The Myth(s) of Mental Illness: Considerations for Juvenile and Family Courts

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Ezra Neal
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1 The Myth(s) of Mental Illness: Considerations for Juvenile and Family Courts Shawn C. Marsh, Ph.D. Chief Program Officer Juvenile Law National Council of Juvenile and Family Court Judges

3 Sound familiar? Defiant Angry Irritable Vindictive Blames others for problems

4 What is mental illness?

5 Szasz

6 James Pavlov Freud Lewin Erikson Rogers Skinner Piaget Bandura Becker

7 Social construction

8 Text becomes reality JUVENILE SEX OFFENDER

9 Disorder extinction 1973: Homosexuality removed from DSM 1980: New diagnosis ego-dystonic homosexuality (lack of heterosexual desire, persistent distress in face of homosexual arousal, etc.) 1986: All form of diagnosis entirely removed

10 Culture bound illness

11 Amok (running amok) / Berserker Region/Culture: Southeast Asia, Scandinavia Loosely translated as "rampage" in Malay, amok is a dissociative condition characterized by a non-premeditated violent, disorderly, or homicidal rage directed against other objects or persons. The condition, which is often accompanied by amnesia and exhaustion, is typically incited by a perceived or actual insult and can occur as part of a brief psychotic episode or as an exacerbation of a chronic psychotic illness. A similar state, berserker, is used in Old Norse literature to describe a frenzied rage in Viking warriors.

12 Koro Region/Culture: Asia, Southeast Asia Koro is intense anxiety related to the belief that one's own genitalia are shrinking or receding, resulting in possible death. Localized epidemics have been reported.

13 Gururumba Region/Culture: New Guinea Gururumba describes an episode in which the afflicted person (usually a married man) begins burglarizing neighboring homes, taking objects that he considers valuable but which seldom are. He then runs away, often for days, returning without the objects and amnestic about the episode.

14 Wendigo Psychosis Region/Culture: Various Wendigo psychosis describes an insatiable craving for human flesh even when other food is available. It was first described in Algonquin Indians who felt that tribe members engaging in cannibalism then turned into, or were occupied by, a feared, flesh-eating creature or spirit called the wendigo.

15 Why does psychology and psychiatry seem so fuzzy? The brain and human behavior is so complex it can blow your mind (pardon the pun).

16 Myth #1 Psychology and psychiatry are just about couches, mommy/daddy issues, repressed memories, mind reading, and hocus-pocusnew-age-feel-good-selfhelp-or-hysteria-nonsense.

17 Myth #2 Some human behavior just cannot be understood.

18 Myth #3 The medical model or disease model is the only viable way to understand and treat mental illness.

19 Myth #4 Mental illness is a function of nature not nurture.

20 Myth #5 Medication is the only effective treatment for mental illness.

21 Myth #6 Once mentally ill, always mentally ill.

22 Myth #7 Mental illness is highly associated with violence.

23 Myth #8 Mental illness precludes one from being an effective parent, productive adolescent, engaged citizen, etc.

24 Myth #9 Courts have a limited role in helping treat mental illness.

25 Myth #10 Mental illnesses are the same no matter where you go.

27 Bonus Myth Psychologists and other mental health professionals make a ton of money.

28 DSM-5: Controversy Development process Net widening Net shrinking Financial Stigma handbook?

29 The Bipolar Diagnosis Explosion The frequency of diagnosis of bipolar disorder in adolescent inpatient discharges increased by 5X over 10 years (Case et al, 2007) The frequency of diagnosis of bipolar disorder in adolescent outpatients increased by 40X over 10 years (Moreno et al, 2007) There is no credible scientific evidence indicating why this shift should have occurred We must look to diagnostic practices to understand how we got into this situation MUST require discrete episodes of illness with a return to baseline functioning!

30 1 2 3

31 Over-Reliance on Vague Symptoms Current over-diagnosis seems related to reliance on symptoms of anger, irritability, and impulsivity - symptoms far from specific to ADHD, bipolar disorder, etc.

32 Strategies

33 Managing Challenging Behaviors IT IS NOT ABOUT YOU!

34 Managing Challenging Behaviors A triad of core characteristics that can help Honesty Humility Humor

35 Managing Challenging Behaviors Acknowledge concerns Manage expectations Empathize Avoid the hook Contain emotions Focus on concrete tasks

36 Final thought People in pain are very good at doing things that are bad for them in order to feel better

38 If you are not a member of the NCJFCJ, please join today just visit the registration desk!

The DSM-5: Juvenile Court Changes from a Mental Health Practitioner s and Defender s Perspective

The DSM-5: Juvenile Court Changes from a Mental Health Practitioner s and Defender s Perspective Presented by: Antoinette Kavanaugh, Ph.D Forensic Clinical Psychologist, IL Mary Ann Scali, JD, MSW National