Chemically Imbalanced: Everyday Suffering, Medication, and Our Troubled Quest for Self-Mastery
Chemically Imbalanced is a field report on how ordinary people dealing with common problems explain their suffering, how they're increasingly turning to the thin and mechanistic language of the "body/brain," and what these encounters might tell us.
Today in Labor History December 15, 1973: The American Psychiatric Association voted to remove homosexuality from its official list of psychiatric disorders, the Diagnostic and Statistical Manual of Mental Disorders. In the 1950s and 1960s, some therapists used aversion therapy to "cure" male homosexuality. Like in Anthony Burgess’s, “A Clockwork Orange,” they would show patients pictures of naked men while giving them electric shocks or drugs to make them puke. In the 1973 vote, 5,854 members voted to remove homosexuality from the DSM, while 3,810 voted to retain it. In a compromise, they agreed to remove homosexuality from the DSM, but replaced it with "sexual orientation disturbance" for people "in conflict with" their sexual orientation. They did not completely remove homosexuality from the DSM until 1987.
@MikeDunnAuthor@bookstadon
What an insane world that 5,000 PhDs got to 'debate' and determine what's 'curable' and what's not; but I guess letting a bunch of elected Libertarian wallies make regressive choices is just as nuts
In the Aotearoa New Zealand the people who voted for 'parental choice' and against removing conversion therapy as a 'treatment' are part of NZ's Coalition of Chaos #nzpol#conversiontherapy#mentalhealth
TITLE: Correctional Psych: Links to 15 Articles on Addressing the Mental Health Needs of Justice-Involved Individuals in Custody & the Community
Thank you Dr. Pope.
-------- Forwarded Message --------
Correctional Psych: Links to 15 Articles on Addressing the Mental Health Needs of Justice-Involved Individuals in Custody & the Community
Psychiatric Services issued the following announcement about a curated collection of articles:
Correctional Psychiatry: Addressing the Mental Health Needs of
Justice-Involved Individuals in Custody and the Community
/Editor’s Choice provides essential curated collections from recent issues of Psychiatric Services/.
The legal aims of the correctional system are to protect the community and to punish, deter, and offer rehabilitation to the offender. These goals may be at odds with the aims of psychiatric providers working in such settings. Consequently, jails and prisons can be challenging settings for the provision of mental health services for patients, providers, and the correctional staff. Even so, encounters with the criminal justice system can create opportunities for individuals with a severe mental illness, a substance use disorder, or both to obtain needed treatment that may otherwise be unavailable or difficult to access or that an individual would not choose to pursue in the community. With the development of diversion models and community-based forensic programs, such patients now have access to unique treatment strategies addressing concomitant legal and mental health needs.
This collection provides an update regarding correctional mental health care. The provision of mental health services within correctional environments continues to pose unique challenges, such as limited access to medications that are readily available in the community. Diversion programs that transition justice-involved individuals with mental illness from traditional criminal justice pathways toward treatment may reduce the burden of severe mental illness within correctional facilities and the risks to patients in such settings. At the same time, patients may be hesitant to engage in systems that they perceive to be coercive or overbearing. Innovations in meeting the mental health needs of incarcerated and justice-involved patients remain vital due to the ongoing high prevalence of mental illness and barriers to care faced by these populations. /Brian Holoyda, M.D., M.P.H./ /Jacqueline Landess, J.D., M.D./ /Lisa B. Dixon, M.D., M.P.H. /
a) It's timely and vaguely related to the Iowa transgender material,
b) It's about a psychology professor,
c) It mentions Univ. of Florida turning over to the state government the mental health records of transgender students (!!)
See below.
Thank you Dr. Pope.
--- Forwarded Message ---
Subject: Psychology Prof Brought Millions to FL State U, Now Warns of Unsafe "Hostile Environment" for Black & LGBTQ Students, Faculty, & Staff
Date: Fri, 08 Dec 2023 07:01:51 -0800
From: [email protected]
The Tallahassee Democrat includes an article: “This professor brought millions to Florida State. Now he's leaving a 'hostile’ environment” by Walter R. Boot, Ph.D.
