#Mental Health Clinic Baltimore MD

[accesshealthservices]

Tackle A Particular Mental Illness Or Life Stress.

Psychotherapy is a general term that is used to describe the process of treating psychological disorders and mental distress through the use of verbal and psychological techniques. During this process, a trained psychotherapist helps the client tackle specific or general problems such as a particular mental illness or a source of life stress. 

Depending on the approach used by the therapist, a wide range of techniques and strategies can be used. Almost all types of psychotherapy involve developing a therapeutic relationship, communicating and creating a dialogue, and working to overcome problematic thoughts or behaviors.

Visit More: https://www.accesshealthservices.org/psychotherapy/

[lboogie1906]

Captain Dr. Oscar Clement Allen (May 21, 1921 - September 24, 2004) was born in Baltimore. The eldest of four siblings, he was reared in Gloucester, Virginia. His parents were John T. Allen, a farmer, and Bertha Frazier Allen, a homemaker. He attended the racially segregated Woodville Rosenwald School and graduated as valedictorian at 14 years of age. He received a BS from Virginia State College and an MD from Howard University College of Medicine. He completed a rotating residency at the Freedman’s Hospital. His psychiatry residency was at the Northport Veterans Administration Hospital in Long Island.

He married Hattie Hylton Lawson (1947) a registered nurse, educator, and author. They became the parents of two physicians.

He practiced medicine privately and was the Medical Director of Willia Hardgrow Mental Health Clinic in Bedford-Stuyvesant. He was a senior psychiatrist for the New York City Board of Education. He devoted his medical practice to Child Psychiatry for half a century, emphasizing the underserved Black community in Brooklyn and Manhattan. He selected Psychiatry as his specialty because he was deeply moved by his experiences in WWII when he witnessed the severe impact of war on the US soldiers’ psyche serving in Korea and Japan.

A veteran of the Army and its medical corps, he rose to the rank of Captain. He was honored as an outstanding psychiatrist in Brooklyn by the Provident Medical Society of New York. He was elected President of The COMUS Club in Brooklyn and honored as “COMUS Man of the Year”.

He was a member of Mt. Lebanon Baptist Church in Bedford-Stuyvesant for over 50 years. He was a Life Member of the National Medical Association, the American Medical Association, and the American Psychiatric Association.

An avid photographer, musician, swimmer, chess player, world traveler, and pianist who concentrated on the works of Frédéric Chopin, he traveled with his family to all 50 states, throughout the continents of Europe and Africa, North and South America. He visited the Union of Soviet Socialist Republics and the People’s Republic of China. #africanhistory365 #africanexcellence

[professionalhealthcarephri]

Need For Professional Elder Care in Baltimore and Arlington, MD

Moving around, taking care of the home, and engaging in outdoor activities helps a person feel comfortable. Unfortunately, advancement in years can rob most individuals of ordinary comforts and independence. Statistics reveal that the baby boomer generation is aging rapidly and will soon depend on their children and friends for daily living. The adult children should use professional services for elder care in Baltimore and Arlington, MD, thus ensuring peace of mind for all concerned. ​ The care provider is sure to be well-trained and adaptable. The senior individual may require close assistance with multiple things every day. It is the onus of the caregiver to understand the need and provide the right sort of help without being unruly or downright rude to a helpless older adult. Some of the aspects that may require care by a professional include the following:-

· Routine Domestic Chores- A senior citizen who may be plagued with illness and lack of mobility cannot handle most everyday tasks. The care provider is sure to take over simple yet essential chores such as carrying the laundry inside, changing light bulbs, and helping with dressing. Keeping the home neat & tidy may be ensured by the professional, enabling the homeowner to be at ease.

· Meal Preparation- The seniors often cannot cook their meals and rely on take-out food and home delivery. Consuming such food regularly can affect the digestive system adversely. A care provider is adept at rustling up simple, home-cooked meals. Serving the meal to the individual can ensure proper nutrition, too.

· Companionship- The old and infirm are often neglected in society. The seniors have to be content with their own company, and being unable to enjoy the love of their loved ones takes a toll on their mental health. The trained care provider can step in here and chat with the older adult as required. Reading aloud to the patient, discussing interesting topics, and playing board games together can relieve the emotional burden by creating a deep bond between them. Finding a friendly face always by the side and receiving assistance can result in peace of mind with several years of life being added to.

