Christian counseling: Nouthetic vs. Biblical

Last night, I spent some time on the phone with my husband’s friend’s sister (aka my former pastor’s sister). We’ll call her Natalie.

Natalie was very sweet and kind, really encouraging and strengthening me by sharing her testimony of faith in God. She suffers from anxiety and panic attacks, which has led her to take Paxil (on and off) for the past 7 years. She says the drug has helped her tremendously and who am I to knock the drug (knowing what I know about Paxil/Seroxat) when she has seen the wonders that it has worked in her life?

I briefly explained my story of depression, history of suicide, and diagnosis of bipolar disorder. Although she couldn’t fully relate, she was very sympathetic and understanding. In fact, our conversation was so fruitful, I ended up taking notes!

Jay AdamsWe briefly touched on the issue of Nouthetic counseling (NC). She has undergone the course and simply needs to be certified. The counselor I currently see is associated with the Christian Counseling Education Foundation (CCEF), which has roots in NC and was founded by the man—Jay Adams—who developed the method. However, CCEF is now known for what is called biblical counseling. The organization has since moved away from pure Nouthetic methods and become more a bit more varied, taking bits and pieces of psychology (and perhaps psychiatry) that line up with the Bible. Adams, disagreeing with the organization’s approach, founded the Institute for Nouthetic Studies and uses the Bible as the sole counseling textbook. According to the wiki entry on Nouthetic counseling, Adams developed the word Nouthetic based on the “New Testament Greek word noutheteō (νουθετέω), which can be variously translated as ‘admonish,’ ‘warn,’ ‘correct,’ ‘exhort,’ or ‘instruct.'”

NC was developed back in the ’70s as a response to the popularity of psychology/psychiatry. Many Christians reject some of the teachings of such popular psychologists as Freud, Jung, Adler, Maslow, etc. Adams’ highly successful book, Competent to Counsel, criticizes the psychology industry and counters its teaching with a Nouthetic approach.

But NC has its Christian critics.

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"Being bipolar"

Here’s a comment that stuck out to me recently that I wanted to highlight:

I think a lot of us feel like our disorder defines us and who we are. Often times, I feel this way. When I meet new people (which is a difficult thing in itself), I can always tell a difference in how they treat me once they learn that I’m bipolar. It only serves to solidify the notion that being bipolar defines me.

When I began this blog, my subtitle for my blog, depression introspection, was “a born-again Christian female ponders whether she is her diagnosis or whether her diagnosis is part of her.” I wrote back in February 2007 about how people are not their diagnoses. I no longer subscribe to the idea that I am bipolar but that I, rather, suffer from bipolar disorder. I beg to differ that we are not our diagnoses and I will do everything I can to remind myself that Marissa does not equal bipolar disorder. I am so much more than my diagnosis. As I said on my “Who I Am” page in the More About Me section:

This blog has helped me to recognize many of the things that I am.
That
I truly am more than my diagnosis and that my diagnosis does not define
me. I am not just a person with manic and depressive episodes. I am a
person with a personality….
This is my journey to learn more about myself, my diagnosis, my medical
treatment, and anything relating to my personal life and general mental
health.

Not only that, but as a Bible-believing Christian, I’m learning that my identity needs to be grounded more in God and what He thinks of me rather than what I think of myself.

2-Year Anniversary: The Long and Winding Road

I’m aware that my blog has taken a significantly dark turn.  This may alienate some of my readers who seek happier, brighter topics. I don’t think my posts have been negative; on the contrary, I think they’ve been positive. Positive and educational.

I’ve been exploring the topic of suicide recently because it’s a subject that’s quite near and dear to me, now more than ever before.

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The Act and Follow-through of Suicide: Part IV

Compilation of Statistics Regarding Suicide

Scott Anderson in his NYT article weaves the grim statistics of suicide in and out of his story. Here’s the morbid list:

General

  • mental illnessThe nation’s suicide rate (11 victims per 100,000 inhabitants) is almost precisely what it was in 1965.
  • In 2005, approximately 32,000 Americans committed suicide, or nearly twice the number of those killed by homicide.
  • The National Institute of Mental Health says that 90 percent of all suicide “completers” display some form of diagnosable mental disorder.