Here’s the author note:
Walter R. Boot, Ph.D., is a professor of psychology at Florida State University and has been a member of the FSU faculty since 2008.
Here are some excerpts:
In early 2022, “Don’t Say Gay'' became law based on the premise that the mere mention of LGBTQ people is dangerous. The run-up and aftermath of its passage involved hostile rhetoric painting queer and trans individuals as pedophiles and groomers, rhetoric that came not just from citizens but from state officials.
As it became increasingly clear that LGBTQ students, faculty, and staff at Florida State University had targets on their backs, I explained my concerns in an April 2022 email and made a simple request of FSU President Richard McCullough: give us a reason to stay.
<snip>
His response was something along the lines of, “If I say or do anything, I will be fired, and my replacement will be worse.” His office tells me that he disputes this account.
Later, I was told his refusal to express support was because “the University’s 501(c)(3) status limits the University’s participation in political advocacy.” My concerns were dismissed as mere politics. Since then, matters have only gotten worse.
In December 2022, the FBI alerted FSU to a threat of mass violence against gay people on campus. FSU has yet to acknowledge this threat publicly. We learned about it only through a newspaper article the next month after an arrest had been made.
Alarmed by this incident and concerned for campus safety, I again pressed President McCullough’s office to express support for queer and trans community members publicly. They did not.
Gov. DeSantis then demanded that universities turn over information about transgender students. Information requested included intimate information about treatments, surgeries, mental health diagnoses, and facilities that transgender students were referred to for care. FSU complied with this request, shifting its response from silence to active harm.
<snip>
Equality Florida and the Human Rights Campaign have issued travel advisories citing the very real perils of traveling to or living in Florida while queer or trans. At FSU, these perils are exacerbated by uncaring leadership.
I will be leaving FSU at the end of this year. The purpose of my message is not to change the mind of members of the administration. Any additional efforts seem futile. It is to foreshadow the experience of anyone considering FSU as their home, particularly individuals who are Black, trans, gay or lesbian, queer, or who belong to any other group currently under siege by the state of Florida.
I brought millions of dollars of funding to FSU, volunteered for service roles demanding significant commitments, and stepped up to teach classes no one else could or would. I went above and beyond what is required again and again.
Yet, President McCullough remains unwilling to even offer a few words of public support for queer and trans members of the FSU community.
If you are considering FSU as your home, do not expect them to make any effort to support or protect you in an increasingly hostile and dangerous environment for people like us. Consider your options carefully. You deserve better than what FSU has to offer.
Ken Pope
Ken Pope, Nayeli Y. Chavez-Dueñas, Hector Y. Adames, Janet L. Sonne, and Beverly A. Greene
Speaking the Unspoken: Breaking the Silence, Myths, and Taboos That Hurt Therapists and Patients (APA, 2023)
Hector Y. Adames, Nayeli Y. Chavez-Dueñas, Melba J.T. Vasquez, & Ken Pope:
Succeeding as a Therapist: How to Create a Thriving Practice in a Changing World (APA, 2022)
Ken Pope, Melba J.T. Vasquez, Nayeli Y. Chavez-Dueñas, & Hector Y. Adames:
Ethics in Psychotherapy & Counseling: A Practical Guide, 6th Edition (Wiley, 2021)
“When people show you who they are, believe them the first time.”
—Maya Angelou
Iowa Senate File 538- gender transition procedures related to minors strips providers of Medicaid funding from Sept 18 forward and doesn't allow Medicaid to be used by clients for gender affirming treatment. If a counselor has a transgender client, and has used the gender dysphoria code and many others (7 pages of ICD codes) then they will be retroactively stripped of funding. I am so angry for clients and for providers. As a clinician, I feel so mad that states are telling transgender youth in lower SES that they can't be who they truly are, and now they can't even talk to a counselor. I just can't. @socialwork@Email2TootBot#SocialWork#psych#psychology#iowa#lgbtqia#transgender#transgenderrights#counseling#counselor#therapist#therapy
Christine -- This is horrible! What do you mean by retroactive? Does Iowa Senate File 538 claw back past payments? Cut providers off from Medicaid for past use of those billing codes? Does it totally drop those providers from the Medicaid program?