· Timely Medication- The number of medicines to consume will increase in proportion to one’s age. It is not uncommon for older adults to forget to take their medicines on time. The care provider will help out here as well. Reminding the patient to take the medication at the right time is a responsibility that the professional undertakes excellently. Moreover, discussing the dos and dints with the doctor and taking the patient to the hospital/clinic as per the appointments can go a long way in keeping the patient healthy

Apart from daily caregiving to older adults, such professionals may be hired to provide home care in Kensington and Baltimore, MD, to facilitate a patient's recovery or provide nursing assistance to ensure treatment and independence.

[healthyhorns]

Healthyhorns Staff Features: Shalini Tewari, MD

Shalini Tewari (she/her/hers) is a staff physician in the General Medicine clinic at University Health Services.

Prior to joining the Healthyhorns team in August of 2012, Dr. Tewari completed her internal medicine residency in Baltimore and pursued further fellowship training and employment in New York City.

“I first started working part time in college health at the Fashion Institute of Technology in 2005 while living and working in New York City,” Dr. Tewari said. “At the time, I was also serving a wider age distribution of chronically ill patients in an adult ambulatory medicine clinic. I found that I loved the excitement of being on a bustling campus full of students, many of whom were at the start of their professional journeys while also trying to navigate their physical and mental health and well-being independently, often for the first time.”

Dr. Tewari and her family made the move to Austin in 2011 and she waited for a job to open up at University Health Services.

“The influence that UT Austin has on the vibe and culture of this city was immediately palpable to me, which is why I applied and waited for a staff physician position to open at University Health Services,” Dr. Tewari said. “I was thrilled to become part of the UT family.”

In her role as a provider in the General Medicine clinic, Dr. Tewari said she provides care for students for a variety of reasons.

“I see and manage the gamut when it comes to student concerns,” Dr. Tewari said. “From acute illnesses to injuries to primary or assisted management of chronic medical conditions to  mental health support – I am proud to be someone students can turn to when they need services of this kind.”

Dr. Tewari takes pride in adhering to the mission and values that are upheld at University Health Services and within all areas of Healthyhorns.

“Our common philosophy as healthcare providers at UHS is that our students are the most important people on campus,” Dr. Tewari said. “We strive to listen carefully to patients, comprehend their biggest concerns, and convey evidence-based health information in a way that is understanding and supportive.”

Dr. Tewari said she has enjoyed working with college students for much of her professional career and is truly honored to help improve their physical health and overall sense of well-being.

“I admire the resilience students have despite having to deal with so many ‘new normals’ that the pandemic and pressing world problems are bringing to light,” Dr. Tewari said. “I enjoy our partnered decision-making and helping my student patients navigate their health needs as they learn to advocate for themselves, all while facing the academic, social, and professional challenges that happen at an institution of higher learning.”

Make an appointment to see Dr. Tewari at University Health Services by booking online within the MyUHS Patient Portal or by calling 512-471-4955. Learn more about UHS at healthyhorns.utexas.edu or by visiting us in person in the Student Services Building, 100 West Dean Keeton Street, 1-3 Floors.

-Erin Garcia, Healthyhorns Outreach and Social Media Coordinator

[sk3tchisworld]

ENORMOUS TRIGGER WARNING

This post contains mentions of violent death, mental illness, criminal activity, police brutality, drug activities, and dead animals. While not described in horrific detail they are present. Please proceed with caution or not at all.

I am 33 years old and I believe I am on the spectrum. I am currently diagnosed with BPD (borderline personality disorder) and Bipolar II (less severe manic episodes). Although other analysis has suggested updated diagnosis of Cyclothymic, unspecified BPD, with narcissistic traits. With a lot of research, I've learned that BPD is sometimes mistaken for autism and so I dare to conclude the reverse is possible. I am seeking a diagnosis and trying to chronicle my experiences until then.

Day One

Literal Thinking/Missing Social Cues

Getting a diagnosis as an adult is HARD. But I grew up in the 90s and what I've experienced would have not qualified me at the time. While I'm looking to get a diagnosis I've understood they ask a lot of questions that are not natural to answer. Sometimes, I think something is significant and I will hold that memory for a while, only for it to be forgotten as soon as someone asks. So, as long as this blog exists I'll have a record.

