May 26, 2011

Changing the Definition of Mental Illness

For better or for worse, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is used as a core learning tool in social work programs across the country. Currently, I am taking a psychopathology class at UCLA where students are taught the basic criteria for differentiating groupings of mental disorders (i.e. thought vs. mood disorders), and how social workers might begin to formulate diagnoses for patients/clients in various practice settings.

In order to keep readers informed about the revisions to the DSM, I wanted to mention two of the more prominent changes expected to appear in the fifth version of the DSM, which is due out in 2013. Last November, the DSM task-force announced that 5 personality disorders will be removed. Ironically, narcissistic personality disorder will be among the personality disorders axed from the manual. More recently, psychiatrists have debated the inclusion of hypersexual disorder and compulsive gambling as official diagnoses.

As a social worker, I am disappointed in what little discussion there is regarding the role of culture in conceptualizing mental disorders in the DSM. Currently, cultural considerations are a mere afterthought in the manual, and any considerations to this issue are thrown in the appendix of the DSM. A mere 7 pages are devoted to the topic in the 943-page manual!

Because there is such a dire need to contextualize mental disorders with cultural considerations, I wanted to applaud Jonathan Metzl, a psychiatrist at The University of Michigan, who just released a new book called The Protest Psychosis: How Schizophrenia Became a Black Disease. Metzl evaluated hundreds of patient records, studies, and pharmaceutical advertisements to uncover how and why schizophrenia is over-diagnosed in African American men. I believe this is a must read for every mental health professional, and a great way to start the discussion on how and why we need to expand cultural considerations in the DSM. In the following video, Metzl explains the root cause of how Schizophrenia came to be over-diagnosed in African Americans:

May 22, 2011

UCLA MSW Program: Learnings from the 2nd Year Placement Process

One of the main reasons I started this blog was to address the lack of knowledge exchange among prospective students and professionals within the social work field. I hope to continue this exchange by providing some experiential information and advice I believe is crucial for students who embark on the second year internship placement process. While this post is primarily for prospective UCLA students, I believe a candid student perspective can help MSW faculty create a more equitable and seamless process for their students.

As mentioned in a previous post, the UCLA MSW program assigns students to their first year internships. Fortunately, students are permitted to choose the agencies they wish to interview and intern with for their second year. While I am privileged that there are so many incredible agencies and organizations to work with in the Los Angeles area, I must admit that I am frustrated with the way UCLA structures and regulates the second year placement process. I won't go into every bone of contention, however, I want to bring up a few issues I was particularly bothered by.

I found it incredibly aggravating that UCLA students are only allowed to select two agencies to interview with, while USC, in addition to other Cal State programs, allow their students to select up to five. If for no other reason, all MSW students should have an equal opportunity to interview with the same number of agencies. Furthermore, this creates a sticky situation for UCLA students who do not receive either internship, as they have to search for new agency internships that are not necessarily preferred. Secondly, UCLA started their interview process weeks after USC and other programs. I was told by a few sources that a gentleman's agreement existed among MSW programs about the time students could start interviewing with agencies. It makes me concerned that USC/other programs did not honor this agreement. Lastly, a handful of agencies offer open-houses, an opportunity for prospective interns to learn about an agency and engage with current staff members. However, faculty at UCLA created a rule that if you choose to attend an information session, you must select this agency as one of your two choice agencies. As someone who believes open-houses are an opportunity to decide whether the agency is the right fit or not, it seems backwards to force students to commit to selecting an agency prior to attending an open-house.

