GAP Blog

  • 9 Jan 2017 9:07 PM | Anonymous

    The stress of a crisis can lead to progressive “wear and tear” on the brain. Even mild stress can cause a rapid and dramatic loss of mental functioning. Left unattended, prolonged stress can impair brain structure and function, impacting not just the thinking brain, but regions that process emotions too.

    One of the major brain regions involved in flexible thinking and decision-making is the prefrontal cortex (PFC). This region, which specializes in higher order thinking processes, is ordinarily directly connected to regions that process emotions, in particular, the amygdala. Under stressful conditions, the usual connection is disrupted. This makes people much more vulnerable to many symptoms, including anxiety, emotional dysregulation, and fixed and faulty thinking as well. Understanding how to productively change one’s mindset is critical to building resilience after a crisis.

    Here we examine helpful mindset shifts that one can institute after a crisis. We also explain our growing understanding of how these shifts may cause corresponding brain changes too. Many of these interventions have been empirically shown to be useful, while the actual state of knowledge about how these interventions affect brain changes is still in its infancy.

    One such person who used these mindset shifts to recover from a crisis was Joe, who was at “Ground Zero” after the September 11 attack on the World Trade Center. He lost his best friend in the attacks. He was immensely distressed when he sought psychotherapy a year later. He had spoken to many people and therapists about this, but his anxiety persisted. He entered therapy with me and I hypothesized he had cemented those memories into his brain, making them hard to directly access and understand.. So we worked on mindset shifts to get his mind off the tragedy and trauma and back to his daily life.

    Attending to mindset shifts takes advantage of the brain’s ability to change, and in allowing one to be more adaptive, specifically enhances resilience. As a result, one may be able to decrease anxiety and restore thinking closer to one’s prior baseline. It is helpful to employ more active mindset shifts early on. Even a year later, using the mindset shifts below was helpful to Joe.

    Distraction—Look beyond the crisis: After a crisis, deliberately focusing on one’s resilience instead of the disaster is preferable. Even if one cannot muster up thoughts of one’s own resilience, replacing the anxious contents of one’s thoughts with more neutral contents can be immensely helpful. Although it is tempting to debrief after a crisis, the exact opposite (distraction) is far more helpful to the brain. Distraction decreases negative feelings, lowers blood flow to the anxiety center (amygdala) in the brain, and also increases blood flow to the thinking brain (PFC.) This allows one to have less reactivity and clearer thinking. In Joe’s case, he had to start to notice what he could look forward to in his life. When tempted to talk abut the disaster, he learned to distract himself with video games, eventually feeling less distressed. Distraction is a common technique across empirically validated psychotherapies for a variety of mental disorders.

    Reappraisal—Find productive ways to understand what has just happened: Lowered reactivity can also be achieved by reappraisal—a way of looking at what happened that is less anxiety-provoking. Like distraction, reappraisal can also lower negative feelings (although distraction is more effective in this particular way it can lower negative feelings much more). It also lowers activation of the amygdala and increases activation in the PFC regions. In addition to these shared effects with distraction, reappraisal also uniquely activates brain networks that process the emotional meaning of the crisis, allowing one to make more sense of a traumatic event. For example, rather than focusing on the devastation that occurred, it helps to look for the opportunity after the devastation, and to celebrate one’s survival and resilience rather than mourning the losses one has incurred. In Joe’s case, seeing his survival as an opportunity to do something great with his life helped steer him toward a career change that made him happier. In the field of trauma study, this is an important clinical goal known as traumatic growth.

    Expressive Suppression—Wait out your first reactions: Expressive suppression is another strategy to regulate emotions in which one suppresses an instinctual and reactive behavior or expression in exchange for a more well thought-out one. Although this is helpful too, it is less effective than reappraisal in reducing negative feeling states, and less effective in re-establishing helpful thinking patterns and social relationships. This technique probably works by enhancing one’s attention to subtle physiologic changes and helping the brain manage the conflicts after a crisis as well. Joe rarely used this method, but when he did, he would simply pause before reacting if anyone spoke about 9/11.

