By SONJA BISBEE WULFF
The Coloradoan
Dec. 1, 1999

Dr. Christian Hageseth III has closed his longtime practice under order from the Colorado Board of Medical Examiners.

For more than a year, the state regulatory board has been investigating a formal complaint filed by the ex-husband of former patient Laurel Burson, who is now Hageseth's wife.

Last week, the board permanently revoked his medical license, effective immediately.

"They've taken away my ability to care for people," said Hageseth, who's practiced in Fort Collins for 21 years. "It's immensely painful."

Paul Burson, who won a civil suit against Hageseth in Larimer District Court, claims the psychiatrist counseled his wife to leave him and then developed a sexual relationship with her.

Hageseth, 58, denies the charges, saying he didn't "become intimate" with Burson until a year after her therapy ended.

A local jury awarded Paul Burson $217,373 in damages in April 1998. Last fall, the American Psychiatric Association expelled Hageseth from its roster for "unethical conduct."

Hageseth married Laurel Burson on Oct. 30, 1998, and continued his local practice - until last week when he lost his license. Hageseth said he feels "bad that people got hurt," but he called the board's decision "irregular and highly unfair."

"I have had four experts evaluate me," he said. "All four say I'm safe to practice, and there's no danger."

Hageseth said he's seen other psychiatrists get romantically involved with patients yet receive only a slap on the wrist from the medical board.

Hageseth, who's already spent $50,000 in legal fees plans to plead his case to Gov. Bill Owens.

"All I did was love this sweet woman," he said.

Loss another crisis for those who need help

By SONJA BISBEE WULFF
The Coloradoan

The Fort Collins mental health community is reeling from the abrupt loss of psychiatrist Dr. Christian Hageseth.

In a community already short on psychiatrists, Hageseth has maintained a full practice, including a large number of indigent patients, for the past 21 years. Recently he has handled almost a third of patients hospitalized at Mountain Crest.

But now when these patients call his office, they get a recording directing them to the Yellow Pages.

The Colorado Board of Medical Examiners, has revoked Hageseth's license, his patients are learning this week through the mail.

"We felt it immediately," said Dr. John Nagel, medical director at Mountain Crest, who has been deluged with calls from panicked Hageseth patients, some in urgent need of medication.

Nagel criticized the state medical board for not giving Hageseth the two or three months needed to transition psychiatric patients smoothly to new physicians.

"It puts a lot of people and a lot of lives at risk," he said.

The most vulnerable patients are those among the low-income population, said Joan Cmar, a therapist with Poudre Health Services District's Mental Health Connections.

With the shortage of local psychiatrists, people with health insurance have trouble accessing care, said Cmar, who's also received numerous calls from Hageseth's patients. For people who can't pay, it's next to impossible, she said.

"(Hageseth) connected to the indigent population more readily than any other psychiatrist in town, Cmar said. "It's going to be a huge loss for the community."

The other major concern is for psychiatric patients who require hospitalization.

Only four psychiatrists - including Dr. Cliff Zeller, who was recruited this fall - remain on staff at Mountain Crest.

"We have been in something of a scramble to cover all the bases," Nagel said.

The result will be more instability, Cmar said.

Untreated mental illness can lead to family difficulties, unemployment, violence, suicide and a host of other problems, she said.

Mountain Crest is actively recruiting psychiatrists, with a couple of possibilities in the works. However, since the candidates are not from Colorado, they would have to go through a lengthy licensing process.

"It's probably months off," Nagel said.

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Discover how therapy and medications are used in the treatment of phobias - agoraphobia, social phobia, specific phobias.

Treatment of phobias involves behavior therapy, medication, and counseling.

Agoraphobia

Treatment of agoraphobia involves

• patient education,
• behavior therapy (exposure with response prevention), and
• medication.

Patients need to understand their condition and receive reassurance that they are not "going crazy" and that their condition can be managed. Because they may have received some explanation that their symptoms are caused by a medical disease, they need to be educated about agoraphobia.

Exposure with response prevention is a very effective behavior therapy for people with agoraphobia. In this treatment, the patient (1) is exposed to a situation that causes anxiety or panic and then (2) learns to "ride out" the distress until the anxiety or attack passes. The duration of exposure gradually increases with each session. This treatment works best if the patient is not taking tranquilizers because tranquilizers can prevent the experience of anxiety.

Antidepressant medications (except bupropion, Wellbutrin ®) have been shown to reduce the occurrence of panic attacks. Some studies have shown paroxetine (Paxil ®) to be quite effective.