Demographics

  • Both elderly men living in Western states and white male adolescents from divorced families are at elevated risk.

Premeditation vs. Passion

  • [T]he person who best fits the classic definition of “being suicidal” might actually be safer than one acting in the heat of the moment — at least 40 times safer in the case of someone opting for an overdose of pills over shooting himself.
  • In a 2001 University of Houston study of 153 survivors of nearly lethal attempts between the ages of 13 and 34, only 13 percent reported having contemplated their act for eight hours or longer. To the contrary, 70 percent set the interval between deciding to kill themselves and acting at less than an hour, including an astonishing 24 percent who pegged the interval at less than five minutes.
  • “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total. By the early 1970s, the amount of carbon monoxide
    running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

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Diagnosing myself

Thoughts on Bipolar Overawareness Week: Part III

In all seriousness, I have wondered about the BPD diagnosis but in my mind, have somewhat fallen short. I don’t think my symptoms are strong enough to be plastered with a BPD label.

To conclude my several-post rambling, I should answer the question that I initially posed. Do I think bipolar disorder is overdiagnosed?

No.

Many of my fellow bloggers will likely disagree with me. Zimmerman’s study at Rhode Island Hospital took into account whether those “diagnosed” with bipolar disorder had a family history of the diagnosis in the family. Maybe I’ve turned to the dark side. Just because I don’t have a family history of bipolar doesn’t mean that I can’t suffer
from the disorder. However, I have a family history of schizophrenia: one father and two aunts. Does this put me at a higher risk for schizophrenia? Definitely. Does this mean I could suffer from bp and have the schizo gene pass me by? You bet. I don’t think that I need a first-degree relative to suffer from bp to make me a classic diagnosis for bp.

For instance, when it comes to my physical appearance, I’m the only one on both sides of the family who suffers from severe eczema to the point where my dermatologist suggested a punch biopsy. Does that mean that I need to have a family history of eczema to obtain the malady? Not necessarily. Why is bipolar disorder any different?

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Thoughts on Bipolar Overawareness Week: Part II

Here are some things that have occurred in my life:

  • racing thoughts
  • spending sprees when I have no money
  • cleaning at odd hours of the night
  • thinking that I’m the most amazing job interviewer ever
  • worrying that people are watching me through video cameras or the wall in public bathroom stalls
  • afraid that a video camera exists in our bedroom (I know it doesn’t. I think?)
  • talking to "friends" who don’t really exist
  • disobeyed parents
  • talked back to authority
  • suicide attempts
  • rage/anger/hostility/irritability
  • temper tantrums
  • violent outbursts
  • socially awkward
  • extreme mood swings (happy to sad or angry in the same day)
  • doing things and barely remembering them
  • memory loss/forgetfulness
  • chronic fatigue
  • indecisiveness
  • no interest in sleep
  • inability to focus on one thing for an extended period of time/lack of concentration
  • anxious about being around people I don’t know/don’t like
  • anxious to go out and spend time with friends and/or family
  • impulsiveness
  • overeating
  • persistent, negative thoughts

All right. So those are some things that have occurred over the course of my life. Let’s see what I diagnoses I can pigeonhole myself into.

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Thoughts on Bipolar Overawareness Week: Part I

I finally sat down and read all those posts that I linked to about Bipolar Overawareness Week. I mentioned in my previous post that I feel like I had a contrarian view. Well, I do. Somewhat. Although it’s probably not as contrarian as I’d think.

Let’s take my experience, for example.

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Tardy Bipolar Overdiagnosis Week Post

Ok, so I’m incredibly late on this bipolar overdiagnosis week thing (one week, of course) but a bunch of blogs that I know of have already blogged about it. In fact, there have been so many posts on it that I haven’t been able to read and keep up on them all. All I know is that a recent study came out saying bipolar disorder is overdiagnosed. In the meantime, read blogs that have commentary on the matter (most of the links from Furious Seasons):

Furious Seasons — Study: Bipolar Disorder Overdiagnosed

Furious Seasons — Making Sense of Bipolar Disorder Overdiagnosis

Furious Seasons — Major Researchers Support Bipolar Overdiagnosis Study

Furious Seasons — Mental Health Month Meet Bipolar Overdiagnosis Awareness Week

PsychCentral — Bipolar Disorder Overdiagnosed

Psychiatric Drug Withdrawal and Recovery — Celebrating Bipolar Overawareness Week

Clinical Psychology & Psychiatry: A Closer Look — Bipolar Overawareness Week Starts on Monday

I’ll give many of these posts a read before I say anything about it. But as of right now, I’m sitting here with a contrarian view, believe it or not.