I have been historically called 'gullible'. People told me some of the most outlandish stuff and I nodded and accepted it as truth. I was laughed at and repeatedly tricked because, I quote, "You believe anything!" It's made me less open to learning from people or even socializing.

Examples

"I was in a mob and maimed people to collect money."

I will purposely not retain this information, but okay. 🤷🏾‍♀️

"There's a bring your own roadkill bar and grill out 264."

Gross, but okay.

"I'm a descendant of Christopher Columbus."

Not impossible, so okay.

What do all of those statements have in common? They are generally hard-to-believe statements but they all have a grounding in possible facts. We have billions of people on this planet, all with their own lived experiences. Who am I to question their life? I know some incredible things have happened to me that people would never believe. Not to mention, I loved to read and research obscure topics. This made me open-minded to niche topics.

When I talk to people, my brian goes into overdrive. I am trying to nail this interaction so much I find myself processing a lot of data from a few seconds. I do this even to people I am extremely close to. I study everything from your posture to the smell of your breath (if applicable). This seems to have made me good at detecting moods, health, and intentions. Sometimes.

My process of thinking goes (in no special order):

How familiar am I with this person?

Deciphering accents (and deciding if they're a local)

Analyzing body language

Connecting to my personal experiences, imperial data, and loose research

when is it appropriate to respond (if at all)

What is the appropriate emotion to the information shared

Do I look interested?

Am I fidgetting too much?

Why are they telling me this?

Don't look at your phone again...

What is my dog doing over there?

Maintain eye contact!

Shit, what did I miss?

Sound intelligent, but not too intelligent. You always confuse people with your $10 words.

Did you just make this about you? They didn't ask about your 'similar experience'.

Was that a withdrawal? What did I say wrong?

To be more clear, I'll go through each one of the examples.

I was in a mob and maimed people to collect money.

I grew up in Baltimore, MD. While I grew up generally unaware of the insane danger that was lurking nearby, it was regularly presented to me. A house exploded less than a block away from me. My father's best friend was shot in the face with a shotgun and dumped on the intersection I lived on. I lived three doors from the corner. I was less than half a mile from a notorious crack dealing location. I lived directly around the corner from a methadone clinic. My mother was a drug addict!

By my teenage years, I explored out of my sheltered bubble and learned more. My boyfriend's best friend's brother (that's a mouthful) was an infamous 'King Pin' that had for, reasons, ended up a near complete quadriplegic. Yes, I met him. My boyfriend (now husband) witnessed police suffocate a friend by pressing on his book bag. Yes, it was very George Floyd-esque with the crying for air. My boyfriend was a young teen just trying to walk home from school. Later on in life, his god sister was beaten by cops while she was trying to get help after being mugged. They were, at the time, harassing a homeless man in a wheelchair.

The chances of someone being an ex-member of an Italian mob seem reasonably high in my world.

There's a bring your own roadkill bar and grill out 264.

In my mid-twenties, I made the big leap to the south. I had seen the ugliest my hometown could offer and wasn't interested. A friend had suggested moving south where she now resided for safety and affordability.

One of our first introduced neighbors wanted to surprise the city couple. I didn't discount the likelihood. There were a lot of hunters and farmers in this area. I had very little experience or education in that field. I knew they ate things I had never heard of and decided not to judge and shrug.

Do you know I repeated that stupid statement to other people for YEARS?

*sigh*

I'm a descendant of Christopher Columbus.

This happened today, when I decided I knew a little of what this blog would be used for. An elder couple stopped me while walking my dog by the Waterfront to ask me about the town. They were retirees and by their questions, they were probably shopping around to move.

I have a poor sense of direction and couldn't navigate them to any specific locations. I joked about this. Then the gentleman dropped this.

I 💯 believed him until his wife laughed.

Without her chuckle, I would have held that nugget and shared it with my husband later. He elaborated and said that it wasn't impossible (it's not) because he was of Italian heritage. I mean, it was a stretch but considering what Christopher Columbus is now understood to have contributed to history I'd redraw that part of my family tree. Expeditiously.