Benzodiazepines are effective in treating anticipatory anxiety as well as symptoms of panic attacks.

Social Phobia

Treatment of social phobia involves

• behavior therapy (exposure with response prevention)
• social skills training, and
• medication.

Most people benefit from combining medication with supportive counseling or group therapy. Also, avoiding alcohol and drugs is of particular importance for people with social phobia, because social withdrawal and isolation typically accompany substance abuse.

Exposure with response prevention is an effective treatment for social phobia. It is particularly useful in a group therapy setting, which can provide a social or performance situation for the patient.

In social skills training, first, the sills lacking are identified. The patient is then taught appropriate skills. They practice skills in a group therapy setting and then practice them in social situations they encounter in their daily activities.

Medications used to treat social phobia include:

• Paroxetine and other SSRIs
• Beta-blockers
• Monoamine oxidase inhibitors (MAOIs)
• Benzodiazepines

Paroxetine (Paxil ®), an SSRI antidepressant, has been shown to be particularly beneficial to adults with social phobia. This class of drugs is also used to treat generalized anxiety disorder and panic disorder. These drugs work by altering levels of serotonin (a neurotransmitter that affects many behavioral states), which helps reduce anxiety.

Beta-blockers prevent norepinephrine from binding to nerve receptors in many areas of the body. They slow the heart rate and are effective in reducing physical symptoms such as nervous tension, sweating, panic, high blood pressure and shakiness. Although the FDA (food and drug administration) has not approved beta-blockers for the treatment of social phobia, psychiatrists may prescribe them. They are effective in reducing symptoms performers experience with "stage fright."

Some small studies have shown monoamine oxidase inhibitors (MAOIs) to be helpful in treating social phobia. They are used to treat other psychiatric disorders, including major depressive disorder.

Benzodiazepines may also help control social phobia. They are used frequently to treat many anxiety disorders, including generalized anxiety disorder.

Specific Phobias

Treatment of specific phobias involves:

• exposure and response prevention,
• progressive desensitization, and
• medication.

There is a wealth of evidence that suggests that exposure and response prevention is the most effective treatment for specific phobias. This form of treatment is used to treat other anxiety disorders, including obsessive-compulsive disorder.

Progressive desensitization is not as effective as exposure and response prevention, but is used in people with specific phobias who have great difficulty facing the object or situation that causes their fear. This treatment involves learning relaxation and visualization techniques. The patient is exposed to the source of fear gradually. For instance, a person with fear of heights looks down from a second-story window of a skyscraper. Once the person begins to experience anxiety, they are removed from the situation. They then learn to visualize being in the situation without experiencing anxiety. Once they are able to look out that window without experiencing anxiety, they move up to the third-story window, and so on.

Benzodiazepines have been known to reduce anticipatory anxiety in people with specific phobia. For example, people who are afraid of flying may find that these drugs help control their fear and make flying possible.

SSRIs, like Paxil (Paroxetine), can be effective in controlling specific phobias. These drugs may be particularly helpful in people whose phobia interferes with their ability to function in normal daily activities, like riding the train to work or speaking in front of groups.

Sources:

• Hahlweg, K., W. Fiegenbaum, M. Frank, and others. "Shortand Long-Term Effectiveness of an Empirically Supported Treatment for Agoraphobia." Journal of Consultative Clinical Psychology 69 (June 2001): 375-382.
• Walling, Anne D. "Management of Agoraphobia." American Family Physician 62 (November 2001): 67.
• National Institute of Mental Health (NIMH). Anxiety Disorders. NIH Publication No. 00-3879 (2000).
• Zoler, Mitchel L. "Drug Update: SSRIs in Social Phobia." Family Practice News31 (February 1, 2001): 28.
• Bourne, Edmund J., Ph.D. Beyond Anxiety and Phobia: A Step-by-Step Guide to Lifetime Recovery.Oakland, CA: New Harbinger Publications, 2001.
• Antony, Martin, M., Ph.D., and Richard P. Swinson. Phobic Disorders and Panic in Adults: A Guide to Assessment and Treatment.Washington, DC: American Psychological Association, 2000.

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Panic attack sufferers engage in catastrophic thinking. Remember, people get over panic attacks.

Now we are continuing the "thinking" part of the relaxation work. Remember how we explained that clear thinking can lead to calm breathing and vice versa? We're now going to demonstrate an essential component to controlling your thoughts in order to empower you to control your bodily responses.

Although not a relaxation technique per se, there is one simple thought that will calm you down immediately:

Your panic attack is not a catastrophe

This panic attack or anxiety state in which you find yourself feels like a catastrophe, but in reality, it is not.

