Global Initiative Hilversum becomes equal FGIP member
This used to be the website of the headquarters of Global Initiative on Psychiatry with headquarters based in Hilversum, The Netherlands.
In the course of 2012-2013 Global Initiative-Hilversum became an equal member of the Federation Global Initiative on Psychiatry (FGIP) and in November 2013 the "separation" was completed.
In practice this means that Global Initiative-Hilversum will develop its own website, separate from FGIP, and will foxus in its work not only on developing countries but also on The Netheralnds itself. The new website, which is currently under development, will therefore be both in English and Dutch.
This website is now exclusvely for FGIP or, with its new name: Human Rights in Mental Health - FGIP.
For more information on Global Initiative-Hilversum see "FGIP member organizations"
The news about Robin Williams committing suicide really hit me. Not because he was a wonderful actor, who seemed so much the epitome of enjoying life, and not because of the sheer tragedy of a person actually getting to the point of hanging himself because he could not take it anymore, and then the relatives having to find him there, under such circumstances…
No, what hit me was his age: 63. It immediately brought back memories of my father, who like Robin Williams seemed to be enjoying his life, always smiling, always joking, family around, travelling and exploring the world… yet when he was exactly that age, he was in bed and refused to come out, and had only one wish: to die.
My father suffered from depression, and looking back it was much more serious than we realized at that time. He was seeing a psychiatrist at least since he came back from Canada with his family, in 1961. It was an unsolicited return to his homeland, unsolicited because he fundamentally disliked the provincial atmosphere in The Netherlands. Yet he had lost his job in Canada at the Canadian Broadcasting Corporation and thus he had no choice – there was a family to feed. To him this was a cardinal psychological defeat, and although he had a wonderful career in The Netherlands afterwards, being one of the first and prime experts in public relations, this forced return always dominated his life and thinking.
His depression was probably always there, on and off, but we never noticed. Anyway my mother was very good in shielding him, protecting him, and giving him a trustful environment. It really came out in 1979, when he fell ill physically, and immediately suffered a burnout. There are many aspects to the reasons why, which are not important here, but the bottom line is that the very delicate house of cards that kept him going came rumbling down, and nothing was left. He was at home, in bed, and refused to get out. Life had lost all meaning.
We got him on the move, by the sheer luck that I needed somebody to write a biography of Andrei Sakharov and as a former journalist he was the perfect choice to do so. He did, and wrote several more books, among others about the Holodimor in Ukraine, and for more than ten years we worked together. For me this was an unforgettable experience – for him it was probably the same, but also it was the way to battle his depression.
In the end, he stopped working in the late 1990s, because of what we now know was the onset of pre-fontal dementia. He went through many bad years, but the “gift” of dementia – if one may call it such – is that in the end his depression left, and the last one-two years of his life were very happy ones. Yes, he was demented, but he was happy, humorous, almost the man we used to know when he was not depressed and not demented.
Gradually through time, I have come to understand that I have much more of my father’s genes than I knew, or hoped. My father was the favorite parent, for all three of the kids, but at the same time my mother was the eternally optimistic one, almost pathologically optimistic, even irritating at some times. So having my mother’s genes was not really “the best”. On the other hand, she remained active until she died at the age of 87, was unbeatable, always smiling, even during the last moments of her life. She was an unbelievable character, and so having her genes was not really such a bad thing after all.
Consequently, for many years I happily accepted that my mother’s genes were dominant in me, in spite of the negative “irritating” side effects. Yet what I always knew, or felt, was that my father’s depressive tendencies, his fears and anxieties, are equally strong within me. I hid and hide them, both for myself and for others, but they are there, and they are undeniable. I share his fears and anxieties, his inability to function in social environments, his feeling of being lost and never being able to “really” deliver, his feeling that so much more is expected from you and you will never be able to cope. I share his anxiety when travelling, his conviction that you are never “enough”… It is all there, and with time it is getting stronger…
In the early 1980s, my father and I went to New York together. I was just over twenty then, I hardly knew my father because he had always been away (and protected by my mother), but there we went. The morning after we arrived I found him crying on the side of his bed. “I want to go home”, he said, “I can’t do this”. He was so scared, so much in pain that I called the airline company and booked him on the next day’s flight. He calmed down, we went out, did our sightseeing, even went to see some of my USSR-related contacts, and in the evening he said – I will stay one more day, just let’s rebook the ticket. The next morning I would find him in distress, but having booked him on the next day’s flight sort of helped him to cope. That is how we spent four-five days in New York, me as a young adult taking care of his father who before had been God knows what, Chairman of the World Association of Ports and all that stuff… but who was now just his scared father who couldn’t manage traveling anymore.