Regardless, I am aware of people doing deep dives into their genealogy. It's a hobby for some, a short rabbit hole for others. How do I know he's lying?

In Conclusion

I'm aware that clinical studies look for you to misinterpret sayings like, "Pulling a fast one," or even, "Pulling my leg,". And I may be mislabelling something else like missing social cues, such as humor. I have laughed at serious things and looked solemn for complete jokes.

It's not that I don't enjoy or recognize humor. When it's overt, at least. Dry humor and sarcasm usually get lost in the old categorization part of my brain. Yet I use both, almost excessively.

But, I have no idea when someone is getting over on me. I've misused phrases and struggled to connect to new ones.

Anyway, day one.

[mybookplacenet]

Featured Post: Unbelievable Grief: Incredible Grace, a memoir by Carrie Boone

About Unbelievable Grief: Incredible Grace, a memoir: Have you ever felt so confused and overwhelmed by untamable emotions? You are not alone. Grief is a very unpredictable and ever-changing process. Carrie figured that because she had been exposed to some grief and loss situations early in her life that this made her well prepared for loss going forward. Well, she was wrong! Even though Carrie had been exposed to grief and loss as early as the age of 8, she would learn that the loss of a very dear loved one to ALS (Amyotrophic Lateral Sclerosis) would send her on an unpredictable and turbulent journey of grief and despair. After enlisting in counseling services for herself, she would learn that her human nature had made her susceptible to a shared experience similar to the one’s she would assist with in her work as a mental health professional. Carrie would learn that even through pain and suffering that God would render his ultimate grace and healing through her grief journey. She found deeper answers to these questions: 1. Did you know that there is no universal template for grief, it is unpredictable? 2. Did you know that there is no time schedule or limit for the grief process, it takes time? 3. Did you know that news of a terminal illness such as ALS (Amyotrophic Lateral Sclerosis can cause one to grieve prior to one’s death? 4. Did you know that God’s grace is sufficient and will help during the turbulent times? Targeted Age Group: 18-90 Written by: Carrie Boone Buy the ebook: Buy the Book On Amazon Buy the Book On Barnes & Noble/Nook Buy the Print Book: Buy the Book On Amazon Buy the Book On Barnes & Noble/Nook Author Bio: Carrie S. Boone is a native of Baltimore, MD. She is a licensed clinical social worker(LCSW-C), therapist and certified grief professional. She is a dedicated wife and mother to two beautiful children. Carrie is a proud graduate of the historic Morgan State University School of Social Work. In her hobby time, she enjoys spending time with her family, traveling, and crafting. Follow the author on social media: Learn more about the writer. Visit the Author's Website Read the full article

[the-courage-to-heal]

Childhood:

The book Sybil and the subsequent 1976 movie in which Sally Field portrayed a girl with more than a dozen different personalities were the result of a collaboration between psychiatrist Cornelia Wilbur and author Flora Rheta Schreiber. The goal was to have people better understand a child abuse victim who developed alternative personalities as a coping mechanism.

While the book and movie raised the profile of what is now known as dissociative identity disorder (DID), they also created some significant misconceptions.

“Do people come into my office and switch personalities in a dramatic way, with different voices. Does their makeup suddenly change? No,” said Milissa Kaufman, MD, PhD, about the character Sybil. “It may feel like that to them internally, but there’s no dramatic thing that happens.”

Kaufman, director of the Dissociative Disorders and Trauma Research Program at McLean Hospital and medical director of McLean’s Hill Center for Women, said patients with DID, a form of post-traumatic stress disorder (PTSD), often carry on very normal, high-functioning lives. She pointed to Robert Oxnam, a China scholar and president emeritus of The Asia Society, who shared his life story in the 2005 book A Fractured Mind: My Life With Multiple Personality Disorder.

That is because DID is a coping mechanism, usually brought on by childhood abuse, and is a kind of ingenious, unconscious way of displacing situations onto other aspects of themselves.

“It’s the ‘not me’ phenomenon,” said Kaufman. “Little children have magical thinking. It’s at this age in development where you believe in Santa Claus, or where little children personify stuffed animals. There are displaced thoughts and feelings that are difficult for them, so they are put on these other entities. It’s a normal developmental stage that children go through.”