If you think about it, a catastrophe is a situation which won't get better or which will drastically alter your and your loved one's lives in a profoundly and perhaps chronically negative way.

In contrast:

• Panic attacks end, usually within ten minutes.
• People get over panic attacks; you don't have a life sentence of panic.
• Your panic attack is not effecting the safety or health of someone you love.

Therefore, your panic is NOT a catastrophe. It certainly feels bad, but it will end; you will not suffer for the rest of your life.

People's tendency to feel like they are in the midst of a catastrophe in situations that are serious and upsetting, but not necessarily catastrophic, is called "catastrophizing" by psychologists. Beyond helping to achieve some perspective on the reality of panic attacks, understanding the concept of "catastrophizing" is also a useful tool when you are not feeling panicked, but need to cope with an unpleasant situation.

People tend to catastrophize when they lack mature coping skills. This is not a criticism. Many, many people manage to make it to adulthood without ever developing the coping techniques they will need to face adversity. Whatever the reasons that might have caused a given person to grow-up without coping techniques, the good news is that they can be learned. In the meantime, learning to get a hold of catastrophic thinking is a first step in banishing your panic and putting you in the position to develop functional coping mechanisms.

People catastrophize because of a phenomenon known as "regression." When we are upset and we lack coping techniques, we regress: go back to a time in our lives (childhood) when our thinking was very black and white. Black and white leaves no room for gray, so something is either perfect or else it is a catastrophe -- there is no room for the middle ground of experience. In the next two lessons, we will be discussing regression and healthy ways to overcome the instinct to regress.

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While depression in older adults is the mental health problem most often discussed, anxiety is the most common disorder they actually face.

In older adults, anxiety is twice as likely to strike as depression

Sometimes James Coats would wake his family in the darkness of a quiet night because he was sure he was about to die. His chest hurt, he felt dizzy, and he had an overwhelming sense of doom."I'd haul my wife and children off to the emergency room at two or three in the morning, because I thought I was having a heart attack," says Coats, 56, a semi-retired construction contractor who lives near Raleigh, N.C. "I'd find out it wasn't a heart attack, but it sure felt like one."

Coats had other unexplained symptoms. His heart rate and respiration would suddenly increase. He would begin to perspire excessively, and tremble. But most of the time he would be filled with a pervasive anxiety that left him incapable of doing such simple things as leaving the house.

It took nine years for Coats to find out that he has an anxiety disorder, and only after the proper diagnosis did he get the help he needed.

The Other Mental Health Problem

While depression in older adults is the mental health problem most often discussed, it is not the most common one faced by older adults -- a fact publicized in a new government report, Mental Health: A Report of the Surgeon General, released in December 1999.

Anxiety disorders, like the kind experienced by Coats, are the most common form of mental illness among adults, including those age 55 and older, according to the report. These conditions -- such as panic attacks, phobias, and obsessive-compulsive disorder -- are "important but understudied conditions in older adults," according to the report.

People age 55 and older are more than twice as likely to suffer from anxiety as depression. According to estimates in the report, during any one year, about 11.4 % of adults age 55 and older have anxiety, compared to 4.4% who have a mood disorder such as depression.

The 458-page report - the first-ever on mental illness from the U.S. Surgeon General - incorporates reams of recent research from all age groups. Like past reports on such health issues as smoking, this one tries to enlighten the public about a health problem so they can "confront the attitudes, fear, and misunderstanding that remain as barriers [to treatment] before us," Surgeon General David Satcher, M.D., Ph.D., writes in the preface.

R. Reid Wilson, Ph.D., who treated James Coats, is a psychologist at the University of North Carolina, Chapel Hill, and also has a private practice. "Anxiety disorders in the older population appear to be an unrecognized and unaddressed problem," he says.

Defining the Problem

The umbrella term "anxiety disorder" is used to describe a range of mental health problems, including:

• Phobias, such as fear of flying, heights, or public places
• Panic disorder, or the sudden feeling of impending doom
• Obsessive-compulsive disorder, in which people experience senseless or distressing thoughts that lead them to repeat actions, like hand washing multiple times in rapid succession
• Generalized anxiety disorder, often described as "a constant state of worry"

Occasional feelings of anxiety are a normal part of life, but anxiety disorders cause people "to become preoccupied with their thoughts to such an extent that it disrupts their everyday lives and drains their mental energy," says Wilson.