    Enhanced self-esteem—Do things that help your self-esteem: Self-esteem is defined as an evaluation of one’s own goodness or worth. When one’s life is threatened, it helps to have good self-esteem. Good self-esteem helps by restoring the “thinking-feeling” connections in the brain. As a result, one avoids unnecessary defensiveness (which can deplete brain resources needed for proactive decisions.) Higher self-esteem helps people become more self-reflective and less reactive under situations of stress. This ability to regulate one’s emotions also enhances one’s willpower to thrive. Joe reflected on the strength of his past friendship and what made him special to his friend, in the process appreciating himself more.

    Practice mindfulness-based stress reduction(MBSR): MBSR includes multiple forms of mindfulness practice, including formal and informal meditation practice. The formal practice consists of various approaches in which one ignores mental chatter. This includes focusing one’s attention on one’s breath or body while noticing the fleeting nature of sensory experience, or shifting one’s attention across multiple sensory modalities. It may also include open monitoring of moment-to-moment experience, or walking meditation too. It is very effective in reducing the impact of stress and anxiety on the brain. Mindfulness may increase the density of gray matter on the brain, and in addition to enhancing one’s attention, it is also helpful in regulating the brain’s emotional centers as well. It changes the brain to become more aware of subtle physiologic changes too. Just eight weeks of mindfulness practice may induce brain changes similar to the changes seen with long-term meditation. Joe simply practiced 20 minutes of mindfulness on most days, and his anxiety was significantly reduced.

    Crises can have shocking and devastating effects on our brains, but we are fortunate to be able to change our brains with mindset shifts that facilitate emotion and thought control.


  • 11 Aug 2016 9:05 PM | Anonymous

    “James had been up all night pacing and cursing, and was becoming increasingly angry at me when I suggested he take his medication. I was getting scared. When his father was alive we could manage him together, but now that he’s gone and I’m in my 70’s, sometimes it is just too much. So I called the police. I just wanted them to take him to the hospital, so he could get back on his meds and get stabilized. But when the police came, they had their guns drawn and tackled him to the ground and handcuffed him. I’ll never forget the look he gave me as they yanked him out the door, there was such pain and betrayal in his eyes.”

    James’ mother

    The police are often called by family members like James’ mother to intervene with individuals during mental health crises. In fact, “nearly 1 in 10 police encounters involve individuals with mental disorders.” (GAP, 2016) Yet, many law enforcement agencies are ill prepared to deal with the complexities involved when intervening with a person with active psychiatric symptoms, such as paranoia, hallucinations or despondency to the point of having suicidal thoughts. In some cities, such as Cleveland, it has been determined that there was a pattern and practice of excessive use of force, and persons with a history of mental health issues were overrepresented in those on the receiving end of this excessive use of force. As a result of this finding by the Department of Justice, the Cleveland Community Police Commission (CCPC) was formed as stipulated in a consent decree between the US Department of Justice and the City of Cleveland in May, 2015. In September 2015, ten members chosen by a selection panel as well as representatives from three police organizations, were sworn in to serve on the Commission for four years, representing civil rights advocates, youth or student organizations, underrepresented minorities, faith based communities, academia, business, and individuals with expertise in the challenges faced by in people with mental illness or experiencing homelessness. As a community psychiatrist, I am on the Commission as a representative of the latter two groups.

    The mandate of the Cleveland Community Police Commission is:

    “To make recommendations to the Chief of Police and the City, including the Mayor and City Council, on policies and practices related to community and problem-oriented policing, bias free policing and police transparency;

    To work with the many sub-communities that make up Cleveland for the purpose of developing recommendations for police practices that reflect an understanding of the values and priorities of Cleveland residents; and

    To report to the city and community as a whole and to provide transparency on police department reforms.”

