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Federal Push for Privacy Hampers Addiction Research and Care

Medicare -- New York Times - Tue, 04/28/2015 - 12:00am
Medicare and Medicaid data offer the best available window into health outcomes and costs. Now a part of that information is hidden.
Categories: Elder, Medicare

Out Soon: First Official Consumer Guide To ‘The Bible Of Psychiatry’

CommonHealth (WBUR) - Fri, 04/24/2015 - 12:34pm

The DSM-5, widely known as the “bible of psychiatry,” is close to 1,000 pages and not exactly user-friendly. (Photo: Wikimedia Commons)

On average, says Dr. Paul Summergrad, the outgoing president of the American Psychiatric Association, he gets three or four calls a week that go something like this: “Hi, I’d love to chat — we haven’t talked in a while — but I’m calling about a personal problem — I’m worried.”

Almost always, Summergrad says, “It’s about a parent, an aunt, an uncle, a brother, a sister, a child — usually an adolescent or young adult who’s at the age of onset of these conditions, and they’re trying to figure out what to do.”

Summergrad, who’s also psychiatrist-in-chief at Tufts Medical Center, doesn’t mind a bit. “It’s actually the best job that I have, taking those calls,” he says. “That’s one of the most important things I ever do, because I’m trying to get people to the right sources of help.”

Now he has one more source to recommend: On May 1, the American Psychiatric Association is officially releasing its first-ever consumer guide to the DSM-5, the compendium of mental disorders that’s referred to in virtually every news story ever written about it — including this one, now —  as “the bible of psychiatry.” The new consumer-oriented book is called “Understanding Mental Disorders: Your Guide To The DSM-5.”

The new consumer guide to the DSM-5 (Courtesy APA.)

The DSM-5 — DSM stands for Diagnostic and Statistical Manual — took more than a dozen years to develop and sparked controversies over some psychiatric disorders as it was compiled, drawing criticism both within the field and from without. But it was finally published in 2013 — the latest version of the go-to reference on psychiatric diagnosis and treatment.

No one would call it user-friendly, though; it’s a thick tome of 991 pages in the paperback edition, and written for clinicians and researchers, not laypeople.

So the new consumer guide, Summergrad says, “is a way of trying to provide some help and guidance and understanding for either the individuals themselves, for their family members, or for other caregivers.”

It’s also intended for tables in the offices of primary care doctors, psychiatrists and psychologists, he says, to explain diagnoses in language for laypeople.

As one of those laypeople myself, I felt a little confused. The consumer guide, like the DSM itself, is organized in categories of diagnoses: psychotic disorders, bipolar disorders, anxiety disorders, and more.

That would mean that in order to use it, I’d need to already have a diagnosis, right? But if I were like one of Dr. Summergrad’s callers, worried about a loved one and needing guidance on what could be wrong, could a book that explains diagnoses help me?

“I think we’ll find out exactly how people use it, but it is intended as a supplement to professional care, not a substitute,” Summergrad says. Oftentimes, he notes, family members speak first with a primary care doctor or pediatrician — a good place to start — or, in this Internet age, they may find possible diagnoses online that they want to explore.

Dr. Paul Summergrad (Courtesy APA)

“We’ll find out what’s useful and not useful,” he says, “and get important feedback from patients and families and others.”

Some initial feedback from Lisa Halpern, director of recovery services at Vinfen, a Cambridge, Mass. nonprofit that offers psychiatric and other support services, who kindly agreed to review a copy:  Indeed, she says, in this Google-driven age of self-diagnosis, it could be a real challenge for readers to keep in mind that the book is not intended for generating a diagnosis, but rather as a companion to professional care.

A positive note: The book uses personal vignettes as illustrations, and “It’s not one-size-fits all. I thought this was the right message,” says Halpern, whose background includes Duke, Harvard and a schizophrenia diagnosis. “Diagnosing people is an art and a science, and each person is unique. The DSM-5 is very much about science but the art piece comes with the personal vignettes. That spoke to me.”

Her only major criticism, Halpern says, is that the chapter on “treatment essentials” spends six pages on medication and just one page on humor, friendship and peer support. “I thought there should have been more of a balance between the two,” she says.

Overall, she says, the book is a strong companion guide: “The DSM-5 by itself can be very overwhelming to people, and anything that helps break down those barriers, break down the silos between psychiatrists and persons seeking help, can be helpful.”

The Checkup: a WBUR/Slate health podcast Subscribe on iTunes | The Checkup on Slate

The guide’s publication reflects the broader trend of growing public discussion about issues of mental health, Summergrad says, and greater recognition of psychiatric challenges — from speeches at this year’s Academy Awards to President Obama’s remarks honoring a veteran who committed suicide at a White House ceremony at which he signed a bill aimed at preventing such suicides.

