Not left in the waiting room like someone with a broken arm. Staff training is also a must, because they need to be alerted about the needs of people with a mental health issue.

Hopefully answers will be forthcoming. In the meantime, hospitals should take this opportunity to review their own ER procedures to ensure they take into account the needs of people who have a mental health concern.

Read the full story: Family seeks answers after woman with schizophrenia dies on road

Photo: Renee Ciarafoni-McGrath with her mother, Cindy, at Renee’s wedding supplied by the family.

But unlike a lot of people with psychiatric disorders, Mary Moe apparently didn’t have the same freedoms you and I take for granted. Such as the freedom to decide what to do with our own bodies.

Or whether to give birth if we’re pregnant.

In Mary Moe’s case, the state Department of Mental Health intervened on behalf of Mary’s parents. They filed a petition to have the woman’s parents named as guardians. Why?

So the parents could give their consent for an abortion.

Then it got even more scarier when the case ended up in a local Massachusetts courtroom and the judge sided with the parents. And went one step further…

Mary Moe (a pseudonym) has been pregnant twice before. In the first pregnancy, she had an abortion. In the second she gave birth to the boy. The boy is now in her parent’s custody.

According to the report in The Boston Globe, at some point “between her abortion and the birth of her son, she had a “psychotic break’’ and has since been hospitalized numerous times for mental illness, court records say.”

Once you get into the public mental health system in this way, things can go downhill quick when it’s not just your life in the balance.

Norfolk judge Christina Harms, now retired, had to decide this gut-wrenching case. I would assume she might take into account Mary Moe’s wishes about wanting to keep the baby:

[Mary Moe] described herself to court officials as “very Catholic,’’ and said she would never have an abortion. When asked about an abortion at a December hearing, she replied that she “wouldn’t do that.’’

So what did Judge Harms rule?

[...] Harms ruled that the woman was not competent to make a decision about an abortion, citing “substantial delusional beliefs,’’ and concluded she would choose to abort her pregnancy if she were competent.

The woman would “not choose to be delusional’’ if competent, Harms ruled, and would choose to have an abortion “in order to benefit from medication that otherwise could not be administered due to its effect on the fetus.’’

Seems like a stretch, but… wait a minute… Did the judge just ignore the person’s own wishes about keeping their baby? What do delusional beliefs have to do with wanting or not wanting a baby??

But here’s where it gets a little crazy…

Unbidden, the judge further directed that the 32-year-old woman be sterilized “to avoid this painful situation from recurring in the future.’’

Huh?? So not only does the judge suggest the person get an abortion — something Mary Moe doesn’t want but something her parents do — but then she further suggests that she get sterilized.

She ordered that the woman’s parents be appointed coguardians to give their consent to the abortion and sterilization. The parents, who have custody of the woman’s son, believe that terminating the pregnancy is in their daughters’ best interests, according to court records.

The case was thankfully kicked up to a higher court upon appeal, were perhaps more reasoned minds prevailed.

But the appeals court concluded that Harms improperly decided the matter of the woman’s competence, and noted that a court-appointed specialist had determined that the woman would “decide against an abortion if she were competent.’’ Without conducting a hearing, Harms found the specialist’s report inconclusive.

And that sterilization order? Thankfully gone.

In sharp words, yesterday’s decision also denounced the sterilization order, a directive that several legal specialists said they had not heard of in recent memory.

“No party requested this measure, none of the attendant procedural requirements has been met, and the judge appears to have simply produced the requirement out of thin air,’’ wrote Appeals Court Judge Andrew Grainger.

Here’s the real kicker though… This is just the one story we know about because the records — which are usually sealed — were unsealed on appeal. In most state cases where this sort of thing is decided, you’ll never hear about it.

It goes on every day in the U.S., hundreds of times a year.

The reason for a judge to be involved in the process in the first place is to ensure the rights of the patient are being protected. In this case, sadly, it doesn’t appear the judge took them into account as much as she should have.

These cases are rarely black and white, but in this case at least, it appears the judge overstepped her boundaries and made significant, life-impacting decisions with little regard for the freedom and rights of the individual. Let’s hope by showing the spotlight on this case, it helps to — if not prevent future abuses — at least make others think twice.

Read the full article: Court strikes decision for mentally ill woman’s abortion