I'll go read this bill when I can -- clients in a moment to see.
Okay -- quick look -- seems already signed by the governor but not in force yet. Is this tied-up in court?
@knitting@Curator@nature I seem to have hit a patch of sadness for no apparent reason in the middle of my shift. Please share cheerful, bright, happy things. They can be sarcastic cartoons, photos of nature, beautiful art, knitting, abstract weirdness, anything. I just need a perk up please. #mentalhealth#december
As November highlights to us the importance of inclusion, we delve into the records of Fulbourn Hospital (formally Fulbourn Asylum), held by Cambridgeshire Archives. Bringing light to mental health histories is instrumental in helping us learn today. We can understand better the lives that were lived, and the practices faced by the patients who were in this type of care.
Doctor appt today, and he happily wrote up all the pain relief I needed prescribed for my shoulder.
I thought it might be difficult to get him to prescribe endone, panadeine forte, mobic, panadol osteo, and palexia.. but we went over how I was taking them all and he agreed that I was fine with how I was approaching it - and that taking such a variety of things meant actually taking less opioid based meds because I was able to keep on top of the pain with things like panadol osteo.
We also did my mental health plan and I hit a 40 on the K10.. which is Very Fucking High. We talked about that, and about how therapy is helping and that a big part of the 40 score is probably actually pain related as well.
He agreed that I showed great insight into my illness and that I was comfortable with being vulnerable enough to ask for help, so I get to skip hospitalisation (fucking yay!) because I have a good support system and I know how to access acute assistance if needed.
But still, 40 was even higher than I was expecting tbh. I'm usually around a 25-27.
TITLE: Polite Example Letter to a Health-Related Website Endangering Your Privacy
THIS is the letter I wish more people would send to health-related websites and merchants when they observe a privacy problem!
fullscript.com is a service that dispenses non-pharma products to patients (like medical grade supplements) based upon doctor's orders. You have to be referred by a physician to get a patient account. They even have a way of integrating with EHR systems.
They need to get security right.
To: Fullscript Support <[email protected]>
Dear Fullscript Team:
I have always appreciated being able to order from your excellent website.
Your service strives to supply patients with supplements and medicines ordered by doctors. As such, what is ordered can give insight into medical conditions that patients may have.
You may or may not be covered by HIPAA regulations, but I'm sure you will agree that ethically and as a matter of good business practice, Fullscript would want to maintain medical privacy of patients given that medical practices trust you.
This is why I'm concerned with the HIGH level of 3rd party tracking going on throughout your product catalogue. On your login page, the Firefox web browser displays a "gate" icon to let me know that information (I believe my email address) is being shared with Facebook. This is also the case with your order checkout page (see attached screenshot showing Facebook "gate" icon, as well as Privacy Badger and Ghostery plug-in icons in upper right-hand corner blocking multiple outbound data connections).
Privacy Badger is a web browser plugin that detects and warns of or stops (depending upon severity) outbound information from my web browser to 3rd party URLs. Directly below is Privacy Badger's report from your checkout page:
~~~~
Privacy Badger (privacybadger.org) is a browser extension that automatically learns to block invisible trackers. Privacy Badger is made by the Electronic Frontier Foundation, a nonprofit that fights for your rights online.
Privacy Badger blocked 23 potential trackers on us.fullscript.com:
insight.adsrvr.org
js.adsrvr.org
bat.bing.com
static.cloudflareinsights.com
script.crazyegg.com
12179857.fls.doubleclick.net
12322157.fls.doubleclick.net
googleads.g.doubleclick.net
connect.facebook.net
www.google-analytics.com
analytics.google.com
www.google.com
www.googletagmanager.com
fonts.gstatic.com
ad.ipredictive.com
trc.lhmos.com
snap.licdn.com
o927579.ingest.sentry.io
js.stripe.com
m.stripe.network
m.stripe.com
q.stripe.com
r.stripe.com
~~~
Please note that I was able to successfully checkout WITH Privacy Badger blocking protections on, so most of this outbound information was NOT necessary to the operation of your website.