I realize that due to nature of MSW programs, the above frustrations might not be addressed in the near future. In order to help students avoid disappointments with the second year placement process, I offer the following advice:

  1. Strategize: Because UCLA students are limited to two agency selections, it might be in a student's best interest to select a "reach" agency and a "backup" agency. Just as college-bound seniors strategize with counselors to maximize the probability of receiving acceptances, MSW students should devise a plan to maximize their ability to secure an internship at an agency of their choice.
  2. Investigate: Find out the number of students from UCLA, USC, Cal-State, C-SUN, and other programs that are vying for the internship you want. Field liaisons can look to historical data for this information. It also helps if you have friends in other programs to investigate this information for you.
  3. Question: Equally important to the number of students applying for the internship, is the number of slots available at the agency. I interviewed at an agency that historically accepted five students, while this year, they only ended up taking two. Also, some agencies "reserve" 1-2 slots for UCLA, while others have no such school preference. Asking your field liaison for this information prior to agency selection is key to evaluating your chances of securing that internship.
  4. Know your strengths and limitations: When an agency states they have a preference for bilingual (English and Spanish) students, take this at face value. If you happen to be bilingual, know this is an incredible advantage.
  5. Be firm about your interests: Regardless of where field faculty believes you should interview, it is ok to say "thanks, but no thanks" if the agency doesn't jive with your interests.

May 13, 2011

The University of Michigan Depression Center: The Depression Toolkit

As a University of Michigan alumna, I subscribe to a monthly newsletter called "Michigan Today," to keep myself informed about new developments and progress of the University. To my delight, this month's e-newsletter featured a link called "Help for the depressed," which leads readers to an online toolkit for individuals suffering from depressive disorders. 

The toolkit is extremely comprehensive, and a great website for individuals and families to familiarize themselves with depressive symptoms, treatment, and coping strategies. Readers can find quick assessment tools, information about how to find the right therapist, medication logs, goal setting forms, and numerous other tools all available to download.

There is also a page devoted to self-care that details 12 different ways an individual can proactively manage their symptoms. As someone who personally exercises for self-care, I particularly like their video on "quick tips on incorporating exercise." Other strategies include positive self talkmanaging stressjournalingestablishing support systems, and developing an appropriate food plan.

May 10, 2011

Capturing Mental Illness with Art

“This benefit of seeing... can come only if you pause a while, extricate yourself from the maddening mob of quick impressions ceaselessly battering our lives, and look thoughtfully at a quiet image... the viewer must be willing to pause, to look again, to meditate.” - Dorothea Lange

In order to expand my knowledge and understanding of mental illness, I am always on the lookout for powerful images that capture the internal experiences of my patients. I find the most compelling pictures to generate a deeper understanding of my patients' pain and suffering, and in turn, help deepen my empathy and respect for them.

As the above quote states, we often carelessly glance at images in our daily lives, and never take the time to ponder or contemplate their meaning or connection to the present moment. On the days where I feel calloused from the maddening nature of the inpatient unit, I find it helpful to direct my attention to a portrait or photograph to remind me of what my patients are going through.

The following is a collection of pieces from a few artists who did a wonderful job depicting symptoms and related emotions of individuals suffering from psychiatric disorders.

Jason Bard Yarmosky


"Tight End"

Brian Lewis Saunders


"Hydrocodone, Oxycodone, and Xanax"


Andres Guzman

Marion Bolognesi

May 5, 2011

Simulating Auditory and Visual Hallucinations

Throughout my internship at an inpatient psychiatric hospital, I've interviewed dozens of patients who suffer from psychotic symptoms, namely auditory and visual hallucinations. Often times, hallucinations can be so intrusive that a patient is unable to carry on a short conversation or answer a simple question. In my experience, it is pretty easy to tell when a patient is responding to internal stimuli during an interview. He/she will appear distracted, ask me to repeat questions, or give looks of confusions. On rarer occasions, I have witnessed patients talking to and running away from imagined figures. One patient even introduced me to a hallucinatory figure.

While it is impossible for those of us who do not suffer from mental illness to truly understand what it is like to experience these psychotic symptoms, there are a number of simulated videos that attempt to provide us a taste of what it might be like. If you are currently working with individuals who suffer from hallucinations, I encourage you to watch the following videos:

Janssen's Mindstorm: A Simulation of Psychosis

Simulation of Hallucinations:

Teenage Girl Begs to Be Hospitalized after a Psychotic Episode