Like Coats, many older adults suffer for years without knowing what is wrong with them, Wilson says. Only a third of those afflicted seek treatment. Some may feel stigmatized; others may not be aware that the symptoms they are experiencing are part of a treatable mental health condition. According to the Surgeon General's report, anxiety disorders usually first appear when people are younger, but the stress of aging -- deteriorating health, bereavement over the loss of a spouse -- can cause their reappearance in later years.

Help Is at Hand

Today, more is known about treatment for anxiety, and according to mental health experts and research studies, the success rate is usually high, with obsessive compulsive disorder often the only exception. Individual counseling and group therapy can help people understand their anxiety disorder and situations that can trigger it. They can also learn coping methods, such as relaxation techniques. While medications like benzodiazepines have been tried, according to the Surgeon General's report, such drugs are more effective for episodes of acute anxiety in older adults than for the treatment of chronic, or ongoing, anxiety.

After two years of group therapy, Coats learned how to use such techniques as exercise, self-help groups, and relaxation tapes to help him cope with his anxiety. "I'd say I was plagued by it for 16 years,'' he says. "I used to keep it all to myself and not talk about it. But now I find the more I talk about it and face my anxiety, the better I feel."

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What Psychiatrists Hate: (A Unique Poll)

Among these: Ritual abuse legends, Multiple Personality theory, Repressed memories of childhood sexual abuse trauma, The APA's DSM IV, Psychodynamics, Psychoanalysis, Shock treatment, Freud, Laing, Frontal lobotomy, anal personality tests.

THE INDEPENDENT (London)
March 19, 2001, Monday; Pg. 5
BY Jeremy Laurance Health Editor

DOCTORS TEND to bury their mistakes but a group of the world's leading psychiatrists has chosen to dig them up and put them on display - in the hope of avoiding similar mistakes in the future.

A unique poll of 200 specialists in mental health from around the globe has produced a selection of the worst publications in the history of their discipline.

The results of the poll, carried out on the eve of the millennium 14 months ago, have been seen by The Independent. They show a psychiatric profession at the start of the 21st century throwing off the shackles of the past and dismissing some of the greatest names of the last century.

Among the nominations for the worst research paper ever published were: Sigmund Freud, father of psychoanalysis, nominated for his complete works; R D Laing, leader of the 1960s anti-psychiatry movement, nominated for The Divided Self; and Egaz Moniz, inventor of psychosurgery (the frontal lobotomy) and one of only two psychiatrists to win the Nobel prize.

The exercise, to mark the millennium, was partly tongue in cheek but partly intended to highlight where psychiatry had almost run off the rails. It shows psychiatrists dismissing the "shock 'em and slice 'em" brigade as well as challenging the psychoanalytic movement.

"They show we are ruthless iconoclasts," said Simon Wessely, professor of psychiatry at King's College and the Maudsley Hospitals, south London, and organiser of the poll.

The poll was followed by a meeting held at the Maudsley hospital attended by 150 psychiatrists at which a votes were cast to decide the ten worst papers of the millennium from over 100 nominations. The inclusion of Freud in the final list, at number six, was "slightly tongue in cheek" but also reflected the widespread view that despite having a major literary and cultural impact he had done nothing for patients, Professor Wessely said.

R D Laing, the charismatic and influential psychiatrist who argued in the 1960s that it was not schizophrenics who were mad but society, was included for the harm his misguided theories had wreaked. "It was bad enough for parents having a child who was schizophrenic but being told it was their fault was even worse. It is true parents can influence the outcome of the illness but no one now thinks they are the cause," Professor Wessely said.

Egaz Moniz, the most nominated individual in the poll, was shot dead by a disgruntled patient. The surgery he invented turned people into automatons and is now rarely performed. After winning the Nobel prize in 1949, he went on to write a history of playing cards.

Professor Wessely said that the selection was "utterly unscientific" and that nominations from the Nazi era were excluded because they would have swept the board. Despite that, research carried out in the name of psychiatry over the last century reached in some cases bizarre and disturbing limits.

The accolade of worst research paper went to a brutal experiment carried out in the early 1940s. Scientists stopped the blood flow to the brain in 100 prisoners and 11 chronic schizophrenics by pressing the carotid artery in their necks - to see what effect it would have.

They measured the time before the unfortunate subjects lost consciousness and started fitting, observing in a paper published in Archives of Neurology and Psychiatry in 1943 that "no significant improvement in the psychiatric status of the schizophrenia patients was noted after repeated and relatively prolonged periods of arrest of cerebral circulation."

Professor Wessely said: "Wasn't that a surprise? It was a worthy winner."