Where DID veers from “not me” is when abuse—physical, sexual, or emotional—is introduced into their young lives.

“If you’re being abused at night, you think to yourself that can’t possibly be happening. It has to be happening to some other little girl. It’s not me,” she said. “If a little girl is being abused at night and has to wake up the next morning and go to school and do sports and do homework and have to do as much as they can to not have people get angry at them, they displace it onto another aspect of themselves.”

“A child doesn’t have many other ways to cope. They can’t go to their parents, since that is the origin. They feel like there are other people inside of them, and they can’t tell anybody.”

Dissociation can be found in 1-3% of the general population and as high as 20-30% in psychiatric populations, about the same prevalence as schizophrenia, Kaufman said. A 1986 study by Frank W. Putman and others in the Journal of Clinical Psychiatry found the average patient with DID has been in the mental health delivery system for an average of 6.8 years and has received three other diagnoses. This reflected either misdiagnoses or occurrences of other diagnoses or symptoms that delayed an accurate diagnosis.

Dissociation occurs along a spectrum, from “spacing out” while driving and missing an exit to being hyper-focused on a topic. Along the range are memory issues, like gaps in recall, often associated with PTSD. Further along are depersonalization and derealization—which Kaufman described as a profound detachment from sense of self or sense of body, a sensation of being apart from one’s self, perhaps viewing what is happening from a distance.

The furthest end of the spectrum is fragmentation of identity, where “my feelings or my thoughts or my body feel like they don’t belong to me,” she said.

Richard Loewenstein, MD, a psychiatrist in the Trauma Disorders Program at the Sheppard Pratt Health System in Baltimore, noted in a 2018 paper in Dialogues in Clinical Neurosciencethat dissociative identity disorders are among the oldest reported psychiatric disorders, with case reports appearing at the end of the 18th century.In more recent times, DID was viewed as being “rare and exotic,” except during wartime. Yet, the diagnosis was not without controversy, even among mental health professionals, with a history going back to Freud and questions about what real memories are. That was rekindled in the 1980s cases involving child abuse at day care centers in many parts of the country. Among the models developed at the time, one suggested DID could be produced in highly hypnotized, suggestible patients.

Rather than simply reveal forgotten traumas, the theory went, hypnosis could be used to implant false memories.DID can also be wrongly connected to malingering (exaggerated) and factitious (inauthentic) disorders, where patients make claims either with or without a motivation for personal gain. The best-known example of factitious disorder is the severe form once known as Munchausen syndrome.“That’s not what it looks like,” said Kaufman. “It’s a very real, very well-studied psychiatric disorder.”“It most often is chronic,” she continued. “It typically is at the hands of a caretaker. It can be sexual abuse, it can be physical abuse, it can be emotional abuse. But generally, people who have DID have had many different types of abuse at the hands of multiple perpetrators.

The women she works with at the Hill Center usually arrive with histories of childhood abuse, PTSD, co-occurring disorders such as eating disorders, or substance abuse issues. While DID affects men, she believes many are less likely to come forward for help.“I think there’s even more of a stigma for men to talk,” she said. “It may be that, or a lot of mental health professionals are not trained to ask questions. They may not be on alert for it, because the media depicts women most often as having this disorder, so maybe they don’t even ask.

”DID is also treatable with a three-stage set of professional guidelines established through expert consensus.The initial stage focuses on stabilization and safety. The goal is to

“get things calmed down and life in order. It can take a while for someone to feel comfortable and safe. It can take years.”

Once that is achieved, clinicians move on to the second stage, where the patient begins to process the traumatic events that have affected them. In the final stage, the emphasis is on

”getting your life back, mourning what you have lost and moving on without dissociation, learning how to be in the world without dissociating.”At the same time, scientists are exploring potential biological or genetic links that could predispose a person to DID. Studies to date have shown that in the classic form of PTSD, the brain’s amygdala—which controls the “fight-or-flight” response—is overactive while the prefrontal cortex is not, generating a hyper-aroused state. But in the dissociative subtype of PTSD, Kaufman said, the prefrontal cortex is overactive to the point where a person can be numb and detached.In fact, she explained, both the amygdala and prefrontal cortex become overactive in patients with DID.

