Montana Mental Health Bulletin

GENIUS may be an ABNORMALITY

Perhaps “genius” in any field could be considered an abnormality. Abilities can be very uneven and people who excel in one area often do poorly in others. Hans Asperger died in 1980 believing that certain gifted children might also be autistic. The term “Asperger’s Syndrome” was coined a year later by UK psychologist Lorna Wing. She described the disorder as a continuum that “ranges from the most profoundly physically and mentally retarded person … to the most able, highly intelligent person with social impairment in its subtlest form as his only disability. It overlaps with learning disabilities and shades into eccentric normality.”

People who have Asperger’s Syndrome have average — or even high — IQs, while 70 percent of those with other autistic disorders suffer from mild to severe mental retardation. At the far end of the spectrum are “profoundly affected” children. If not forcibly engaged, these children spend their waking hours in trance-like states practicing repetitive activities such as staring at lights, rocking, making high-pitched squeaks, and flapping their hands. Asperger’s Syndrome is less disabling, but these people, too, have trouble with social interactions, motor skills, and sensory processing and tend toward repetitive behavior.

The Engineer’s Disorder
There is evidence that high-functioning autism and Asperger’s Syndrome have a strong genetic basis. G. R. DeLong and J.T. Dyer found that two-thirds of families with a high functioning autistic member had either a first or second degree relative with Asperger’s Syndrome. Simon Garon-Cohen, an autism researcher at the University of Cambridge, found that there were two times as many engineers in the family history of people with autism. Temple Grandin, Ph.D., author of the book Thinking in Pictures, is autistic – and she fits this pattern. Her grandfather was an engineer who co-invented the automatic pilot for an airplane. Bill Gates’ single-minded focus on technical minutiae, rocking motions, and flat tone of voice are all suggestive of an adult with some trace of the disorder. Albert Einstein also had many autistic traits. He did not learn to speak until he was three, and he lacked concern about his appearance. His uncut hair did not match men’s hairstyles of his time. Einstein performed poorly in spelling and foreign languages.

Although there is still no known cause, no miracle drug, and no cure, the last twenty years have yielded significant advances in developing methods of behavioral training that help autistic children find ways to communicate. These techniques require prodigious amounts of persistence, time, money, and love, but the result could be genius.

– Gratefully adapted from an article by Temple Grandin, Ph.D., and published in Paradigm, Spring 2003.

Dr. Temple Grandin has a Ph.D. in Animal Science and the author of Thinking in Pictures (Doubleday 1995), which is the result of Dr. Grandin’s determination to find answers for herself and others who share this ability. Dr. Grandin is currently an assistant professor at Colorado State University and a frequent lecturer on autism.

From the Desk of the President

In our continuing effort to take the Montana Mental Health Association in New Directions, the MMHA Board of Directors is working harder than ever before. We are taking a close look at every part of our organizational structure, with thought to reorganizing, maximizing our talents, and making best use of every dollar available to us. I feel privileged to be part of such a talented, energetic board. Each and every member is working hard to bring the organization to the forefront of Montana’s efforts to educate, advocate and inform. We are actively fighting stigma and advocating for providers, consumers, families… and a healthier Montana. We will be conducting a membership drive later this summer and really need your assistance as we continue to grow. Please watch for the new MMHA logo in your mailbox. Your support is the only way we can continue to make a difference.

Cindy Dolan , President
Montana Mental Health Association

Voice of the Consumer

by Joyce Stephens

When I had my first panic attack, I thought I was having a heart attack. I had chest pain, my heartbeat was very rapid, and my skin felt damp and clammy. I couldn’t seem to get enough air into my lungs, which added to my distress. I was taken to Immediate Care, where they assured me that it was not my heart, but probably a “panic attack.”

It was several months before I had another attack. This time I called my doctor. After listening to my symptoms, he suggested I take one aspirin. If the chest pain stopped, I was to get to the Emergency Room because that was one sign that it could be a heart attack. If the aspirin did not stop the chest pain, I was probably having a “panic attack.” Since then, I have learned that I am not causing these attacks. It isn’t like deciding to go to lunch on Tuesdays – they can happen anytime of the day or night, while I’m at home alone or with family, while I’m at work or even driving my car. When they start, I become agitated and my mind won’t stay focused. I start worrying about what to do next, or that I can’t finish this or that now because I have something more important to do. At work, I pace back and forth trying to decide what to work on, accomplishing nothing. If I’m driving and start to get that anxious feeling, I try to get home quickly, because during an attack, I want to drive 120 miles an hour, as if I’m trying to catch up with myself.

