328 On Mary Brooks Meyer, see Theodore Lidz’s “Adolf Meyer and the Development of American Psychiatry,” published in the American Journal of Psychiatry 123 (1966): 328.
329 The quotation on the goal of medicine comes from Adolf Meyer’s late essay “The ‘Complaint’ as the Center of Genetic-Dynamic and Nosological Thinking in Psychiatry,” New England Journal of Medicine 199 (1928).
329 The passages from Sartre come from his novel Nausea, pages 4, 95–96, 122, and 170.
329 The passagess byBeckett are taken, respectively, from Malone Dies and The Unnamable, and appear in the volume Molloy, Malone Dies, The Unnamable, on pages 256–57 and 333–34.
330 The story of the discovery of antidepressants is told over and over again. A nice version of it is in Peter Kramer’s Listening to Prozac, and a more technical one in Peter Whybrow’s A Mood Apart. I have relied on both of these, as well as on the detailed history that forms the backbone of David Healy’s The Antidepressant Era. I have also incorporated information from oral interviews.
331 The Kline/Lurie–Salzer/Kuhn debate is in David Healy’s The Antidepressant Era, pages 43–77.
331 The discovery of neurotransmitter theory and the early work on acetylcholine, as well as the discovery of serotonin and the link between substance and emotional function is from Ibid., 145–47.
331 The 1955 article referenced is A. Pletscher et al., “Serotonin Release as a Possible Mechanism of Reserpine Action,” Science 122 (1955).
331 The work on lowering serotonin levels is in David Healy’s The Antidepressant Era, page 148.
332 The development of the MAOIs is in Ibid., 152–55.
332 Axelrod’s work on reuptake is in Ibid., 155–161.
332 Joseph Schildkraut’s original article is “The Catecholamine Hypothesis of Affective Disorders: A Review of Supporting Evidence,” American Journal of Psychiatry 122 (1965): 509–22.
332 I am indebted to David Healy for his critique of Schildkraut.
333 The Scottish scientists who worked on receptor theory are George Ashcroft, Donald Eccleston, and team members, as is explicated in David Healy’s The Antidepressant Era, page 162.
333 The story of Carlsson and Wong and serotonin is in Ibid., 165–69.
334 The development of individual drugs is chronicled on the Web sites maintained by their manufacturers. For information on Prozac, see Lilly’s Web site at www.prozac.com; for information on Zoloft, see Pfizer’s Web site at www.pfizer.com; for information on drugs in development at Du Pont, see their Web site at www.dupontmerck.com; for information on Luvox, see Solvay’s Web site at www.solvay.com; for information on drugs in development at Parke-Davis, see their Web site at www.parke-davis.com; for information on reboxetine and Xanax, see Pharmacia/Upjohn’s Web site at www2.pnu.com; for information on Celexa, see the Web site of Forest Laboratories at www.forestlabs.com.
CHAPTER IX: POVERTY
335 That the poor depressed tend to become more poor and depressed is indicated by a number of studies. Depression’s effect on the ability to earn a living is reviewed in Sandra Danziger et al., “Barriers to the Employment of Welfare Recipients,” published by the Poverty Research and Training Center of Ann Arbor, Michigan. This study indicates that among poorer populations, those with a diagnosis of major depression cannot in general work twenty hours or more a week. That they become increasingly depressed can be adduced by studies that show poor treatment records for poor and homeless populations, such as Bonnie Zima et al., “Mental Health Problems among Homeless Mothers,” Archives of General Psychiatry 53 (1996), and Emily Hauenstein, “A Nursing Practice Paradigm for Depressed Rural Women: Theoretical Basis,” Archives of Psychiatric Nursing 10, no. 5 (1996). For an excellent discussion on the relationships between poverty and mental health, see John Lynch et al., “Cumulative Impact of Sustained Economic Hardship on Physical, Cognitive, Psychological, and Social Functioning,” New England Journal of Medicine 337 (1997).