“The trauma state in DID looks like classic PTSD,” said Kaufman. “In a numbed state of mind, it looks more like the dissociative subtype, where, the brakes are on too tight.”Scientists are also looking at the brain’s attentional activation system, how a person concentrates.“People who are dissociative have a really refined ability to focus attention, particularly in multitasking,” she said, saying researchers are working to understand how the brains of people with DID have a different allocation of resources toward attentional systems.Finally, there are also studies on potential genetic links.“You aren’t born with DID, but you can have a genetic predisposition to dissociate, so we are also looking for genetic markers.”But Kaufman stressed that people with DID should not give up hope.“It’s treatable. It’s a pretty phenomenal coping mechanism when you are growing up, but it becomes disruptive when you don’t need it anymore.”

source

[madamlaydebug]

BELOVED DR. PATRICIA NEWTON~❤️🖤💚

We pour libation for Dr. Patricia A. Newton, an African-centered psychiatrist, traditionalist, elder, & our dear sister in honor of her passing and her life. Her spirit will live on eternally through her contributions to getting our people’s minds right.

About Dr. Patricia A. Newton

Dr. Patricia A. Newton was an internationally acclaimed psychiatrist, thought leader, scholar, lecturer, published author, pioneer, and traditional Ghanaian Royal. Above all, she was a community elder, a wife, and a friend. We honor her, her family, and her life in this space.

Philosophies

From a European worldview, the fields of psychology and psychiatry do not mix. Dr. Patricia Newton stood strong as an African-centered psychiatrist who understood the importance of both psychiatry and psychology. She saw that the trauma Black people face has both environmental and chemical origins.

Most notably, Dr. Patricia Newton founded the Black Psychiatrists of America in Maryland. Through that organization, her writings, appearances, and community outreach, and international collaborations, Dr. Newton redefined how we look a Black psychiatry today.

Organizational Contributions

In 1969, she founded the Black Psychiatrists of America (BPA) to create resources for psychiatrists who recognize that European psychiatry training is inadequate to address the healing that Black people throughout the Diaspora need. She grew that organization into an international organization. She later went on to serve as a President before becoming the CEO & Medical Director serving on its Council of Elders.

Beyond her role, this organization is her legacy and has grown into a hub and a resource for thought leadership in Black psychiatry.

Dr. Patricia Newton in Private Practice

As a behavioral science specialist, Dr. Patricia Newton founded and became the president and medical director of Newton & Associates and President of Newton-Thoth, Inc. According to her bio, her clinical psychiatry focus involved anxiety disorders with special emphasis on PTSD, depression, chronic mental illness, and transcultural psychiatry encompassing the interface of Western and Traditional African healing systems.

Dr. Patricia Newton and African Spirituality

Dr. Patricia Newton also paved the way by integrating African spirituality as a foundational part of Black mental health. She was enstooled as both a queen mother and female king (Divisional Chief) in Ghana, West Africa, where she received the traditional name Nana Dr. Akosua Akyaa. Her positions were not honorary titles. They were actual positions with full rights and entitlements that make her an Ashanti Royal.

She pioneered work with traditional healers domestically in the US and internationally in Africa, South America, and Brazil. In her work internationally, she engaged psychiatrists and other wellness professionals in Africa, South America, the Caribbean. Through those interactions, she pioneered techniques for the chronic mentally ill. She also developed cultural competency mental health standards for professionals to help HIV/AIDS.

Education and Accolades

Dr. Patricia A. Newton received her undergraduate degree from the University of Arkansas at Pine Bluff. She received two master’s degrees. Her master’s degree in Molecular Biology is from George Peabody College of Vanderbilt University in Nashville, TN. She earned her master’s degree in Public Health at the Johns Hopkins School of Public Health & Hygiene in Baltimore, MD.

Also, according to her bio, she served on the academic faculty for over sixteen years at Johns Hopkins School of Medicine while becoming the first female chairperson of the Department of Psychiatry at Baltimore’s Provident Hospital.

Dr. Newton attended medical school at the Washington University School of Medicine in St. Louis, MO, and her psychiatric training there as well. Additionally, she was one of the first American Psychiatric Association APA/NIMH Fellows as a psychiatric resident that permitted her to attend the inaugural meeting of the BPA’s Transcultural Psychiatry Conference in Haiti in 1979.