    In order to work toward the restoration of trust of the police by the community, efforts are being made to create opportunities for ongoing community input and to make the process as transparent as possible. Therefore meetings of the full Commission, town hall meetings and topic specific work groups meetings are all open to the public. Meeting times and locations are publicized in a number of venues and meeting minutes are posted on the Commission website. Areas of inquiry and recommendations by the Commission will include recommendations for redesign of the existing Cleveland Police Review Board, which investigates citizens’ complaints against police officers. They will also include policy review on areas that relate to Bias Free Policing and Use of Force, as well as the training of police officers. The latter will include special “Crisis Intervention Team” training preparing officers to respond appropriately and empathically when responding to mental health crises.

    In addition to the Cleveland Community Police Commission, a Mental Health Response Advisory Committee( MHRAC) was also formed in order to foster relationships and build support between the police, the community, and Cleveland’s mental health providers, and to help identify problems and develop solutions designed to improve outcomes for individuals in crisis. This group has made specific recommendations regarding the Crisis Intervention Team training, so that there will be a cadre of highly trained police officers to respond to calls involving a mental health crisis. I play a liaison role between this group and the CCPC, keeping the Commission informed about the work of the MHRAC and advocating for the recommendations of this group to the CCPC.

    My work on the commission has been challenging due to the enormity and urgency of the task we face. It has been all the more challenging due to an ambitious schedule of mandated reports that was imposed on us. These included early, successive recommendations pertaining to the Police Review Board, Bias Free Policing and Use of Force, all of which needed to be based on and heavily guided by community input generated at the above mentioned public meetings, held across the city, our own careful review of policies, and our review of best policing practices, nationally.

    The committee that selected Police Commission members focused on the range and diversity of backgrounds of members, which is our biggest strength. But as you might imagine, it also poses challenges in reaching consensus and decisions about recommendations.

    Each meeting is open to the public. And we usually allow 30 min at the end of each meeting for public comment. We continually strive to balance adequate time for citizens (many of whom have been quite understandably frustrated , angry and fearful for years) to be heard, with adequate time to do the policy review and crafting of recommendations that is the mandated work of the Commission.

    We are very hopeful about a pilot project which will allow mental health workers to ride along with police in the police district found to be receiving the highest volume of calls related to mental health issues or crisis situations. The impact of this pilot project will be closely monitored, and success will be defined as an increase in the use of de-escalation techniques, a decrease in the use of excessive force and the diversion of individuals experiencing a mental health crisis from the criminal justice system to a medical or social service setting for appropriate intervention and treatment.

    Being on the Cleveland Community Police Commission is allowing me to use my expertise as a community psychiatrist to shape recommendations for a process that should make it possible for mental health clients, like James, to avoid involvement with the criminal justice system, as much as possible, and have effective compassionate interactions with police officers when they do intervene. James’ mother should someday soon be able to ask for a CIT trained officer when she does call the police for help, in an attempt to obtain competent, compassionate support when she needs it most in her daily struggle to help her son.

    People with Mental Illness in the Criminal Justice System, Group for the Advancement of Psychiatry Committee on Psychiatry and the Community, American Psychiatric Association Publishing, 2016.