Home bipolar test? What. In. The. World.

DNA strand

I stumbled upon an AP article on Yahoo! News titled, “Home bipolar disorder test causes stirs.” No kidding.

I read the article trying to figure out how this company, Psynomics, is able to genetically figure out who is more predisposed to what.

To take the test, patients receive by mail a plastic cup that they spit into, seal and send back to Psynomics. The company analyzes DNA in the saliva.

Psynomics will send patients’ test results only to their doctors to avoid the risk of self-diagnosis.

Here’s a sample report located on the Web site (PDF file).

Are you interested? If you’re anyone other than a white person of Northern European ancestry who shows some bipolar symptoms and has at least one other bipolar family member, then you don’t meet the criteria for this testing. Even if you do, save your money and buy something else – the test costs a steep $399 and the results aren’t entirely certain. In fact, researchers and doctors say there is very little data at the moment to support testing DNA for bipolar disorder or other mental illnesses.

[Dr. John] Kelsoe, 52, acknowledges that bipolar disorder probably results from a combination of genetic factors and life experiences, and that the presence of these gene variations does not at all mean that someone will, in fact, develop the disease. He admits, too, that his findings about the genetic basis of the illness are far from complete.

“The goal of this is to try and help doctors make an accurate diagnosis more quickly so the patient can be treated appropriately,” Kelsoe said. “Anything is going to help, even if it just helps a little bit.”

I’m worried that people are going to think that they have bipolar disorder, fork over the money for gene testing, and be told when that they have bipolar disorder when they really don’t. Why manufacture a mental illness for a person that may not exist?

In coming months, at least two other startups led by genetic researchers are set to release their own psychiatric genetic tests. One test claims to predict the risk of developing schizophrenia. The other is designed to forecast the likelihood that some medications for major depression could heighten suicidal thoughts in patients.

As much as I’m not a fan of psychiatrists and there’s always the chance for misdiagnosis, I call this company a scam designed to prey upon people’s insecurities. (Perhaps bipolar people would purchase this in the midst of a spending spree?) Regardless, some people are buying into this product that even the maker admits isn’t entirely accurate.

Psynomics has sold only a few tests so far but is projecting sales of 1,800 tests in 2008 and 30,000 in the next five years.

Considering that it now has major media coverage, it’s likely to take off even more.
(Image sciam.com)

Blogs around the way

I’m catching up on reading my fellow bloggers’ posts (see Blogroll to the right), so if you’re not reading their site already, I’d encourage you to do so. Below  are some posts that caught my attention. Some might be a little dated.

Gianna at Bipolar Blast: Has a video up of Gwen Olsen, an ex-pharma rep who says that pharmaceutical companies aren’t in the  business of curing but in the business of "disease maintenance and symptom management." It’s nothing new but here are two quotes that caught my attention:

"And what I’m saying is provable is that the pharmaceutical industry doesn’t want to cure people. You need to understand specifically when we’re talking about psychiatric drugs in particular that these are drugs that encourage people to remain customers of the pharmaceutical industry. In fact, you will be told if you’re given a drug such as an anxiolytic, or an antidepressant, or an antipsychotic drug, that you may be on the drug for the rest of your life. And very frequently, people find that they are on the drug for a very long period of time, if not permanently, because they’re almost impossible to get off of. Some of them can have very serious withdrawal symptoms – most of them can have extremely serious withdrawal symptoms if they’re stopped cold turkey – but some people experience even withdrawal symptoms when they try to titrate or they try to eliminate the drug little by little, day after day."