336 On depression among women, see chapter 5.
336 On depression among artists, see Kay Jamison’s Touched with Fire.
336 One example of depression among athletes may be found in Buster Olney, “Harnisch Says He Is Being Treated for Depression,” New York Times, April 26, 1997.
336 On depression among alcoholics, see chapter 6.
336 That the poor have a high rate of depression can be adduced from the statistic that welfare recipients have an incidence of depression three times that of nonwelfare recipients, put forth in K. Olsen and L. Pavetti, “Personal and Family Challenges to the Successful Transition from Welfare to Work,” published by the Urban Institute, 1996. Sandra Danziger et al.’s “Barriers to the Employment of Welfare Recipients,” published by the Poverty Research and Training Center of Ann Arbor, Michigan, indicates that depressed welfare recipients are more likely to be unable to hold jobs, thus completing the circle of poverty and depression. Robert DuRant et al.’s “Factors Associated with the Use of Violence among Urban Black Adolescents,” American Journal of Public Health 84 (1994), indicates a connection between depression and violence. Ellen Bassuk et al.’s “Prevalence of Mental Health and Substance Use Disorders among Homeless and Low-Income Housed Mothers,” American Journal of Psychiatry 155, no. 11 (1998), reviews a number of studies indicating elevated levels of substance abuse among the depressed.
337 The efficacy of most pharmacological and psychodynamic treatments appears to be fairly consistent across populations. Depression among the indigent should therefore have the same efficacy rates as for a more general population. The difficulty with this population, in the current system, is of getting the treatment to patients.
337 The statistic that 85–95 percent of people with serious mental illness are unemployed in the United States is taken from two studies by W. A. Anthony et al.: “Predicting the vocational capacity of the chronically mentally ill: Research and implications,” American Psychologist 39 (1984), and “Supported employment for persons with psychiatric disabilities: An historical and conceptual perspective,” Psychosocial Rehabilitation Journal 11, no. 2 (1982).
337 On the early puberty of children of depressed mothers, see Bruce Ellis and Judy Garber’s “Psychosocial antecedents of variation in girls’ pubertal timing: Maternal depression, stepfather presence, and marital and family stress,” Child Development 71, no. 2 (2000).
337 Characteristic behavior of girls with early puberty is described in Lorah Dorn et al., “Biopsychological and cognitive differences in children with premature vs. on-time adrenarche,” Archives of Pediatric Adolescent Medicine 153, no. 2 (1999). For a broad review of the literature on early puberty, promiscuity, and sexual activity, see Jay Belsky et al., “Childhood Experience, Interpersonal Development, and Reproductive Strategy: An Evolutionary Theory of Socialization,” Child Development 62 (1991).
338 On medicaid programs and the mentally ill, see Lillian Cain, “Obtaining Social Welfare Benefits for Persons with Serious Mental Illness,” Hospital and Community Psychiatry 44, no. 10 (1993); Ellen Hollingsworth, “Use of Medicaid for Mental Health Care by Clients of Community Support Programs,” Community Mental Health Journal 30, no. 6 (1994); Catherine Melfi et al., “Access to Treatment for Depression in a Medicaid Population,” Journal of Health Care for the Poor and Underserved 10, no. 2 (1999); and Donna McAlpine and David Mechanic, “Utilization of Specialty Mental Health Care among Persons with Severe Mental Illness: The Roles of Demographics, Need, Insurance, and Risk,” Health Services Research 35, no. 1 (2000).
338 Examples of successful aggressive outreach programs may be found in Carol Bush et al., “Operation Outreach: Intensive Case Management for Severely Psychiatrically Disabled Adults,” Hospital and Community Psychiatry 41, no. 6 (1990), and José Arana et al., “Continuous Care Teams in Intensive Outpatient Treatment of Chronic Mentally Ill Patients,” Hospital and Community Psychiatry 42, no. 5 (1991). For information regarding outreach programs for homeless populations, see Gary Morse et al., “Experimental Comparison of t
he Effects of Three Treatment Programs for Homeless Mentally Ill People,” Hospital and Community Psychiatry 43, no. 10 (1992).