  • 15 Sep 2015 9:03 PM | Anonymous

    Written by Op-Ed

    Organized psychiatry took a very different position than psychology on the question of who should participate in the interrogation of detainees in the War on Terror. In 2005, it came to light that the Department of Defense issued guidelines that permitted physicians to participate in the interrogation of detainees, and so called Behavioral Science Consultation Teams (BSCTs) were conducting in these interrogations in Guantanamo Bay, Cuba. In October 2005, as President of the American Psychiatric Association, I flew to Guantanamo Bay to visit the prison and to observe first-hand the ongoing role of physicians and psychologists in the interrogation process. I was accompanied by the President of the American Psychological Association as well as a number of interested parties, including Department of Defense personnel, the Surgeon General of the Army, and the Surgeon General of the United States. We spent a long day touring the prison, interviewing members of the BSCTs, and then, after flying back, spent a long evening at the Officers Club at Andrews Air Force Base debating the question of participation in the interrogation process. After that site visit, I took the issue to the governance of the American Psychiatric Association and, after a number of months, the APA endorsed a strong position statement which stated, “No psychiatrist should participate directly in the interrogation of persons held in custody by military or civilian investigative or law enforcement authorities, whether in the United States or elsewhere.” Shortly after, the American Medical Association passed a similar resolution as did the Royal College of Psychiatrists in Britain. The American Psychological Association took a different position on the appropriateness and ethics of participation in interrogations and stated that it was permissible under certain conditions to participate in these interrogations to glean intelligence in the War on Terror. Pentagon officials said they would use only psychologists, and not psychiatrists, to help interrogators devise strategies to get information from detainees at places like Guantanamo Bay, Cuba. Dr. William Winkenwerder, Jr., Assistant Secretary of Defense for Health Affairs in the United States Department of Defense, told the New York Times (June 2006) that the new policy favoring the use of psychologists over psychiatrists was a recognition of differing positions taken by their respective professional groups.

    Recently, an internal investigation conducted by the American Psychological Association revealed that psychologists in leadership at the American Psychological Association had multiple conflicts of interest in keeping the association’s ethics policies in line with the Defense Department’s interrogation policies. How was it that psychiatry differed so strikingly from psychology on this particular ethical issue?

    Psychiatrists as physicians have strong ethical prohibitions in participating in torture that date back to the 1975 World Medical Association Declaration of Tokyo. This declaration stated, “Physicians can play no role whatsoever in torture or cruel, inhumane, and degrading treatment.” The question of interrogation of detainees and its relationship to torture has been a prominent issue in the news with detainees often subjected to stress interviews, sleep deprivation, and other more extreme measures to gain intelligence in the War on Terror. The policy positions of the American Psychiatric Association in contrast to the American Psychological Association took a number of months with some internal debate as to the relationship between interrogation and torture, with the American Psychiatric Association coming out firmly against psychiatrists’ participation in interrogation at any level. It was seen as consistent and in line with the ethical prohibition of physicians in executions, assisted suicide, and other areas where it would be clear that our Hippocratic Oath “to do no harm” would be violated. It is commendable that a group of dissidents within the American Psychological Association protested its association’s position on this issue and doggedly pursued it so that there would be a full investigation, which has brought to light the issues revealed in the report.


  • 15 Sep 2015 9:01 PM | Anonymous

    Written by Stewart Adelson and Kyle Knight

    Stewart Adelson, an assistant clinical professor at Columbia University medical school, was principal author of the American Academy of Child and Adolescent Psychiatry’s practice guidelines on LGBT youth. Kyle Knight is a researcher in the LGBT rights program at Human Rights Watch.

    When the White House announced its support for ending the use of “conversion therapies” for lesbian, gay, bisexual and transgender people under 18, it sent a supportive message to young people who identify as LGBT or are questioning their gender or sexuality. Therapies that aim to “cure” or “convert” gay or transgender people have failed to produce evidence that they work or are safe; indeed, there is wide consensus among professionals that these therapies are ineffective and harmful. The anti-LGBT animus inspiring these practices creates stigma.

    As they take steps to end such practices, however, legislators and practitioners must be careful not to encroach on effective therapy options for young people who are exploring the complex matters of gender and sexuality.

    Children have the right to discover and be accepted for who they are. Growing up healthy sometimes involves changing one’s mind, and children may need to talk honestly about this possibility with a therapist. Bans could have the unintended consequence of deterring therapists from engaging with children who have questions or even of ensnaring good therapists when they do.

    According to the Centers for Disease Control and Prevention, suicide is the third-leading cause of death in the United States among those age 10 to 14, and the second-leading from age 15 to 24. Gay, lesbian and bisexual youth are two to five times as likely as their straight peers to attempt suicide, and young transgender people are also at heightened risk. Prejudice is a leading factor.