"We have got to start making the pharmaceutical industry accountable for their actions and for the defective products they’re putting on the market. It won’t be long before every American is affected by this disaster and we need to be aware of what the differences are between diseases between disorders and between syndromes. Because if it doesn’t have to be scientifically proven, if there are no tests, if there are no blood tests, CAT scans, urine tests, MRIs – if there is nothing to document that you have disease, then you in fact, do not have a disease, you have a disorder and it has been given and has been diagnosed pretentiously and you need to get yourself educated and understand that there are options and those options are much more effective than drugs."

I’ve always wondered why doctors don’t run tests to diagnose any psychiatric disorders. From NIMH:

Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally. In addition, important neurotransmitters–chemicals that brain cells use to communicate–appear to be out of balance. But these images do not reveal why the depression has occurred.

If MRIs have shown that the people with depression have a part of the brain that functions abnormally then why isn’t it standard for all people diagnosed with depression to have an MRI done to confirm this? I have one of two hypotheses:  it’s too expensive to get an MRI done for each person and that insurance won’t pay for it or the abnormal functioning cannot be detected in the brain of every depressed person.  Therefore, is major depressive disorder really a made-up diagnosis?

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A classic case of twisting the words of someone who supposedly shot the messenger

The subject title is long, but – I think – apropos.

The Treatment Advocacy Center’s post, “A classic case of shooting the messenger,” has been bothering me all day. I’ve been wanting to do further research on their claim that “patients with schizophrenia were 10 times more likely to engage in violent behavior than the general public.” Funny thing is, I didn’t have to look far.

The TAC links to a summary of the CATIE violence study and surprisingly, it contradicts the TAC’s post. I couldn’t help but chuckle once I realized I could easily debunk their claims from what they considered supporting evidence.

USPRA: “Violence is no more prevalent among individuals with mental illness than the general public”
Fact: The CATIE violence study found that patients with schizophrenia were 10 times more likely to engage in violent behavior than the general public (19.1% vs. 2% in the general population).

MY TAKE:Overall, the amount of violence committed by people with schizophrenia is small, and only 1 percent of the U.S. population has schizophrenia. Of the 1,140 participants in this analysis, 80.9 percent reported no violence, while 3.6 percent reported engaging in serious violence in the past six months. Serious violence was defined as assault resulting in injury, use of a lethal weapon, or sexual assault. During the same period, 15.5 percent of participants reported engaging in minor violence, such as simple assault without injury or weapon. By comparison, about 2 percent of the general population without psychiatric disorder engages in any violent behavior in a one-year period, according to the NIMH-funded Epidemiologic Catchment Area Study.”

This data is a little skewed here. (CLPsych or Philip Dawdy could do a better job at clarifying this for me.) First of all, “about 2 percent of the general population without psychiatric disorder engages in any violent behavior in a one-year period.” How many people does this constitute? The sentence doesn’t specify ‘without schizophrenia’; it says “without psychiatric disorder.” That means Americans who do not suffer at any given time from depression, bipolar disorder, psychosis, anxiety, schizophrenia, obsessive-compulsive disorder, postpartum depression, and the list goes on and on. Can anyone compile complete data of Americans who suffer from a psychiatric disorder? (Why do I have the funny feeling that Americans without psychiatric disorders are becoming the minority?)

In the January 1994 issue of the Archives of General Psychiatry, results of the National Comorbidity Study were released. Diagnoses from the DSM-III were applied to the participants ranging from ages 15-54. The study found that 50 percent of participants reported “one lifetime disorder” and 30 percent said they had “at least one 12-month disorder.”

That was January 1994. The American population has grown significantly since then, so I have a hunch that there's an increase in diagnosing people with psychiatric illnesses. But like I said, that’s, uh, just a hunch. (Keep in mind that the study does not include children ranging from ages 4-14 who are likely to receive ADHD and/or bipolar diagnoses.)

Humor me: Let’s take the NC study’s findings and apply it to the current estimated U.S. population (assuming that the percentage of those with a lifetime disorder has remained the same). Out of nearly 300 million Americans (July ’06 estimate), that means about 150 million Americans have at least some form of a psychiatric disorder. If 1 percent of the general population suffers from schizophrenia, that comes out to 3 million people. If we apply CATIE’s violence percentages, TAC’s right; 19.1 percent of schizophrenic patients engage in violent behavior of any kind. However, the CATIE study also says that two percent of the general population without psychiatric disorder engages in violent behavior. That means out of the remaining 150 million, 2 percent of that would be —*drumroll please* — 3 million Americans! Maybe it’s just me, but doesn’t seem 10 times likely. I could always be wrong.