Among the book’s goals, Summergrad says, is to demystify psychiatry.

Sigmund Freud said the goal of psychiatry was “to turn hysterical misery into ordinary unhappiness,” he says. “You know, there’s enough ordinary unhappiness and suffering in life; not everything that’s suffering is a mental disorder. But there are things that are. So the goal here is not to medicalize everyday life. The goal is to help people get guidance about something they’re worried about.”

Readers, thoughts? If you get a copy, please share your reactions.

Categories: Health Care

Centenary of the Landing at Anzac Cove During World War I

In Custodia Legis - Fri, 04/24/2015 - 11:00am

Photograph shows Field Marshal William Riddell Birdwood, 1st Baron Birdwood (1865 -1951), a British general who served as commander of the Australian and New Zealand Army Corps (ANZAC) during the Gallipoli Campaign in 1915 during World War I. (Bain News Service, between ca. 1910 and ca. 1915.) Library of Congress Prints and Photographs Division, http://hdl.loc.gov/loc.pnp/ggbain.20228.

April 25, 2015, marks 100 years since the first landing of Australian and New Zealand troops (known as the ANZACs, for Australian and New Zealand Army Corps) at the Gallipoli peninsula (Gelibolu in Turkish) in Turkey during World War I.  A few years ago I wrote about the significance of April 25th, ANZAC Day, which is a public holiday in both countries.  Commemorative events are held throughout Australia and New Zealand and all over the world, including here in the United States.  Of particular significance are the ceremonies held at the place of the battle.  Each year the Australian and New Zealand governments work with the Turkish government to plan events at Gallipoli, which last year attracted about 5,000 attendees.  The numbers were down by about 1,000 compared to previous years and much less than the estimated 20,000 people who traveled to Gallipoli for the 90th anniversary in 2005.

Planning and preparations for the ANZAC Day events at Gallipoli this year, the centenary, started some time ago.  In 2010, the prime minister of Australia announced the creation of the “National Commission on the Commemoration of the Anzac Centenary,” and later a public fund board and advisory board were established. Funding measures associated with the marking of the centenary in both Australia and at Gallipoli were included in subsequent budgets. The New Zealand government also established an advisory group and appropriated funding for various projects and events.  For example, one of the projects was Archives New Zealand’s digitization of 140,000 New Zealand Defence Force personnel files containing information on all New Zealanders who served in World War I.  Under a joint project with Australia, records from both countries were also made available on the National Archives of Australia’s “Discovering Anzacs” website.  This week, I found my New Zealand great grandfather’s file, showing his deployment to Gallipoli in 1915 to join the ANZACs.

The Australian and New Zealand governments decided to run separate public ballots to allocate tickets for events at Gallipoli on ANZAC Day 2015.  Under an agreement with Turkey, the number of tickets was capped at 10,500: 8,120 Australians, 2,030 New Zealanders, and 350 officials from all nations involved in the Gallipoli campaign, including 100 representatives of Turkey.  The allocation ratio was “based on the relative number of casualties suffered by New Zealand and Australia during the Gallipoli campaign.”  The two countries further allocated a proportion of their places to certain groups, including veterans of any conflicts as well as direct descendants of Gallipoli veterans.

It was estimated that about 40,000 people would apply for tickets for the centenary events at Gallipoli; in the end about 42,000 Australians and 10,000 New Zealanders registered for the two ballots.

Photograph shows Ottoman soldiers during the Gallipoli campaign which took place on the Gallipoli Peninsula in the Ottoman Empire (now Gelibolu, Turkey) between April 1915 and January 1916 during World War I. (Bain News Service, between 1915 and 1916.) Library of Congress Prints and Photographs Division, http://hdl.loc.gov/loc.pnp/ggbain.20342.

The Gallipoli campaign of the allied forces (New Zealand, Australia, Great Britain (including Ireland), Newfoundland, France and India) dragged on for many months and was ultimately unsuccessful, and even labelled a disaster, as the Ottoman forces repelled advances and counter-attacked.  The Allies eventually evacuated the area in December 1915.  The ANZACs and other allied troops suffered heavy losses, as did the Ottoman forces.

Today, Gallipoli is recognized as a prominent place in the history and national identities of Turkey and the two other countries thousands of miles away.  The Turkish government made the area a national park (the Gelibolu Peninsula Historical National Park) in 1973.  It encompasses 33,000 hectares and is on the United Nations list of national parks and protected areas.  Turkey has also submitted the park for inclusion in UNESCO’s World Heritage List.  The Turkish Ministry of Culture and Tourism states that

[t]his area is known for the war cemeteries and memorials for the Turkish and foreign soldiers killed during the Canakkale Sea and shore battles in 1915. There are sunken ships, trenches, castles, towers and hundreds of remains of the war. In total, there are graves and memorials of around 250,000 Turkish soldiers, and 250,000 from Australia, New Zealand, England and France. Thousands of people visit the war cemeteries every year, and it is one of the most famous sites in Turkey.