    The American Psychiatric Association warns that conversion therapies can lead to depression, anxiety and self-destructive behavior — and notes that “therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient.” But supportive psychotherapy can be a crucial resource. The American Medical Association attributes emotional disturbances felt by LGBT people to a “sense of alienation in an unaccepting environment” and calls for affirmative psychotherapy to help people cope and develop.

    President Obama’s embrace of this issue backs up these professional perspectives with governmental authority, and he has left it up to states to take action while highlighting anti-conversion therapy legislation such as bans in California and New Jersey. However, legislative bans may not be the best solution to this problem.

    Psychotherapy is inherently private and complex, and for some individuals, sexual orientation and gender identity can and do evolve in the course of legitimate treatment. The American Academy of Pediatrics, while condemning therapy directed at changing sexual orientation, makes the important point that “confusion about sexual orientation is not unusual during adolescence” and calls for counseling to be available to young people who experience uncertainty. In recent years increasing numbers of children and adolescents report viewing themselves as “genderqueer” — that is, not fitting into binary male-female categories. Good treatment in such cases frequently involves embracing flexibility to help patients discover what feels most authentic to them.

    Rather than legislative bans, conversion therapies should be addressed by state licensing boards and similar regulatory bodies. For mental health practitioners — psychiatrists, psychologists, school counselors and social workers alike — licensure guidelines are designed and enforced by these regulatory bodies, using professional guidelines that already condemn such therapies. Consumer protection guidelines also rule out acts of deception. Put plainly, therapists can’t claim conversion methods work; if they do, they could be fined or lose their license.

    Mental-health practitioners have an important role to play in distinguishing between good and bad practice, and children have the right to speak up both in seeking health care and in policymaking processes that affect them. Childhood and adolescence are crucial times for development, including of sexual orientation and gender identity. Adolescence can also be a particularly turbulent period for mental health as the body develops and social environments and expectations shift rapidly. During this vital stage, youth need information, support and safe spaces to ask questions. Mental health professionals need the latitude to help them.

    The White House’s strides on LGBT rights are notable, and discussion of strategies for ending conversion therapies is welcome. Trauma-inducing practices should not be allowed to masquerade as therapy, but we shouldn’t think of blanket bans as elixirs. To strike the right balance, it is vital to include practitioners as well as youth in the dialogue — so that they have a say in policies that will impact their rights to information, health and integrity.


  • 15 Sep 2015 8:59 PM | Anonymous

    Written by Mark B. Borg, Jr., Ph.D, Grant H. Brenner, MD, and Daniel Berry, RN, MHA

    The current ongoing humanitarian and natural disaster unfolding in Nepal has caught the world's eye. It is estimated that over 8 million souls have been affected. The mass exodus of people from Kathmandu, out of fear of aftershocks and back into traditional homes in the countryside is a factor which will provide greater local support, but will also place a strain on resources as well as complicate aide delivery.

    So far, the number of fatalities is passing 5000, and still counting. While attending to basic needs is a key priority, especially with strained resources (and will remain an issue), the psychological and emotional impact will linger for many years to come. Interventions now combining local and outside expertise may help to mitigate the impact, identify people having more profound difficulty, and help to re-establish a sense of safety and community but there are many other repercussions that need to be addressed.

    Based on an extensive review of the literature, and on-the-ground experience, Hobfall et al. (2007) have listed the following Five Essential Elements for Mass Trauma Intervention as follows. 

    People need:

    • A sense of safety
    • Calming
    • A sense of self- and community-efficacy
    • Connectedness
    • Hope

    What do psychiatrists need to understand in order to have a basic level of preparedness in the event of disaster? Many of the skills we already know are applicable. Disaster psychiatry draws on emergency psychiatry, consultation-liaison psychiatry, an understanding of family and systems dynamics, child psychiatry, basic principles of psychotherapy and psychology, and community psychiatry, to name a few. The basic principles of self-awareness, self-reflective processing, processing with colleagues, and counter-transference come into play. We need to understand who we are, how we are prepared and unprepared, and how we are prone to react, and how we are reacting - to particular situations.