Panic attacks have not ruined my life, but it has taken a lot of time to learn to understand them. I’m not mentally ill and with medication I can handle them pretty well. Large crowds are generally a problem for me, but with some foresight I take my medication about an hour ahead of time.

I’ve talked to so many women who have experienced some of these helpless feelings, and I encourage them to talk to their doctors. No one should be held hostage by these attacks when there is help and hope available.

Walking on the Quicksand of CHANGE

In today’s world, Franklin’s statement remains true as far as it goes, but a third precept is needed to complete a current list of certainties. Change is occurring at an increasingly dizzying rate, and yet solutions have shorter and shorter shelf lives. As suggested by Daryl Conner in his book, Managing at the Speed of Change, people are dealing with a greater rate, volume and complexity of change than ever before. Practically speaking, the amount of change that occurred over fifty years during our grandparents’ era is now occurring about every five years. And these changes are taking place in every area of our lives, from professional to personal to social.

Naturally, change can be positive or negative. Often something that appears to be negative can become positive through a simple change in perception. But any change, whether viewed positively or negatively, results in a certain degree of loss and contains an element of the unknown. Not surprisingly, it is often fear of the unknown and attendant loss that creates the most anxiety regarding.

The perception and management of change can be compared to the feeling of walking on quicksand; “a…. soft, shifting mass that yields easily to pressure and tends to suck down any object resting on its surface.” Successful negotiation of the quicksand of change means finding ways to avoid being dragged down, bogged down or sucked into negative or reactive behaviors. For every change, the first question is, “Can I live with this?”

Some people thrive on and strive for change. Others are hesitant but take it in stride, while looking on the bright side. Another group is hesitant and sees the negative side, while a final group tends to be both negative and reactionary. Regardless of which group you fit into, you can easily walk on the quicksand of change using a four-step process. Once you have mastered the steps, you’ll be able to lead your staff, employees, colleagues, and family members through the process.

Step 1 – Ability
Increase skills or develop ability. This includes learning about change as a process, understanding phases, causes, and reactions to change. It also requires working through the grief process. With change comes concomitant loss and loss must be grieved in order to embrace the positive aspects of change.

Step 2 – Attitude
The three most important things to remember when walking on the quicksand of change are attitude, attitude, and attitude! Take charge of your attitude and you’ll take charge of change!

Studies on change, stress, and coping show that individuals who believe they can control the outcomes of their experiences – who have an internal sense of control – cope better than those who feel outcomes are controlled by outside forces. These people choose to be victors, not victims. They do not make excuses, but assume responsibility for their actions, positive and negative. If they can’t change an event, they change their reaction to it. They are masters at living the Serenity Prayer.

We must transform our focus from the negatives and the uncontrollable to the positives and what can be controlled. Change how you think and you change how you feel and respond. A negative attitude is a lot like a flat tire – you’ve got to change it to get anywhere.

At the end of the day, make a list of the things you’re worried about – things that didn’t get finished or that upset you. Then put these “worries” in you desk drawer. Lock the drawer and tell them to “Stay!” They’ll be there in the morning, so why take them home at night? Sarah Breathmach, in her popular book, Simple Abundance, suggests writing down five good things that have occurred during the day. Even on a really crummy day, there will be more than five things to be happy about.

Step 3 – Action
Attitude and abilities will only get you so far. Putting them into action is what counts. Action means getting involved in, participating in, or initiating change. Help make it happen. Communicate (and visualize) that you are in control of the change process. See yourself as a winner. Both are helpful mental actions. Whatever you think is most likely to happen, is most likely to happen. Obviously, just thinking about achieving change is not enough to make it happen. But the more you think about it, the move likely you are to take the steps necessary to make it happen. Affirmations are also helpful. Write, say, or record your hopes, goals, and wishes for change. Be positive. Say, “I am…” instead of “I will be…” to connote that you are in change.