338 L. Lamison-White’s U.S. Bureau of the Census: Current Populations Report indicates that 13.7 percent of Americans are below the poverty line, as taken from Jeanne Miranda and Bonnie L. Green, “Poverty and Mental Health Services Research,” page 4.
338 The study showing that 42 percent of heads of households receiving AFDC meet the criteria for clinical depression is K. Moore et al., “The JOBS Evaluation: How Well Are They Faring? AFDC Families with Preschool-Aged Children in Atlanta at the Outset of the JOBS Evaluation,” published by the U.S. Department of Health and Human Services, 1995.
338 The study showing that 53 percent of pregnant welfare mothers meet the criteria for major depression is J. C. Quint et al., “New Chance: Interim Findings on a Comprehensive Program for Disadvantaged Young Mothers and Their Children,” published by Manpower Demonstration Research Corporation, 1994.
338 That those with psychiatric disorders are 38 percent more likely to receive welfare than those without is shown in R. Jayakody and H. Pollack, “Barriers to Self-Sufficiency among Low-Income, Single Mothers: Substance Use, Mental Health Problems, and Welfare Reform.” This paper was presented at the Association for Public Policy Analysis and Management in Washington, D.C., November 1997.
338 That the state and federal governments spend roughly $20 billion on cash transfers to poor nonelderly adults and their children, and roughly the same amount for food stamps for such families, is taken from the the U.S. House of Representatives Committee on Ways and Means’ Green Book, 1998. It cites, on page 411, government expenditures of $11.1 billion and state expenditures of $9.3 billion on Aid to Families with Dependent Children (AFDC) benefits. This does not count an additional $1.6 billion in federal administrative costs and $1.6 billion in state administrative costs. The federal costs for Temporary Assistance for Needy Families (TANF) benefits are cited as $23.5 billion on food stamp benefits and $2 billion on administration. State and local governments spent $1.8 billion on administration. TANF statistics are from page 927.
339 On the woes of the welfare system, in this example, the child welfare system, see Alvin Rosenfeld et al., “Psychiatry and Children in the Child Welfare System,” Child and Adolescent Psychiatric Clinics of North America 7, no. 3 (1998). They write, “In contrast to the mental health system, nonmedical personnel usually run child welfare. . . . Most foster children probably need a psychiatric evaluation; few get one.” Page 527.
339 Jeanne Miranda has been a real pioneer in this area. Her most notable publications include Kenneth Wells et al., “Impact of disseminating quality improvement programs for depression in managed primary care: A randomized controlled trial,” Journal of the American Medical Association 283, no. 2 (2000); Jeanne Miranda et al., “Unmet mental health needs of women in public-sector gynecologic clinics,” American Journal of Obstetrics and Gynecology 178, no. 2 (1998); “Introduction to the special section on recruiting and retaining minorities in psychotherapy research,” Journal of Consulting Clinical Psychologists 64, no. 5 (1996); and Jeanne Miranda et al., “Recruiting and retaining low-income Latinos in psychotherapy research,” Journal of Consulting Clinical Psychologists 64, no. 5 (1996).
340 That total costs per patient for all the mentioned treatment programs are under $1,000 a year was discussed in much correspondence with the researchers. The exact figures for such programs are of course extremely difficult to calculate and compare because of differences in treatment programs, protocol, and services. Jeanne Miranda estimated her costs at under $100 per patient; Emily Hauenstein provided total costs of $638 per person for treatment regimens that include approximately thirty-six therapeutic meetings. Costing for Glenn Treisman’s work is based on figures he sent me in an E-mail of October 30, 2000. He estimated his operating costs at between $250,000 and $350,000 per year for an outreach service that provides care for twenty-five hundred to three thousand patients. Average cost per patient is therefore around $109.