    Yet, disaster work for the psychiatrist can be radically unfamiliar for many of us. Working in the field, away from the hospital, the private office, divested of medical resources we often take for granted, away from basic resources (food, water, shelter, a stable context) - the most seasoned psychiatrist can get caught up in surprising and sometimes problematic situations and emotional reactions.

    The qualities of the particular disaster are critical to take into account:

    Is it natural or man-made? Man-made disasters are associated with stronger feelings of injustice and activate us differently than do natural disasters. They make sense to us in different ways, and require different explanatory frameworks. Is it a tangible threat such as a conventional explosive, or an invisible threat, such as an airborne biological or chemical agent, or radiation? These qualities activate our own developmental patterns differently, depending upon who we are, and in particular also affect the way we may perceive and misperceive the degree of threat (and hence the level of anxiety and related behavioral reactions).

    Is it a singular event such as an shipping accident, or are there ongoing threats, as with aftershocks in an earthquake? What is the duration of the event itself? If there is an ongoing threat, then it is challenging to establish a solid sense of safety and get on with the process of recovery.

    Is the disaster far away, or local? If it is local, we ourselves are part of the disaster community - and are ourselves affected directly by the event. This changes how we engage and respond in ways which are important to be cognizant of, and periodically re-consider, to avoid potentially powerful maladaptive reactions.

    What are the resources of the community affected? What cultural factors may come into play? What are the material resources and how have they been impacted? How is the infrastructure affected, and how robust was it before the event? What underlying issues were there which may be necessary to take into account, for example poverty, civil conflict, ethnic tension? How is the community responding? In what ways is the community response helpful, and unhelpful?

    Disaster responders have to be acutely aware of how they enter a disaster zone, and especially be mindful of being invited rather than intruding, thoughtful, erring on the side of caution and using tact and diplomacy. More than anything else, taking care to understand, respect and truly appreciate the innate resources present in the disaster community. Crucial is to deeply value local resources - community leaders, religious leaders, local healers and healing customs - and to avoid imposing our cultural belief systems and diagnostic systems on affected populations. What is commonly referred to as "cultural imperialism".

    There are of course many other factors this brief treatment cannot address. Readers may find Disaster Psychiatry: Readiness, Evaluation and Treatment (APPI, 2011) a useful and handy reference.

    It is helpful to spell out some of the common hazards associated with disaster response, in order to help us be prepared for what we may encounter:

    • Enacting rescuer fantasies and placing oneself and others in harm's way
    • Coming to see oneself as an invulnerable hero
    • Becoming too self-sacrificing and neglecting one's own basic needs
    • Developing negative feelings (resentment, for example) toward colleagues or disaster-stricken individuals
    • Becoming burned out or developing compassion-fatigue
    • Activation of one's own unprocessed past traumas

    These behaviors can be understood as counter-transferential and transferential reactions to disasters, as well as "real" feelings which arise in the course of the work. Along these lines, it is worth being aware that the choice to do disaster response work, as with any other intense and demanding job, may arise partially from childhood experiences. Know thyself is the addage of the informed disaster psychiatrist, necessary to protect oneself and others. For this reason, we always recommend that the work be done with at least 2 people working together.

    On the brighter side, disasters bring out the best in human nature. In the immediate aftermath of a disaster, and in the months that follow, the majority of responders shine. The best side of human caregiving is expressed, and people make deep and intimate connections with one another and the people they help, leading to personal growth and enduring meaningful experience.