Step 4 – Allowances
A final step involves making allowances for the experience of change. Adjusting your attitude, developing abilities, and taking action all take time. Allow that time. Set realistic expectations. Be kind to yourself. Be patient. Congratulate yourself on successes and celebrate milestones. Allow for flexibility and learn from mistakes. Allow others to help – and ask for help, but be specific about what you need or want. Allow the expression of grief, but bring back the positive attitude. Above all, encourage humor.

Change is constant. We must learn to deal with it positively or we will sink in its shifting sands. Increase your ability, improve your attitude, take action and make allowances to walk on the quicksand of change.

Sources Cited:

1. Daryl Conner, Managing at the Speed of Change, NY, Villard Books, (1994)
2. Breathnach , S.B., Simple Abundance, NY, Warner Books, (1996)

This article has been gratefully adapted from Walking on the Quicksand of Change; Sandra Jones Campbell, RN, Ph.D.; Paradigm, Spring 2003

Open Invitation The 2003 Annual Meeting to be
held in Eastern Montana

The 2003 Montana Mental Health Association Annual Meeting is scheduled for Friday, June 20th at the Cottonwood Inn in Glasgow Montana. Activities begin at 6:00 P.M.. The agenda includes guest speaker Frank Lane, Director of Eastern Montana Community Mental Health Center and an update on the 2003 legislative session.

Nominations are now being solicited for the association awards that are presented that evening. The Cliff Murphy-Advocate of the Year Award is for an individual who has dedicated ten or more years to noteworthy advocacy on behalf of the mentally ill. The Challes Averill Volunteer of the Year Award is for an outstanding individual who has furthered the cause of mental health in Montana. For more information please call 406-442-4276. Nominations close June 6, 2003.

PANIC DISORDER MAY SURPRISE YOU!

By Mark A. Johnston, M.D.
Diplomat, American Board of Psychiatry and Neurology
Senior Medical Director – Pathways Treatment Center, Kalispell, MT

Intense fear, dizziness, racing heart, a feeling of impending doom: these are the experiences of those affected by the anxiety condition known as Panic Disorder. A person with Panic Disorder experiences episodes of intense fear accompanied by multiple physical symptoms including a racing heart, chest pain and shortness of breath. These episodes, also referred to as panic attacks, produce symptoms similar those experienced during a fight or flight response. After a panic attack, there may be an anticipatory anxiety inspired by the fear that these feelings and physical sensations will recur. This can lead to the avoidance of circumstances that could trigger a new attack.

Approximately 3-4 million Americans have experienced panic episodes, with women about twice as likely to be affected as men. Typically, this condition is expressed in the 20’s or 30’s, although children and seniors can occasionally be affected. The initial panic episode may occur without a triggering event. People often describe the first episode as coming "out of the blue." They may be sitting at a desk or driving a car when a sense of unreality and feelings of intense dread set in. This can trigger the need to escape the current environment.

The circumstances surrounding the first panic attack vary widely. Sometimes, it’s related to a change in environment or life circumstances, increased stress, or major loss. An initial attack could follow a serious medical illness, childbirth or surgery, or be triggered by heavy use of caffeine or some prescription medications. Occasionally, the use of illicit drugs – especially stimulant drugs such as methamphetamine or cocaine – will trigger panic attacks, but some individuals actually wake from sleep in the grip of a panic episode.

Many seek help from a physician or travel to an emergency room during or after a panic attack. The person is frequently reassured that nothing medically wrong. This may leave the individual feeling confused and unsatisfied. They may visit multiple doctors in the belief that they have a heart problem or other serious medical condition. Unfortunately, some doctors do not recognize Panic Disorder. Even if they do, they’ll often encourage the patient not to worry because it’s “only anxiety.” Reassurance alone is unsatisfactory, as the Panic Disorder condition is seriousand requires appropriate treatment.

Untreated Panic Disorder can produce Agoraphobia, which literally means, “fear of the marketplace.” It is used to describe fear of a location or situation where escape might be difficult. About one-third of people with Panic Disorder have some avoidance consistent with Agoraphobia. Commonly, such individuals fear entering retail stores, standing in line, or being in crowds. They may restrict movement to the local neighborhood or – in severe cases – may be unable to leave home. This condition can be so disabling as to render an individual unable to work or socialize.