There are several advertising networks and 3rd party data brokers receiving some kind of information.
I am aware that a limited amount of data sharing can be necessary to the operation of a website (sometimes). I am also aware that this all is not malicious -- web development and marketing does not usually talk to the legal department before deploying tools useful to gathering site usage statistics (Crazy Egg and Google Analytics). However, these conversations need to happen.
As for "de-identified" or "anonymized" data -- data brokers collect information across several websites, and so are able to reconstruct patient identities even if you don't transmit what would obviously be PHI (protected health information). As an example, if Google sees the same cookie or pixel tracking across multiple websites and just one of them sends a name, then Google knows my name. If Facebook is sent my email address (as looks to be the case), and I happen to have a Facebook account under that same email address, then Facebook knows who I am -- and can potentially link my purchases with my profile.
The sorts of computing device data that you are collecting and forwarding here may well qualify as PHI. Please see:
Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates
<https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/hipaa-online-tracking/index.html>
This HHS and OCR guidance includes many 3rd party tracking technologies.
What I would really like to see happen is:
a) A thorough look at what information your website is sending out to what 3rd parties, along with an understanding of how data brokers can combine information tidbits from multiple websites to build profiles.
b) Use of alternative marketing analysis tools that help your business. For example, there are alternatives to Google Analytics that do not share all that data with Google and still give your marketing team the data they need.
c) An examination if you are sharing information about what products patients are clicking on and/or purchasing with 3rd parties. This would be especially problematic. (Crazy Egg tracks client progress through a website, but I'm unclear if they keep the information or just leave it with you.)
d) Use of alternative code libraries that are in-house. For example, web developers frequently utilize fonts.gstatic.com, but you could likely get fonts and other code sets elsewhere or store them in-house.
I appreciate you taking time to read this and working on the privacy concerns of your patients and affiliated medical practices.
Thanks.
~~~~~~
#AI #CollaborativeHumanAISystems #HumanAwareAI #artificialintelligence #psychology #counseling #socialwork #psychotherapy #EHR #medicalnotes #progressnotes @[email protected] @[email protected] @[email protected] @[email protected] @socialwork @[email protected] #mentalhealth #technology #psychiatry #healthcare #patientportal #HIPAA #dataprotection #infosec @[email protected] #doctors #hospitals #BAA #businessassociateagreement #coveredentities #privacy #HHS #OCR #fullscript
TITLE: Further Adventures in the HIPAA Silliness Zone
This short essay was inspired by a video I watched going over Microsoft legal agreements, the upshot of which is that they can harvest and use ALL of your data and creations (See *1 below in References). This inspires interesting HIPAA questions to say the least:
IF you have a HIPAA agreement with Microsoft, do they actually NOT harvest or use your data? How do they track that across all their applications and operating systems to tell?
Do their HIPAA and regular legal departments even talk to each other?
If you have a HIPAA agreement for your work computers, but then access your data through home computers, are all bets off? (And what sole proprietors don't mix use of computers for both?)
Now I don't really believe that Microsoft is doing all of this. What I THINK is that their lawyers just wrote overly broad legalese to protect them from all situations. Still -- legally it leaves us hanging. I certainly don't know that they are NOT doing it.
Then, I start thinking on some of the other crazy security situations I've encountered the past few years:
-- The multi-billion dollar medical data sales vendor that bought a calendar scheduling system, then wrote a HIPAA BAA agreement in which the PROVIDER has to pay any financial damages and penalties if THEY slip-up and lose data. (*2). Gee, what could go wrong?