    The chances of this healthy balance being struck in disaster response, is increased when the organizations sending people have it built into their operations to ensure that there are definitive boundaries put in place to prevent over-engagement. They include limiting the number of hours worked, to setting aside time each day for reflection and processing, attending to team dynamics, shortening the duration of deployments and replacing personnel with fresh volunteers. They also address giving appropriate recognition for effort and accomplishment, setting aside a safe space and room to seek consultation if things get too difficult physically and/or emotionally, and establishing a culture of tactfully transparent communication both horizontally among team members, and vertically with leadership where roles and responsibilities are clearly defined, with room for improvisation and respect for individual capacities and skills.

    Nepal Earthquake Relief: Disaster Psychiatry Outreach is responding to the Nepal earthquake and needs support to implement its Mission. The current fundraising goal of $30,000 will allow three teams to implement our effective strategies of needs assessment, care, training and support on the ground. All funds are used to cover expensive and administrative costs. Our volunteers donate their time pro bono. Please visit: http://www.gofundme.com/dponepal1

    DPO’s mission is to alleviate suffering in the aftermath of disaster through the expertise and good will of psychiatrists. After the initial wave of an acute response is over—DPO volunteers step in to assist with education and services of treating the invisible wounds of psychological trauma. To fulfill our mission, DPO responds to catastrophes and provides education and training in disaster mental health to a range of professionals in the healthcare, public health and emergency management sectors. We:

    Organize volunteer psychiatrists who provide immediate mental health services in the aftermath of disasters in conjunction with government and private charitable organizations;

    Develop and implement educational programs, training, and referral mechanisms, and;

    Develop research and policy in the field of disaster mental health.

    DPO’s activities are guided by its vision to prevent the development of mental illness after disaster. Disaster Psychiatry Outreach is a registered 501(c)3 nonprofit organization in good standing. All donations are tax deductible in full or in part.

    References

    Hobfoll, S. E.; Watson, P.; Bell, C. C., Bryant, R. A.; Brymer, M. J.; Friedman, M. J.; Friedman, M.; Berthold, P.R. ; Gersons, J.; de Jong, T. V.; Layne, C. M.; Maguen, S.; Neria, Y.; Norwood, A. E.; Pynoos, R. S.; Reissman, D.; Ruzek, J. I.; Shalev, A. Y.; Solomon, Z.; Steinberg, A. M., & Ursano, R. J. (2007). Five Essential elements of immediate and mid–term mass trauma intervention: Empirical evidence, Psychiatry, 70, 283-315.


  • 15 Sep 2015 8:57 PM | Anonymous

    Written by Dr. Aaron Krasner

    As a child and adolescent psychiatrist, issues pertaining to technology, mental health, substance use and abuse, and parenting abound. Unfortunately, there are no easy answers – no studies or evidence to inform anticipatory anxieties about “the phone.” On the one hand, these phones are our portals to the world – they proffer hope of social connections, important information, and instant access to a world of data. But in the hands of vulnerable kids and adults, these devices are scary things: implements of impulsive (and permanent) destruction. As we wade into the thorny thickets of technology, we are reminded how little we know. What are tablets doing for (against?) infant brain development. What influence does the seemingly unending proliferation of pornography have on the development of human sexuality? And what of these portable cameras, capturing humanity at its worst – rarely at its best?

    Though we know little, I have unpublished data¹ that suggests that older psychiatrists are reticent to engage in social media or communicate with patients and or colleagues electronically. I am alarmed by this fact. I think younger psychiatrists are languishing without appropriate guidance in this rapidly shifting technocracy I have described above. And I think clinical wisdom is being lost. While younger psychiatrists struggle to answer questions, many senior psychiatrists simply divest of the issues, wishing this steak could be uncooked. It cannot.

    The development of this new GAP website is an important step in this direction. It will allow GAP to more fully enter the digital age. Not in an impulsive, perilous manner but rather in a carefully crafted, contained, and controlled style that will preserve the integrity of the GAP identity while firmly setting foot in this important world. We will simply bring GAP and what it stands for into this new world. Without a substantive online presence, I am concerned for GAPs salience. Our knowledge, like the knowledge of the senior psychiatrists we interviewed in our study, may be lost in the noise. Let us not allow that to happen.


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