THE TEN WORST PUBLICATIONS IN THE HISTORY OF PSYCHIATRY

1. Ralph Rossen: Acute arrest of cerebral circulation in man,1943. An extreme experiment involving almost strangling 100 prisoners and 11 chronic schizophrenics to test the effects of stopping blood flow to the brain. Scientifically dubious and ethically beyond the pale.

2. Valerie Sinason: Treating the Survivors of Satanic Abuse, 1994. Reopened controversy about ritual abuse of children. "Credulous, superstitious, iatrogenic illness-inducing , self-righteous, incendiary garbage," a nomination read.

3. Luke Warm Luke homicide inquiry, 1998: Inquiry into the killing of Susan Crawford, above, a mother of four and girlfriend of a schizophrenic patient, Michael Folkes, who stabbed her 70 times (he had changed his name to Luke Warm Luke). The high point of the blame culture and the stigmatisation of schizophrenics as random murderers. One psychiatrist said: "It implied that whenever anything bad happened it was somebody's fault and these very rare events can be prevented. But they can't."

4. Rosenwald G C et al: "An action test of hypotheses concerning anal personality", Journal of Abnormal Psychology, 1966. Subjects put hands in tubs of soil and slime; speed of action equated to personality. A psychiatrist said: "Shows how silly highly educated people can be."

5. Henry Miller: "Accident compensation neurosis", BMJ, 1961. Argued that people seeking compensation got better as soon as it was paid - shown since by much other research to be wrong. Hugely influential and still cited by neurologists in court cases.

6. The complete works of Sigmund Freud: 1880-1930. Nomination said: "His teaching led to the great psychodynamic movement with its tribalism and hostility to other models of mental illness and treatments. From this root we could select the mish-mash of persons excited about multiple personality disorders, sexual trauma in infancy and other nonsense."

7. Egaz Moniz: Invention of psychosurgery. Portuguese diplomat, present at the First World War armistice, introduced the idea of brain surgery - the lobotomy - to cure mental disorder. A nomination read: "His efforts were useless; his work should have died an aborted death."

8. William Sargeant and Elliott Slater: An Introduction to Physical Treatments in Psychiatry, 1946. Advocated shock treatment, psychosurgery, and more. "Epitome of the mindless period of psychiatry during and after the war."

9. RD Laing: The Divided Self, 1960. Argued that it was not schizophrenics who were mad but society, and the cause lay within the family. "Hugely influential among the chattering classes": "Arrogant, infuriating, confusing philosophy for psychiatry... just plain wrong."

10. DSM-IV - Diagnostic and Statistical Manual: (4th ed). Containing every psychiatric diagnosis, it is criticised for reducing psychiatry to a checklist. "If you are not in DSM-IV, you are not ill. It has become a monster, out of control."

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Difference between night terror and nightmare explained. What causes a child to have night terrors and how parents can help.

It's 10 p.m. As your head hits the pillow, a blood-curdling scream from your toddler's bedroom propels you like a shot down the hallway. You find her sitting up in bed. Wide-eyed, she's screaming and flailing her arms. It's one of the scariest things you've ever seen. As you rush to her, you see she doesn't appear hurt or sick. It must be a nightmare, you think. "I'm here," you say as you put your arms around her wriggling body. But the more you try to calm her, the more upset she gets.

What's going on?

Most likely, your child is having a night terror - a relatively common occurrence that appears mostly in young children, typically between the ages of 3 to 5 years. Two to 3% of all children will experience episodes of night terrors. By the time they reach school age, most of these children will have outgrown these generally harmless events.

"It's frightening but is not unusual or dangerous to a child," says Harry Abram, MD, a pediatric neurologist. "As the brain matures and a child's sleep pattern matures, the terrors go away."

Night Terror or Nightmare?

A night terror is not the same thing as a nightmare. Nightmares occur during the dream phase of sleep known as REM sleep (this stands for Rapid Eye Movement; also known as "dreaming" sleep). The circumstances of the nightmare will frighten the child, who usually will wake up with a vivid memory of a long movie-like dream. Night terrors, on the other hand, occur during a phase of deep non-REM sleep - usually an hour or two after the child goes to bed. During a night terror, which may last anywhere from a few minutes up to an hour, the child is still asleep. Her eyes may be open, but she is not awake. When she does wake up, she'll have absolutely no recollection of the episode other than a sense of fear.

Why Does My Child Have Night Terrors?

Several factors may contribute to your child's night terrors. It's likely that if you or your spouse had night terrors, your child will, too. Fatigue and psychological stress may also play roles in their occurrence. Make sure your child is getting plenty of rest. Be aware of things that may be upsetting to your child, and to the extent you are able, try to minimize the distress.