-- The new AI progress notes generator service that sends data to 3rd parties including Google Tag Manager, LinkedIn Analytics, Facebook Connect, and Gravatar (*3)
-- The countless data breaches currently hitting hospitals across the USA. (*4)
It's all really quite mind numbing if you are a small healthcare provider or sole practitioner. I suspect 99% of us have just tuned this all out as noise at this point. After all, do we have the time or money to take on the legal departments of multi-billion dollar corporations?
The net results of this will be helpless nonchalance, boredom, and a gradual shifting of liability to US when upon occasion data is actually leaked by our vendors. And, of course, ever more fear and uncertainty in professions already full of it. Oh, and client data flowing through data brokers everywhere.
So what can we do? At first glance, not much. We need to be pressuring our professional associations to take on (or further take on) data security concerns including liability of giant "subcontractors" and insurance companies versus small healthcare providers. We also need to be supporting HHS and Federal government efforts to stop 3rd party trackers, including cookies, web beacons, pixel tracking, etc. from being allowable on systems related to healthcare. (*5) Bonus points if the penalties can apply mainly to larger corporations rather than hitting small provider offices hard.
Thanks,
Michael Reeder LCPC
Baltimore, MD
REFERENCES:
(*1)
The following video walks through the Microsoft Services Agreement and Microsoft Privacy Agreement to explain how Microsoft reserves the rights to use all data that you transmit through their services, or create or store in their apps (including data stored on OneDrive). It also collects information from all the programs used on your Windows machine. (This would seem to mean they can harvest data from your local hard drive, but I'm not sure.)
Microsoft Now Controls All Your Data
[https://m.youtube.com/watch?v=1bxz2KpbNn4&pp=ygUkTWljcm9zb2Z0IG5vdyBjb250cm9scyBhbGwgeW91ciBkYXRh](https://m.youtube.com/watch?v=1bxz2KpbNn4&pp=ygUkTWljcm9zb2Z0IG5vdyBjb250cm9scyBhbGwgeW91ciBkYXRh)
"("Data"), how we use your information, and the legal basis we use to process your Personal Information. The Privacy Statement also describes how Microsoft uses your content, i.e. Your communications with other people; the submissions you send to Microsoft through the Services; and the files, photographs, documents, audio, digital works, live streams, and videos that you upload, store, transmit, create, generate, or share through the Services, or any input you submit to generate content ("Your Content")."
(*2)
Full Slate: Last I checked their HIPAA, privacy, and BAA agreements. Although they reserve the right to change these agreements without notification and just post them to their website, so who knows at this point. <https://www.fullslate.com>
(*3)
Autonotes.ai: In fairness, they claim that no HIPAA data should be input into their system, even though you are writing progress notes. As of 7/30/23 they sent some sort of data to Google Tag Manager, LinkedIn Analytics, Facebook Connect, Gravatar which was severe enough that the Ghostery browser plug-in felt compelled to block or flag the transmissions. I hope they have changed this.
It should be pointed out that services similar to Full Slate and Autonotes claim that data sent to 3rd parties is not PHI and/or necessary to the operation of the service. This all could be true. I find that when Privacy Badger, or Ghostery, or my Pihole DNS server block these 3rd party transmissions that the vast majority of the time services work just fine.
Please also see Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates
<https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/hipaa-online-tracking/index.html>
This HHS and OCR guidance includes the sorts of 3rd party tracking technologies often referred to as non-PHI, or de-identified. My non-lawyer mind is suspicious that violations could be found at several services.
(*4)
Just take a look at any of the daily headlines on Becker's Hospital Review:
<https://www.beckershospitalreview.com/cybersecurity.html>
(*5)
Hospital associations sue HHS over pixel tracking ban
<https://www.beckershospitalreview.com/healthcare-information-technology/hospital-associations-sue-hhs-over-pixel-tracking-ban.html>
--
#AI #CollaborativeHumanAISystems #HumanAwareAI #artificialintelligence #psychology #counseling #socialwork #psychotherapy #EHR #medicalnotes #progressnotes @[email protected] @[email protected] @[email protected] @[email protected] @[email protected] @[email protected] #mentalhealth #technology #psychiatry #healthcare #patientportal #HIPAA #dataprotection #infosec @[email protected] #doctors #hospitals #BAA #businessassociateagreement #Microsoft #coveredentities #privacy #HHS #OCR
In the latest episode of the Conflict Tipping Podcast, we explore the often overlooked but vital topic of mental health amidst conflict. Join us as Dr. Nawaraj Upadhaya discusses the importance of primary mental health care, and how he is trying to make it more accessible in crisis areas.