It is strange how things go. When my father became demented and became untenable, we managed to get him into a mental institution in Rotterdam for evaluation. I will never forget the image. There was my proud father, who had seemed for so many years to be such a strong unbeatable man, sitting at the table, crying, and taking my hand asking whether I could help him because he couldn’t understand anymore what was going on…
Mental illness, or whatever you call it, is so devastating, so painful, and yet it is so close. We all think, or hope that it stays away from us, but it doesn’t. Sooner or later all of us are affected, and it totally changes the outlook on life.
I still miss my father, every day. But I hope he felt that I supported him during the times when he needed it, even when he was no longer able to ask for help.
Robert van Voren
DSM and ICD – two psychiatric classifications on the block - Peter Tyrer
What are these acronyms and are they of value to psychiatry? The answers to the first question are simple. DSM stands for Diagnostic and Statistical Manual for Mental Disorders, and its 5th revision was published in May 2013, and ICD is short for the International Classification of Diseases, the 11th revision which is due to be published in 2015 or 2016. The value question is a matter of debate. Only the complete anti-psychiatry zealots believes neither classification is of value, but the amount of confidence we have in both of them varies from almost religious belief to extreme scepticism.
Where do I stand? In the middle, wobbling on top of a rickety fence. I have rechristened the acronym, DSM as both Diagnosis for Simple Minds, and Diagnosis as a Source of Money (Tyrer, 2012), as both are true. The ‘operational criteria’ are listed for each disorder and can be ticked off simply, and the American Psychiatric Association relies on the income from DSM for much of its core work. But I am being slightly unfair; DSM is a noble but flawed attempt to give order to a very disordered subject. Psychiatric classification involves much more guesswork than medical classification and filling the gaps is a task that all can criticise successfully with all getting prizes. DSM-5 has come in for heavier criticism than other revisions, as it planned originally on making the classification a true beacon of science – a ‘paradigm shift ‘ in which biological measures would be used to describe the new disorders. But it never got to first base. Instead we have a reshuffle of disorders, and new ones that tend to increase pathology in the population. These include premenstrual dysphoric disorder, disruptive mood dysregulation disorder, illness anxiety, hoarding, binge eating and minor neurocognitive disorder. Allen Frances, the chair of DSM-IV, berates the new DSM masters as being out of control and has led the campaign to save the world from being diagnosed with a DSM disorder (Frances, 2013).
ICD is in somewhat better odour, not least as it is the official classification of disease across the world. But the revision of the classification is badly resourced and it is difficult for it not to follow the much better funded studies that back up DSM. But it is fighting back, and when I spoke in Vilnius in April at a meeting of the Lithuanian Psychiatric Association (Lietuvos psychiatry asociacija) there was much more enthusiasm for a reinvigorated classification that was not linked to any one country and which could be embraced by practitioners across the world. And there are benefits from a world-wide approach. Russia uses ICD and at a meeting of the Serbian Psychiatric Association two years ago Valery Krasnov of the Moscow Research Institute of Psychiatry presented data on the epidemiology of ‘sluggish schizophrenia’. Although this was never an ICD diagnosis it was widely used to imprison dissidents in psychiatric institutions, and Valery’s statistics showed that this strange disorder had almost completely disappeared from national figures since its heyday 40 years ago – mainly being replaced by personality and mood disorders. One of the essential tasks of a good psychiatric diagnostic system is to be embraced sufficiently to be independent of political pressures of all sorts and we hope that ICD-11 when it appears will be a much cleaner and well-organised diagnostic system than it has been in the past.
Tyrer P. (2012). DSM – in 100 words. British Journal of Psychiatry, 200, 67.
Frances A. (2013). Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. New York: William Morrow.