Children usually have night terrors at the same time each night, generally sometime in the first few hours after falling asleep. Doctors suggest you wake your child about 30 minutes before the night terror usually happens. Get your child out of bed, and have her talk to you. Keep her awake for 5 minutes, and then let her go back to sleep.

Night terrors can be a frightening phenomenon of childhood but they are not dangerous. If they occur frequently or over a long period of time, however, discuss this with your child's doctor.

What Can I Do?

It's helpful to know that although these events may be disturbing for you, night terrors themselves are not harmful to your child. But because a child may get out of bed and run around the room, doctors do advise parents to gently restrain a child experiencing night terrors. Otherwise, let the episode run its course. Shouting and shaking your child awake will just agitate her more. Remember to warn babysitters and other family members who may be present overnight so that they will understand what is happening and won't overreact.

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USA Today Series
12-06-1995

Dick Cavett, talk-show host. "In my case, ECT was miraculous. My wife was dubious, but when she came into my room afterward, I sat up and said, 'Look who's back among the living.' It was like a magic wand,'' he wrote in People in 1992.

Lou Reed, rock musician. "Lou's conservative parents, Sidney and Toby Reed, sent their (17-year-old) son to a psychiatrist, requesting that he cure Lou of his homosexual feelings and alarming mood swings. . . . Lou suffered through eight weeks of shock treatments haunted by the fear that in an attempt to obliterate the abnormal from his personality, his parents had destroyed him,'' according to Transformer: The Lou Reed Story.

Thomas Eagleton, former Democratic senator. He lost the Democratic vice presidential nomination in 1972 when it was revealed that he received shock treatment for depression.

Ernest Hemingway, writer. He had shock therapy at the Mayo Clinic in 1961, shortly before committing suicide. He told biographer A.E. Hotchner, "What is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient.''

Sylvia Plath, poet. She wrote a shock therapy scene in her autobiographical novel The Bell Jar: "I wondered what terrible thing it was that I had done'' to get shock therapy.

By USA TODAY

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Night terror defined. Causes and symptoms of night terrors and how to help someone experiencing night terrors.

First of all, before getting into detail about what this entails, I would like to state a night terror is nothing like a nightmare. This is a common misperception and misdiagnosis for those who don't fully comprehend the situation or what the individual is trying to explain. This is frustrating for those actually experiencing the night terrors because they feel their problem is being slighted and not taken seriously.

Have you ever spoken to someone who has gone through a night terror or witnessed an individual actually going through one? Speaking to someone about it first hand is really quite interesting, but witnessing it can be very frightening. More frightening, I might add, for the witness than for the person going through the night terror. While it is more common for the individual not to recall the events, or pieces of the events the next morning, unlike with a nightmare, a surprising few remember every detail. No one really knows for certain why night terrors occur, but it has been determined that they can be manifested in several ways:

• eating too heavy of a meal before bedtime
• being over tired at bedtime
• certain medications
• too much stress

Be advised, night terrors are not the sign or result of a psychological disorder. Most often there is nothing significant to become alarmed about. Night terrors are also misdiagnosed for Post Partum Stress Disorder. Anyone who has ever been through or witnessed a night terror will tell you this situation is not even close to that assessment.

Symptoms of night terrors include, but are not limited to the following:

• sudden awakening
• persistent terror at night
• screaming
• inability to explain what happened
• sweating
• confusion
• rapid heart rate
• usually no recall
• crying
• eyes may be open, but they are sleeping
• some remember parts, while others are able to remember the entire thing

Night terrors have been reportedly occurring in approximately five percent of children between the ages of three and five. Studies have indicated these instances do occur in adults also, but are far less common. If you are concerned about someone you know experiencing night terrors, there are some things you can do to help make it less dangerous for the individual:

• remove anything they could come in contact with that could cause harm to them physically
• do not tell them they are only dreaming or yell at them, it is more disturbing than helpful
• do not try to be forceful or make physical contact, you may hurt yourself or the individual
• speak in a reassuring voice and be there for them at the end for comfort
• keep in mind they do not know what they are doing

Remember that their panic can last between five and twenty minutes after the night terror has ended. The best thing you can do, no matter how disturbing the situation is to witness, is not to overreact. This will create nothing positive out of this already stressful event. If you notice this is becoming a nightly ritual with you child, it may be a good idea to contact their health care provider. That way anything more significant can be ruled out or addressed and dealt with properly.

next: Coping with Night Terrors
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Testimony of Anne Krauss, former staff member of the NY OMH Before the Mental Health Committee of the NY State Assembly