343 That depression among the poor is not usually manifest in the cognitive arena of personal failure and guilt, but rather in somaticization, is indicated in Marvin Opler and S. Mouchly Small, “Cultural Variables Affecting Somatic Complaints and Depression,” Psychosomatics 9, no. 5 (1968).
347 The article in The New England Journal of Medicine on economic hardship and depression is John Lynch et al., “Cumulative Impact of Sustained Economic Hardship on Physical, Cognitive, Psychological, and Social Functioning,” vol. 337 (1997).
348 On the phenomenon of learned helplessness, see Martin Seligman’s Learned Optimism.
353 The rate of schizophrenia among low-income populations is in Carl Cohen, “Poverty and the Course of Schizophrenia: Implications for Research and Policy,” Hospital and Community Psychology 44, no. 10 (1993).
360 The antarctic ozone “hole” is defined as an “area having less than 220 dobson units (DU) of ozone in the overhead column (i.e., between the ground and space).” As the Environmental Protection Agency’s Web site points out, “The word hole is a misnomer; the hole is really a significant thinning, or reduction in ozone concentrations, which results in the destruction of up to 70 percent of the ozone normally found over Antarctica.” I take from One Earth, One Future: Our Changing Global Environment, page 135: “The first unmistakable sign of human-induced change in the global environment arrived in 1985 when a team of British scientists published findings that stunned the world community of atmospheric chemists. Joseph Farman, of the British Meteorological Survey, and colleagues reported in the scientific journal Nature that concentrations of stratospheric ozone above Antarctica had plunged more than 40 percent from 1960s baseline levels during October, the first month of spring in the Southern Hemisphere, between 1977 and 1984. Most scientists greeted the news with disbelief.” See the EPA’s Web site dedicated to the ozone hole at www.epa.gov/ozone/science/hole/holehome.html. The British Antarctic Survey publishes yearly updates on the state of the antarctic ozone. For current information, see www.nbs.ac.uk/public/icd/jds/ozone/index.html.
CHAPTER X: POLITICS
361 For a general overview of changing government policies in the area of mental health, there are a number of informative Web sites focused on mental health advocacy, support, and education. I would particularly recommend the Web sites for the National Institute of Mental Health (www.nimh.nih.gov), the National Alliance for the Mentally Ill (www.nami.org), the Treatment Advocacy Center (www.psychlaws.org), the National Depressive & Manic-Depressive Association (www.ndmda.org), and the American Psychiatric Association (www.psych.org).
365 For Tipper Gore’s remarks on her own depression, see her interview published as “Strip Stigma from Mental Illness,” USA Today, May 7, 1999.
365 A plethora of articles have been published on Mike Wallace and his depression. See Jolie Solomon, “Breaking the Silence,” Newsweek, May 20, 1996; Walter Goodman, “In Confronting Depression the First Target Is Shame,” New York Times, January 6, 1998; and Jane Brody, “Despite the Despair of Depression, Few Men Seek Treatment,” New York Times, December 30, 1997.
365 For William Styron’s description of his depression, see his elegantly written first-person memoir Darkness Visible, which was one of the first open modern portraits of depressive illness.
366 The National Alliance for the Mentally Ill (NAMI) provides excellent information regarding the ADA, including summaries, consumer and advocate information, and contact information. This may be found at http://www.nami.org/helpline/ada.htm.
367 The Civil Aeromedical Institute (CAMI) is the medical certification, research, and education wing of the U.S. Department of Transportation Federal Aviation Administration. For the full FAA regulations, see the CAMI Web site at www.cami.jccbi.gov/AAM-300/part67.html.
368 The quotations from Richard Baron come from his unpublished manuscript “Employment Programs for Persons with Serious Mental Illness: Drawing the Fine Line Between Providing Nec
essary Financial Support and Promoting Lifetime Economic Dependence,” pages 5–6, 18, 21.
369 For information on the NIH, as well as its various departments and budgets, see its Web site at www.nih.gov.
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