Find the episode on your podcast platform of choice, or linked below!
I've started a new Fetlife group for disabled people. It was started after it became apparent that the other group was going to allow chasers to fetishise and objectify disabled people and that the group wasn't safe for us.
Have you nominated your favorite #IndieBooks for the #IndieInkAwards yet? Nominations are open for the month of November for several awards from Side Character MVP to Wittiest Character, & to highlight amazing #LGBTQ Representation, #MentalHealth Rep, #Disability Rep, #BIPOC Rep, & more. Open to all fiction genres and YA, NA, & Adult books. While you're there, you might find more #BooksToRead !
A fifth-grader from #Brownsville ISD reported being bullied by his principal. Five days later, he was handcuffed and detained. He spent 3 days in solitary confinement.
I'm always a bit skeptical of presentations from tech company CEOs on
how their product areas are necessary in the mental health field.
That said, this article has a few good points:
/"Umar Nizamani, CEO, International, at NiceDay, emphasised that AI will
inevitably become an essential tool in mental health care: 'I am very
confident AI will not replace therapists – but therapists using AI will
replace therapists not using AI.'"//
/
I am beginning to think this also -- for better or worse. I took a VERY
fast 60 second look at NiceDay and it appears to be another
all-encompassing EHR, but with a strong emphasis on data. Lots of tools
and questionnaires and attractive graphs for therapists to monitor
symptoms. (I need to take a longer look later.) So data-driven could
be very good, if it does not crowd out the human touch.
/"Nizamani said there had been suicides caused by AI, citing the case of
a person in Belgium who died by suicide after downloading an anxiety
app. The individual was anxious about climate change. The app suggested
'if you did not exist' it would help the planet, said Nizamani."//
/
YIKES... So, yes, his point that care in implementation is needed is
critical. I worry at the speed of the gold-rush.
/"He [//Nizamni] //called on the industry to come together to ensure
that mental health systems using AI and data are 'explainable’,
'transparent', and 'accountable'." //
/
This has been my biggest focus so far, coming from an Internet security
background when I was younger.
/"Arden Tomison, CEO and founder of Thalamos"/ spoke on how his company
automates and streamlines complex bureaucracy and paperwork to both
speed patients getting help and extract the useful data from the forms
for clinicians to use. More at: https://www.thalamos.co.uk/
/"Dr Stefano Goria, co-founder and CTO at Thymia, gave an example of
'frontier AI': 'mental health biomarkers' which are 'driving towards
precision medicine' in mental health. Goria said thymia’s biomarkers
(e.g. how someone sounds, or how they appear in a video) could help
clinicians be aware of symptoms and diagnose conditions that are often
missed."//
/
Now THIS is how I'd like to receive my AI augmentation. Give me
improved diagnostic tools rather than replacing me with chatbots or
over-crowding the therapy process with too much automated tool data
collection (some is good). I just want this to remain in the hands of
the solo practitioner rather than being a performance monitor on us by
insurance companies. I want to see empowered clinicians.
(This will be a very long list by the end of the year if I keep it up. We'll see.)
Your statements are basically done after the first few deadlines. I always thought I'd customize extensively for each school.
Nope.
On a week like this (with so many apps due Sep 15), you just don't have time. You have to trust that you already put in the work with your base template. It's a mental shift from fellowship apps.
Jobs you don't get. Potential futures that disappear. Relationships that change or become strained during this time.
And maybe you don't let yourself fully process the grief yet, because there's no time before the next application, interview, or talk... but I can see how a recovery period will be crucial, no matter the outcome.