Hello. My name is Anne Krauss. I'm presently employed as the Administrator for the National Association for Rights Protection and Advocacy, although I am here today as a private citizen, not as a representative for that organization. Up until March 21 this year, I worked for the New York State Office of Mental Health as Recipient Affairs Specialist for Long Island. On March 9, I received a call from John Tauriello, Deputy Commissioner and Counsel of the New York State Office of Mental Health (NYS OMH) and Robert Meyers, NYS OMH Deputy Director of the Division of Community Care Systems Management. They informed me that if I continued to actively advocate on behalf of Paul Thomas in his efforts to prevent Pilgrim Psychiatric Center from shocking him, OMH would view this as a conflict of interest with my employment. I explained that I was engaged in this activity on my own time and at my own expense. However, they insisted that, since Mr. Thomas is engaged in a legal battle with the organization for which I worked, that it would be unethical for me to advocate for Mr. Thomas while working for OMH. On March 21, I submitted my letter of resignation, which was accepted on March 22.

Up until December, 2000, electroshock had not been an issue to which I had devoted much attention. I would have been surprised to learn that less than four months later, electroshock would be the issue which would lead me to resign. When I learned in December that Pilgrim Psychiatric Center was seeking to treat a patient with electroshock against his family's wishes, I began to seriously educate myself about this complicated issue. When I learned that Paul Thomas, whom I first met in 1998, had received over 50 shock treatments in less than two years despite his objections, I felt compelled to act.

I am a person who firmly believes that it is important to gain a scientific understanding of a problem before reaching any decisions about a course of action. I come from a family of scientists. Both my father and my brother were educated at the California Institute of Technology. I was a physics major at Harvard University when I married and dropped out to raise a family. My husband received a Ph.D. at Cal Tech in biochemistry after receiving a medical degree at Cornell College of Medicine. I eventually finished my undergraduate education at Empire State College, then entered a Ph.D. program in experimental psychology and cognitive neuroscience at Syracuse University. Once again, family obligations cut short my educational pursuits, but my devotion to scientific approaches remains unwavering.

Proponents of ECT claim that research overwhelmingly supports the hypothesis that electroshock is safe and effective. A cursory glance at the research literature would appear to support this claim. However, I would caution the members of this Assembly Committee to look very closely and critically at the scientific evidence which is currently available. In ten minutes, there is not time to adequately examine what research has been done, or, more importantly, what research has not been done. Even if this whole day were devoted to understanding the research picture, we could only scratch the surface. However, let me share some information which I hope will pique your curiosity, as it did mine, so that you will withhold judgment until you have time to thoroughly investigate the evidence.

Electroshock devices are classified by the Food and Drug Administration as Class III medical devices. Class III is the most stringent regulatory category for medical devices. Electroshock devices were placed in this category because of their potential to cause unreasonable risk of illness or injury. These devices can be marketed under current regulations only because they have been "grandfathered" in by virtue of being marketed prior to 1976, when the medical device classification and regulation system was put into place. The manufacturers of these devices have never submitted the evidence which the premarket approval process requires of all devices introduced after 1976. Premarket approval is a process of scientific and regulatory review to ensure the safety and effectiveness of class III devices. Keep this in mind if you hear that older reports of neuropathology resulting from electroconvulsive therapy in experimental animals and humans are "outdated". Similar studies have not been conducted using contemporary shock techniques and devices. Such studies have not been required for marketing, since these new devices are accepted by the FDA to be "as safe and as effective or substantially equivalent" to the older devices. Until such studies are conducted, there is a lack of scientific evidence that these newer devices actually are safer, as claimed.

You may have noticed that I prefer the term "electroshock" rather than "ECT" or "electroconvulsive therapy". The term ECT implies that the effectiveness of the treatment depends upon the production of a convulsion, or seizure. If this were indeed the case, the safest device would use the minimum dosage of electricity necessary to induce a convulsion. Such a device was developed, and, indeed, the memory changes, confusion, and agitation observed in people shocked with this device were not as large as observed in association with higher dose machines. However, use of low dose machines was abandoned, because psychiatrists found them considerably less effective. This suggests that the size of the electric shock, rather than simply the length of the convulsion, plays an important role in this treatment. It also suggests that negative side effects are inseparable from what psychiatrists perceive as the therapeutic effect. It is also interesting to note that even proponents of electroshock do not claim a therapeutic effect lasting longer than a few weeks, which coincidentally is the same length of time required for the most obvious of the memory disruptions to clear.