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Diagnosing Myself

I've been away from this journal for a while for a number of reasons. I'll be candid:

1. Work has become busy. The yearly schedule at work is in line with tax season (even though I don't work in anything related to accounting) so I'm usually busy from January through May. Expect tons of blogging in June and July — there is NOTHING to do.

2. My personal life has become quite busy too. I don't really have a free night except for Sundays and I'm left exhausted from doing something every single night of the week. Free Friday nights tend to be a rare commodity.

3. I feel awful that I can't keep up on anyone's blog at the moment. There are so many wonderful blogs that I'm addicted to reading and it's much too time-consuming at the moment. (I have this tendency to read the first post and then read back entries all the way to January. Before I know it, I've spent 2 hours at work wasting time.)

4. I'm a perfectionist who meticulously reads over most of my previously written posts and corrects grammar, spelling, etc.

There's probably more that I can't remember at the moment, but you get the picture. Now, on to diagnosing myself…

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Fun with ICD-9 codes

I came across a situation recently in which a woman was described having mania in bipolar disorder, but was “diagnosed” with 296.2. And the recommended treatment? Venlafaxine (Effexor).

I swear, sometimes doctors themselves don’t even know what to prescribe.

UPDATE:
Okay, maybe I was wrong?

2007 ICD-9-CM Diagnosis 296.2
    Major depressive disorder single episode
        * 296.2 is a non-specific code that cannot be used to specify a diagnosis
        * 296.2 contains 72 index entries
        * View the ICD-9-CM Volume 1 296.* hierarchy

    Alternate Terminology
        * Depressive psychosis, single episode or unspecified
        * Endogenous depression, single episode or unspecified
        * Involutional melancholia, single episode or unspecified
        * Manic-depressive psychosis or reaction, depressed type, single episode or unspecified
        * Monopolar depression, single episode or unspecified
        * Psychotic depression, single episode or unspecified

So it’s totally possible to have a bipolar episode and be depressed? WTF? Am I depressed with bipolar symptoms or am I bipolar with depressive episodes? Ugh, none of this diagnosis stuff makes sense. Glad I’m not a doctor now.

Article Analysis – “Breaking it down: Mental health and the African community”

Liz Spikol linked to this article back in December and as a Black American with West Indian heritage (and by default, African and French), I couldn’t resist commenting.

Author Morenike Fasuyi blasts the United Kingdom’s mental health system as being less than inadequate for Africans. I don’t doubt it.

I do wonder about Fasuyi’s seemingly sheer hatred for anyone of European descent (in America, we’d refer to them as “white” or “Caucasian”). The article seethes with anger.

“The general consensus suggests that African people have to work twice as hard as their european counterparts in every aspect of our social, cultural and economical existence in order to make ends meet.”

This also is the case for Black Americans.

Fasuyi explains how she’s been diagnosed with bipolar disorder but says her disorder is mainly triggered by things related to Africa: “slavery, politics, oppression.” Her turning point was on May 1, 2004 when “it was as if [her] ancestors called” upon her and “removed the scales from her eyes.” She refers to Karl Marx when speaking about “groups” – Africans – who are oppressed and eventually rise up and lead a revolution. In addition, she believes the numbers 7 and 9 relate to the African people and that 2007 could be the year when “division within the African community” would be “homogenized[d]… to effect change.”

As a Black American, I know that African people truly value their ancestors and even practice ancestry worship. This is where I believe she is coming from. To any other nationality, Fasuyi is crazy (no pun intended). It wouldn’t surprise me if her mental health status file read, “bipolar disorder with psychosis.” Not knowing about African ancestry worship can make any doctor of non-African nationality misdiagnose Fasuyi. To be able to accurately help her, she must be accurately understood.

