American Psychiatric Association Annual Meeting
April 30 – May 4, New York City

Sylvia Caras, PhD

CMHS provided 20 scholarships for consumers to attend the APA meeting. I applied and was accepted.

In the program book, I recognized special acknowledgments to 46 supporters which included 20 pharmaceutical companies whose names were familiar to me and 5 federal agencies (CMHS, CSAT, NIMH, NIDA, SAMHSA).

The plane was packed. The man across from me on the plane talked to his seatmate non-stop for the five hour non-stop flight and then the taxi driver talked at me for another hour. I was getting prepared for the noise of New York

The Javits Convention Center is huge, several buildings, several floors. The registration hall smells very strongly of toxic new carpet smell and I was lucky there was no line and I was able to get out to fresh air within five few minutes.

I took one of the complimentary shuttle busses back to Grand Central and walked to my hotel and studied maybe 10 pounds of material, abstracts, schedules, that was in the conference briefcase … and mapped out an agenda for the convention.

Sunday I realized I was quite afraid being here, felt sadness, loneliness, was remembering psychiatric experiences I would rather not. Tea from Starbucks served by a smiling barista lifted my mood and allowed me to enjoy Fifth Avenue blocked by bicyclists. I was told to use the subway tunnel to cross the street, so as to not interrupt the Tribeca event. I rode the escalator to the third floor of the Hilton and found a large full ballroom. The Many Faces of Anxiety. Breakfast had been sit-down, bacon and eggs, echoing the upscale tone of the whole convention, at least the hotel pharma parts – paper for notes and questions is card stock, handouts are bound volumes and heavy.

Studies show a value for placebo partly because patients in studies are already on the mending side of the curve, hence volunteered for the study.

George Ebert and others were protesting and I joined a dozen outside. They were wearing Stop Force T shirts and holding white balloons and people said there were 1000 Scientologists there the day before. Angela Cerio, Mary Ann and George Ebert, Linda Andre, Tina Minkowitz were people I already knew and I had good conversations with a few others. At the opening ceremony I said hello to a Santa Cruz psychiatrist I know who smoothly wondered if I often attended these meetings, and then I wrapped up the day by hearing about Jon Brock’s conversations in the book exhibit area which might lead Jon to bring out a new publication.

The Exhibit Hall was difficult for me to experience. Wherever I looked I saw the name of a boldly lettered familiar medication and even encountered representatives from two places where I’d been inpatient. "Do you know about the Institute of Living?" Oh, yes, I thought, I do know! DBSA had a booth and I introduced myself and congratulated them on their TA award.

The tone here is too technical, mechanical, impersonal. Probably all medical conferences would be the same, big pharma dollar presence, lots of gadgets, … The psychiatrists were willing to stand in lines of 30 – 50 people to register for freebies, a nice pen personalized with one’s name, a computerized health overview, …

The arrows on the floors of my hotel point one way to even numbered rooms, and the other way to uneven numbers. It seemed odd to me that they weren’t named odd numbers.

The theme of this conference is dissolving the mind-brain barrier and I am seeing an oozing mass of Jell-O melting into a well treated puddle.

Richard Ellis and I both arrived in good time for the holistic health lecture. The speaker heads a UN connected agency, the Art of Living Foundation, artofliving.org , which, since most of the world can’t afford drug treatments, teaches holistic interventions for well-being, in particular breath work and meditation. Their goal is to put human values back into everyday life The huge hall is very cold and a noisy blower keeps forcing cold air as the audience shivers and dons coats. Despite that there is an eagerness to participate in the breath/silence/ra chant simple meditation and lots of questions after it is over. The three functions of mind are perception, observation, and expression. Breath is a link between the state of mind and the emotions/sensations. Powerful inhales energize, strong out breaths relax. It takes about 16 hours over 4-6 days to learn the techniques.

There are more psychiatrists in New York City than any other city in the world.

30 minutes of well-paced convocation ceremonies - APA distinguished fellows ceremony, pledge, neck medallions as at graduations, 270 new inducted Distinguished service award to Satcher. Organization award to NMHA. Human Rights award to Walter Reich.

Convocation Lecture: Tom Wolfe: Every human being lives by a set of values which would make his/her own group superior. (see Rawls. S) Wolfe is looking for where this is in the brain. Freud halted brain physiology research. High Vulgarization: Delgado, Physical Control of the Mind, effects of stimulation on the brain, implants in bulls. Wilson – humans are born as photographic negatives, waiting for development. Dawkins, fundamentalist, it’s all Darwinian. Evolutionary psychologists – happiness ‘thermometer’ is set at birth, Joy/despair reactions last about six weeks. Neitzsche, moral vacuum.

I’m struck with the continual input, not just in the Exhibit Hall, but in New York. It seems to me people here pull in and that shuts out others; people focus on their own task at hand. On the sidewalks there is lots of jostling, especially in the rain, with umbrellas, instead of a more graceful dance, shifting and weaving to accommodate each other.

I’m spending lots of time commuting each day, 45 – 60 minutes back and forth from hotel to convention center and from venue to venue.