In considering the evidence, I also caution you to distinguish between solid research evidence and mainstream medical opinion. Remember that Moniz was awarded a Nobel prize for the lobotomy, which was considered a major medical breakthrough in its day. Remember also that tardive diskenesia was recognized by critical researchers and, yes, anecdotally by patients, for well over a decade before the medical establishment was willing to admit the true dimensions of this serious problem associated with pharmaceutical treatment of psychosis. Remember this before you hastily marginalize researchers and patients who are critical of electroshock.

During these past five months I have learned that, despite rhetoric which pays lip service to a concept of recovery from psychiatric disability based on self-help and empowerment, in practice OMH acts as though the only legitimate treatments are pharmaceuticals or electroshock. Twelve years ago I was hospitalized with what was diagnosed as a schizophreniform psychosis, and I had experienced considerable psychiatric disability even prior to my hospitalization. Symptoms of neuroleptic malignant syndrome, a life-threatening side-effect of medication, abruptly ended the pharmaceutical treatment I had been receiving. Since that time, a combination of psychotherapy and self-help through peer support have helped me to recover to a point that I no longer consider myself to have a psychiatric disability.

I realize that my story can be criticized as anecdotal, however, a careful review of the literature will reveal considerable evidence that, even for people experiencing extreme psychiatric states, effective alternatives exist other than drugs and shock. Dr. Bertram Karon conducted a study in which psychotherapeutic treatment of people diagnosed with schizophrenia was compared to pharmaceutical treatment. This study, which was funded by NIMH, provided evidence that the outcomes for the group treated with psychotherapy were superior to those of the drug treated group.

In his book, Recovery from Schizophrenia, Richard Warner compares conditions in non-industrialized countries to those in the West, in an effort to explain why, although the appearance of altered state is relatively constant across cultures, recovery rates seem to be much higher in the non-industrialized world. The factors he identifies which appear to promote recovery in non-western cultures are remarkably similar to those present in the self-help community which I found helpful in my recovery.

Both of the people I know for whom OMH is seeking court ordered shock have not been given adequate access to psychotherapy. Limitations on visitation have also seriously curtailed their access to peer support. One person is still not permitted to receive visitors other than immediate family members. The ward environment in which he must live would be stressful for anyone, and certainly has not been designed to effectively promote recovery in a person who is experiencing an altered state. Yet OMH claims that electroshock is the only available option for both of these individuals, because of dangerous effects each has experienced from drug treatment.

Recommendations:

At a minimum, a moratorium on forced electroshock treatment should be sought in New York State until FDA premarket approval requirements are met. No person should be involuntarily subjected to treatment with a Class III device for which the FDA has not yet received reasonable assurance of both safety and effectiveness. Acceptance by the medical community is not a substitute for rigorous testing.

Reporting requirements for basic information on each procedure administered in New York should be instituted, including patient age, location of treatment, status as voluntary or involuntary patient, and any death of a patient occurring within two weeks of the procedure. Similar reporting requirements in Texas indicate that a person receiving 60 treatments, the number Mr. Thomas has undergone in the past two years, faces a risk of death of approximately 2%. A retrospective study of electroshock in New York would also be illuminating.

Capacity determinations should be made by psychologists, not by psychiatrists, and certainly not by the same psychiatrists whom have determined that a particular treatment is the best or only treatment option. Under the present system, disagreement with the psychiatrist's opinion is considered evidence of "lack of insight", which in turn is viewed as a symptom of mental illness. Separating the issue of capacity to make a reasoned treatment decision, which is more of a psychological than a psychiatric question, from the question of agreement or disagreement with the proposed treatment, could effectively address this problem. Legislators could gain a better understanding of this issue if they read the transcript of Mr. Thomas' hearing.

It is very difficult to devise a legislative approach to guaranteeing that patients will have access to alternatives to electroshock. Increased funding and continued support for psychotherapy and self-help, including research in these areas, is important. However, as long as mental health treatment is ultimately under the control of psychiatrists, it is likely that alternatives to somatic treatments will not be viewed as legitimate. Psychiatry tends to view all mental difficulties as resulting from physical abnormalities in the brain. At the risk of oversimplification to make a point, I'll claim that in many cases this makes about as much sense as blaming the Intel Pentium processor for Microsoft's buggy software. Perhaps psychiatry's "hardware" bias could be offset through giving greater power to both psychologists, who by analogy are "software" experts, and to those of us who have experienced altered state, and know in the most intimate and direct way how somatic treatments and human relationships impact upon us.

next: Victim of Forced Electroshock The Kathleen Garrett Story
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