Photo by Flickr user Seb Ruiz, Dec. 2, 2006. Used under Creative Commons License, https://creativecommons.org/licenses/by-nc-sa/2.0/.

In 1985, the Turkish government officially recognized the name “Anzac Cove” (Anzak Koyu in Turkish) for the particular beach where the ANZACs landed.  The cove originally “received this name as early as 29 April 1915, by request of the commander of the Anzac Corps, Lieutenant General Sir William Birdwood.”  Official recognition of the name resulted from an agreement between the Australian, New Zealand, and Turkish governments.  The New Zealand Ministry of Culture and Heritage states that:

In 1984, Australia asked Turkey if the cove on the Gallipoli peninsula could be renamed Anzac Cove in memory of the Australian and New Zealand troops who died there in 1915 during the Gallipoli Campaign of World War One. The Turkish Government agreed to change the cove’s name from Ari Burnu and also built a large monument to all those who died in the campaign. In return, the Australian and New Zealand governments agreed to build monuments in Canberra and Wellington to Mustafa Kemal Atatürk, who served as a divisional commander at Gallipoli and went on to become the first president of modern Turkey.

In addition, as part of the agreement, the Australian government “named a stretch of Lake Burley Griffin at the end of Anzac Parade” in Canberra “Gallipoli Reach,” and “[a] section of Princes Royal Harbour in Albany, Western Australia was also named ‘Atatürk Entrance’ in memory of the first convoy that left Australia in November 1914 for the war in Europe.”

Get into khaki. Your comrades at Gallipoli are calling you. This is not the time for football and tennis matches. It is serious. Show that you realise this by enlisting at once [S.l. : s.n., 1915]. Library of Congress Prints and Photographs Division, http://hdl.loc.gov/loc.pnp/cph.3g11204.

Many years before this agreement, the relationship that developed between the three countries was signified in a 1934 statement by Mustafa Kemal Atatürk (although there are apparently some questions about whether he actually made it or not).  This included the following words, now inscribed on the memorials at Anzac Cove and in Wellington and Canberra:

Those heroes that shed their blood and lost their lives, you are now lying in the soil of a friendly country. Therefore rest in peace. There is no difference between the Johnnies and the Mehmets to us where they lie side by side here in this country of ours. You, the mothers who sent their sons from far away countries wipe away your tears, your sons are now living in our bosoms and are in peace. After having lost their lives on this land they become our sons as well.

Anzac Cove was the site of the ANZAC Day dawn service until 2000 when the event was shifted to a purpose-built commemorative site at North Beach.  This was due to issues related to capacity and protection of the area.  The interest in visiting Gallipoli, which is something of a year-round pilgrimage for Kiwis and Aussies living in or visiting Europe, has led to various discussions within and between the relevant countries about how to ensure safety, security, and access, as well as the conservation of what have become sacred grounds.

Today, April 24, is also being observed by people in Turkey and elsewhere as a day of commemoration for the centenary of the start of other events that occurred in the Ottoman Empire during World War I.  These have been in the news a lot over the past two weeks in relation to whether the killing of vast numbers of Armenians during and after the war should be recognized and referred to by Turkey and others as a “genocide.”  The “Great War” remains relevant to nations and peoples who were deeply affected by its complex and tragic conflicts and events, and there is still debate and discussion about this history, 100 years later.

The Library of Congress holds huge amounts of resources (both online and in hard copy) related to World War I and the involvement of, and events that took place in, various countries.  Two weeks ago I posted pictures of parts of the Law Library’s international law collection, which contains various documents that relate to the war.  You can find many thousands of materials from across the Library by searching our online catalog, or indeed our whole website, for terms such as “World War I,” “Great War,” “ANZAC,” “Gallipoli peninsular,” and “Armenian massacres” or “Armenian genocide.”  Some of the items you will come across include posters, declarations, and stories from or about veterans themselves.

Erstürmung des Friedhofs von Kum Kaleh druch die türkischen Truppen in der Schlacht vom 25 und 26 April 1915 / G. Lebrecht 1915 ; Georg Lebrecht für die Leipziger “Illustrirte Zeitung.” (Print shows soldiers advancing under fire at night on the Gallipoli Peninsula.) Library of Congress Prints and Photographs Division, http://hdl.loc.gov/loc.pnp/cph.3a14509.

Categories: Research & Litigation

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