George Stehphanopoulus will be speaking about "his personal struggle with depression."

Pfizer offered a monogrammed pen or desk business card box. For the pen, first I was required to take a test about Zoloft, have it corrected and listen to a pitch from a sales rep, then take my test to enter my name for monogramming in their computer, then return a few hours later for the pen itself. Each of those steps had a waiting line. I estimate the whole process took about 45 minutes because the lines were very long. I am fascinated that professionals at this level want freebies as much as I and that they value their conference time in this way, maybe $30/hour, the cost of one of the pens. I used the time to observe, feel it was part of my being there, and had the pen monogrammed for a friend in Santa Cruz.

I’m still having trouble navigating the convention center, but after a few false turns found Coercion and Treatment: Medical, Legal and Ethical Issues which mentioned ethics not at all. I felt sad and somewhat fearful as I waited for the roundtable to start and when I saw Mary Zdanowicz’ name plate I got panicky and practiced the breath exercises I’d learned the first day. I had made plans to meet Celia Brown for lunch and that helped hold me together too. Mary is an attractive redhead and while I tried hard to make her totally wrong, I’m only unable to fault her arguments and beliefs, not the whole person. My breath stopped as she walked by and I started rehearsing what question or intervention I might make. Ultimately I said nothing, introduced myself at the end, she was apparently as familiar with my name as I with hers. Fisler, an attorney in mental health courts moderated fairly, Bardey, a court forensic psychiatrist and fan of opc is convinced coercion is necessary, as of course is Zdanowicz, Laverne Miller, attorney and ED of the Howie T Harp Center, and Heather Barr, an attorney and advocate. Miller called opc regressive; Zdanowicz interceded no, progressive. That was pretty much the dialogue, respectfully with different views, citing studies with opposite findings, Monohan, Bellevue, Duke, …. Zdanowicz – spectrum of coercion, "coercion is a gradient" (losing one’s rights a little? S.), Kendra’s law creates insight (I have mental illness and need to take medication) and it takes about 18 months on drugs to create at least a "shallow" level of insight,, "removal" to the hospital is an interesting phrase, the clinician is threatened by a comment Laverne makes and puts her down and no one even blinks, Zdanowicz "we are all in agreement" which I know means I am going to be excluded, "force is a sign of caring."

Zdanowicz has three siblings with mental illness. I see a similarity between her beliefs, and Torrey’s, and Carla Jacobs. They all are siblings of people who use lots of mental health services and all seem to me to have a strong need to control and to be right. I wondered if the growing up context of these advocates was pretty chaotic and they took on the job of parenting their siblings in this authoritarian way.

Zdanowicz noted as an example of her sister’s mind so disordered that she needed substituted judgment, force, that if the sister were asked the same question three times in a row she would give three different answers. All I could think of was the expression that you can’t put your toe in the same river twice, that the river is always flowing, changing, different and what if Mary’s sister was in that spiritual space and Mary insisted she be coerced into linearity. It’s very sad.

My sense is Laverne and Heather understand the coercion arguments but that Mary and the other man really don’t "hear" the choice arguments.

Celia Brown and I met for lunch, talked about New York and international organizing.

I went to a session on the impact of budget cuts. NAMI’s Laura Lee Hall wants to "dramatically expand NIMH’s clinical trial networks" so that many (everyone) who is medicated is part of a clinical trial that is researched. Tom Lane noted that the cuts will exacerbate already unmet needs and emphasized that "with hope comes recovery."

Regular staff weren’t sure where to turn in the evaluation forms. I was directed to the locator desk where a very bored woman asked me several questions about was I in the right place, did I want an attendance certificate, well if I just wanted to turn the form in she’d take it. I noticed the first wheel-chair user, a old-old man, and later saw a woman using a white cane. I’ve seen little other visible disability presence at the convention, have noticed few wheelchairs on the sidewalks.

International Perspective on Violence Against Women: widening class divides and increasing social inequality allows the weak to resort to violence to gain respect, legitimizes violence against "the worthless," weakens inhibitions against aggression.

Three-quarters of the world’s 12 million refugees are women.

From the Proceedings Summary:

1A: 30 - 40 %  of patients do not respond to the first treatment offered and typically less than 50% achieve a sustained remission from major depression or anxiety. 

3A: Individuals with bipolar disorder have a higher prevalence of alcohol dependence than those with any other psychiatric disorder. 

8E:  The vast majority of individuals with bipolar disorder ... have outcomes that fall short of optimal results described in randomized controlled trials.

10A: The biological relationship between three neural systems - sex drive, romantic loved, partner attachment - should be considered when prescribing SSRI antidepressants for long-term use among sexually healthy, sexual active patients.

11D:  Depression is associated with a substantially increased risk for osteoporosis.

20A:  Psychiatrists tend to believe in the efficacy of words over action, the primacy of affective states in determining action, and the concept of normalcy, whereas the novelist subscribes to the primacy of free will, of responsibility, and the instantaneous moment of truth in determining a person's fate.

20D: Any competent psychiatrist can become a competent novelist.

20C: Writing is a subtle form of exhibitionism.  (<blush> S.)