Dr. Grossi's Blog
Whenever I discuss mental illness, my patients and colleagues invariably focus on the negative and harmful effects and the associated stigma. This is especially true with regard to bipolar illness which is potentially disabling and life threatening. What is often overlooked by professionals and public alike is that mental illness can have some positive aspects, e.g., positive emotional responses and increased achievement of ambitious goals. Other characteristics that are generally viewed as positive include spirituality, creativity, realism, resilience, and empathy. Mitchell and Romans describe bipolar patients as more reliant on spiritual beliefs which are reported to have an influential effect on the course of illness. Moran and Diamond have described increased empathy in depressed patients. In spite of bipolar disorder being associated with negative financial, social, and interpersonal outcomes, a large number of patients describe positive experiences of sensitivity, alertness, productivity, social relations, sexuality, and creativity. Akiskal et. al. who have published many articles in this area note that samples of creative individuals have an over representation of affective disorder. Cases of full blown manic depressive illness are less common. Cyclothymic and hyperthymic temperaments abound.
These positive psychological aspects of bipolar disorder are of importance to the public and professional community because of the relationship to social stigma and quality of life in patients suffering from major psychiatric disorders. People with bipolar illness have to cope with their illness as well as the negative attitudes about them. Paying attention to the positive psychological characteristics may help to secure better clinical results.
Our current failure or poor success in treating drug use disorder is partially due to our poor understanding of the complex natural history and its development and change over time. If we consider three potential transitions from non-use to asymptomatic use and to problem use and abandon the older designations of abuse and addiction, then we may more meaningfully arrive at fruitful conclusions.
Crompton et al. published recently in the American Journal of Psychiatry the findings of a study they carried out in which they made two assessments of individuals done at three year intervals. Less than 5% started using during the three year interval but of those over 50% had trouble at the three year follow-up. Of those asymptomatic users at the first assessment, 66% had stopped at follow-up while 20% progressed to problem usage. Of the problem users at baseline, 49% had stopped at the three year follow-up, 40% returned to problem usage, and 11% became asymptomatic users.
A variety of factors appear to influence transitions. Drug initiation appears to be linked to younger age, alcohol and nicotine usage and major depressive disorder. Drug initiation progression to problem usage seems related to lack of health insurance, poor physical and psychological health, and a family history of substance abuse. Higher persistent drug abuse is associated with child abuse and schizotypal and narcissistic personality disorders.
The study demonstrates that the course of drug use and problem use is influenced by factors at many levels including sociodemographic, family history of substance use, history of child abuse, current physical/psychological health and psychopathology.
Violence against women is a world-wide phenomena and is a significant issue for public health and social policy. The most common form of this violence is intimate partner violence and can express itself in physical, sexual, or psychological forms. The health impact on women can be seen in increased levels of depression and suicidal behavior, increased homicidal deaths of women, and increased acquisition of HIV. These in turn result in increased economic costs.
There is a growing consensus among most countries to promote gender equality and empower women. These is also a consensus in the research community about studying this problem which has resulted in an expansion in the number of studies examining this violence toward women. A digest of these results shows that globally in 2010 30% of women aged 15 and over have experienced physical and/or sexual intimate partner violence. Regional variation in prevalence is noteworthy. Central Sub-Saharan Africa shows an average percentage of violence toward woman is 65.4%, islands of the tropical pacific region 35.2%, South Asia 41.7 %, Western Europe 19.3%, Middle East 35.4%, and high income North America 21.3%.
The relatively high prevalence in all regions suggests that efforts at prevention are clearly warranted. Experiences of violence in childhood and later perpetuation of violence in adulthood are definitely associated suggests that preventing child maltreatment is an important intervention. This would involve changing parenting styles and social norms. Advanced education of women is associated with lower prevalence of violence although this varies with culture and geography. From the societal level it would be important to convert attitudes that such violence is private into a public concern. Interventions to put a spotlight on problematic drinking patterns in men which are commonly associated with physical abuse of women. Laws should be changed to symbolize the unacceptable nature of this behavior and to provide legal recourse.
Violence toward women is a complex problem and there are no easy or quick solutions. The interventions should be multiple, varied and cut across social, cultural, legal, economic and educational areas.