Treatment
Fortunately, 80– 90 percent of those with Panic Disorder improve significantly and many demonstrate complete resolution of their symptoms. Early treatment can be valuable in preventing secondary anticipatory anxiety and avoidance behaviors. The first step in any treatment of Panic Disorder, however, should be a thorough medical evaluation to rule out other causes. Rarely, cardiac abnormalities or endocrine conditions such as Hyperthyroidism may mimic symptoms of Panic Disorder.

Use of therapeutic medications is an especially effective treatment for many. Medications can reduce the frequency or eliminate the occurrence of panic episodes. A new generation of serotonin re-uptake inhibitor (SRI) antidepressants provide excellent benefits for Panic Disorder and are less likely to cause side effects than the drugs that preceded them. These medications can require 4–6 weeks to become fully effective and to prevent new panic episodes. Often an experienced clinician will prescribe a benzodiazepine medication to provide initial anxiety benefitand immediate protection against panic attacks. This allows some relief until the full benefit of the SRI is achieved.

Although medication therapy has become a mainstay of Panic Disorder treatment, cognitive/behavioral psychotherapy also provides significant benefits for some individuals. Therapy may include identifying patterns of thinking that create a cycle of fear. Other techniques are used to interrupt the cycle of cognitive response, reduce symptoms, and, hopefully, prevent future attacks. Patients may also be trained to use systematic relaxation techniques to reduce anxiety and stress. Many believe that a combination of medication and cognitive/ behavioral therapy is the most effective treatment for Panic Disorder.

The good news is that with proper treatment the great majority of individuals can be helped and need not live in fear of panic attacks.

For more information:

American Psychiatric Association
1400 K Street NW
Washington D.C. 20005
http://www.psych.org

American Psychological Association
750 First Street NE
Washington D.C. 20002
http://www.apa.org

Anxiety Disorders Association of America
11900 Parklawn Drive, Suite 100
Rockville, MD 20852
http://www.adaa.org

National Alliance for the Mentally Ill

200 North Glebe Road, Suite 1015
Arlington, VA 22203 - 3754
http://www.nami.org

Upcoming Calendar of Events

June 12-13, 2003
Victim Offender Mediation Dialogue Training, C’mon Inn, Missoula, MT Sponsored by Mediate First, Inc. For more information, call 406-543-4600 or E-mail mediate1st@msn.com

June 16-17, 2003
The Developing Mind, by Dr. Daniel Siegel, MD, Great Northern Hotel, Helena, MT Sponsored by NASW and Intermountain Children’s Home. For more information, call 406-449-6208

June 17, 2003
METNET - Training for consumers on Self Advocacy and Employment. Sites in Helena, Bozeman, Miles City, Big Timber, Plentywood, and Sidney. For more information, call 1-800-823-MHAM

Coming Next Year

April 1-2, 2004
Cognitive Therapy Unplugged, Essential Therapist Skills for All CT Applications, presented by Christine Padesky, PhD, Hampton Inn, Great Falls, MT Sponsored by MHA Great Falls. For more information, go to: www.padesky.com

News Briefs

The Infinite Mind is the weekly, public radio series on the art and science of the human mind. It is hosted by Dr. Fred Goodwin and produced by the Peabody Award-winning Lichtenstein Creative Media in association with WNYC/NY, and the New York Foundation for the Arts. To find the public radio station in your area that broadcasts The Infinite Mind visit www.theinfinitemind.com/stations.htm. For more information visit www.theinfinitemind.com

The Eating Disorder Institute opens a new inpatient program in the Northwest Region. A new inpatient program for the treatment of eating disorders recently opened in Fargo, North Dakota. The Institute is a collaborative arrangement between the University of North Dakota School of Medicine, MeritCare Health System, and the Neuropsychiatric Research Institute. The program, staffed by full-time psychologists, psychiatrists, counselors, nurses, and dietitians provides comprehensive patient care. Providing an out-patient program since 1996, the Eating Disorder Institute began the in-patient program in April 2003. For information contact Deb Nelson at 1-800-437-4010. Ext. 4111