She asked for an African psychiatrist who might have a cultural understanding of where she was coming from. She mentions this was a slow process since “there [were] hardly any.” She also asked for an African social worker but was given “an insensitive male european (sic) social worker who adversely affected my health with his actions, racist remarks and incompetence.”

She takes a nice jab at Big Pharma and pharma reps, too:

“Maintaining you within the system keeps consultants in their jobs and increases the profit of the pharmaceutical industry, which has a turnover of billions.”

Zyprexa; Cymbalta, anyone?

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Loose Screws Mental Health News

Surprise, surprise — the likelihood of suicide attempts increases with antidepressants.

     “Suicidal patients taking antidepressants have a ‘markedly increased’ risk of additional suicide attempts but a "markedly decreased" risk of dying from suicide, a large Finnish study has found.
     “The research into nearly 15,400 patients hospitalized for suicide attempts between 1997 and 2003 showed that ‘current antidepressant use was associated with a 39 percent increase in risk of attempted suicide, but a 32 percent decrease in risk of completed suicide and a 49 percent reduced risk of death from any cause,’ the authors wrote in a report published in the Dec. 4 issue of Archives of General Psychiatry.
      “The Finnish study analyzed 15,390 suicidal patients of all ages for an average of 3.4 years. The authors said they did this ‘because previous suicide attempts are the most important risk factor for predicting suicide.’”

I think 15,390 patients is a sizeable, significant study that could probably yield semi-accurate statistics.

      “Among the 7,466 males and 7,924 females examined, there were 602 suicides, 7,136 suicide attempts requiring hospitalization and 1,583 deaths recorded during follow-up. The risk of completed suicide was 9 percent lower among those taking any antidepressants than among those not taking antidepressants.
     “But the picture was not so bright for all those who took SSRIs. It was for those taking fluoxetine (Prozac), who had a 48 percent lower risk of suicide than those not taking medication. But the study found that those taking another SSRI, venlafaxine hydrochloride (Effexor XR), had a 61 percent increased risk.”

So Prozac is better than Effexor XR in terms of suicidal risk. Nice, considering that I've had a 10-year history of suicidal attempts and this study seems to show that venlafaxine increases the risk of suicide attempts. Perhaps Effexor should be prescribed to those who aren't/have never been suicidal?

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Who I Am

I am a 26-year-old black female who suffers from bipolar disorder. I was diagnosed with the illness in November 2006. I’d been diagnosed as suffering from major depressive disorder (MDD) beginning at the age of 14. I still consider myself to suffer primarily from depression although I do have occasional manic episodes.

This blog has helped me to recognize many of the things that I am. That
I truly am more than my diagnosis and that my diagnosis does not define
me. I am not just a person with manic and depressive episodes. I am a person with a personality. I’m smart, witty, drop-dead gorgeous—okay, I wish, but I’m not ugly—musically inclined, and ambitious. And that’s just scratching the surface.

I can be happy, sad, angry, and joyful. I have so many emotions that could classify me as anything. I have a short attention span, for instance. The docs missed the attention-deficit hyperactivity disorder (ADHD) diagnosis (although I lack the hyperactivity).  I suffer from anxiety as well but not a single medical record lists me as suffering from generalized anxiety disorder (GAD). So I self-diagnose. It helps me to realize that all of my flaws can pigeonhole me into any diagnosis I choose. I accept my flaws – “diagnosable” or not – and my strengths. This is my journey to learn more about myself, my diagnosis, my medical treatment, and anything relating to my personal life and general mental health.

I’m skeptical of pharmaceutical companies. I don’t hate them; however, many of their practices are shady and I—along with some of my favorite medical blogs —hope to shed light on the “unfavorable” news they choose to keep hidden from the public.

I highlight celebrities who admit to mental illnesses. Many of them suffer from depression, which is the fashionable mental illness of the moment, but others truly suffer from problems that are worth talking about.

I also write about my personal life relating to mental illness. I struggle with constant thoughts of suicide. Readers of this blog will note a pronounced emphasis on suicidal thoughts and behaviors.

Feel free to read on to the next entry about my Perfectionistic Tendencies. Chronicling my journey to managing and treating my illness can hopefully aid me. And eventually, someone else.