Awards and Recognition

Impressively, Dr. Patricia Newton has won many awards and citations, including Essense Magazine’s Woman of the Year in Health & Medicine, Baltimore Magazine’s 100 Most Influential Women in Baltimore, and Towson State University’s Distinguished Black Marylanders.

Moreover, her innovations include culturally competent holistic treatment in chemical dependency and prevention, having her work embraced internationally in Africa, the Caribbean, and in Great Britain with a community-based clinic named in her honor there.

Dr. Mawiyah Kambon, Black Therapy Central co-founder worked closely with Dr. Newton over decades through various collaborations, organizational interactions, and at overlapping speaking engagements. Dr. Kambon will be doing a special tribute to her on an upcoming episode of the Black Therapy Central Show. We will keep you posted on the details.

https://youtu.be/F-pT0pNbi0E

[accesshealthservices]

Adolescent Psychiatry Services : Mental Health Services

Adolescence is a critical period of development where individuals experience significant physical, emotional, and social changes. It is also a time when many mental health conditions emerge or worsen. Visit Now: www.accesshealthservices.org

[manishwebkey]

MASSAGE THERAPY BALTIMORE MD

Now massage is a huge industry with thousands of schools, clinics, and therapeutic work settings as well as licensing and credentialing within each state. Even though MASSAGE THERAPY BALTIMORE MD parlors still exist, their presence remains largely in the seedy hoods and ghettos. Today when you mention massage therapy people don't think of sexual favors but rather a relaxing and pleasing experience. Massage therapy has recovered its respect as a healing art through manipulation of the body and muscle tissue.

The average person would tell you that massage therapy involves rubbing the body with lotion or cream that is relaxing and feels good. This interpretation of massage, although correct in layman's terms doesn't explain what massage therapy is or how it affects the body. Massage therapists manipulate the soft tissues of the body to enhance function, promote relaxation, reduce muscle spasms, pain and inflammation, reduce nerve compression, decrease myofascial trigger points, increase range of motion and joint flexibility, reduce blood pressure, improve posture, calm the nervous system, and improve circulation.

Massage involves manual manipulation of the soft tissue through pressure, tension, motion, and vibration. Based upon specific patient problems will determine the areas that a massage therapist will work on. Techniques can be applied through the hands, fingers, elbows, knees, forearm, or feet depending upon the type of massage. As well as determining the specific tissue to target whether it be a muscle, tendon, ligament, skin, joint, connective tissue, lymphatic vessels or organ. There are numerous types of massage techniques. Some of the common massage techniques include Ayurvedic, deep tissue, sports massage, myofascial release, trigger point therapy, reflexology, medical massage, Swedish massage, stone massage, Thai massage, and shiatsu. In addition to the techniques, there are several different strokes that massage therapist must use such as effleurage, petrissage, tapotement, mobilization, trigger point therapy, neuro-muscular, manual lymphatic drainage and manual traction.

Although massage is considered a complementary and alternative medicine (CAM), it is becoming increasingly part of the medical world. Massage has a variety of settings including health clubs, health clinics, doctor offices, private offices, nursing homes, sports facilities and hospital settings. MASSAGE THERAPY BALTIMORE MD is used in conjunction with several other medical professions such as chiropractic, acupuncture, physical therapy, personal training and sports trainers.

Whatever the reason you get a massage, it is a great therapeutic modality to relieve stress, tension, anxiety, headaches, neck pain, back pain and several other physical or mental problems. If you haven't experienced a massage yet then its time you had one. Many people include massage in their health regimen because it not only has positive effects on the body but on the mind and spirit as well. As your friends for recommendations of a therapist near you!

Graduated with a BA in exercise science and have worked in the medical

Read more… MASSAGE THERAPY BALTIMORE MD

[wp-yahoo-style-1042-yahoopa-blog]

Jenny McCarthy works out with the TV on — is that a good idea?

Jenny McCarthy (Photo: Getty Images)

Jenny McCarthy is known for having a great figure, but she revealed in a new interview that her workout routine is surprisingly simple and relatable.

“I can’t run anymore, my bones hurt,” she told Fox News. “So all I do is an incline of 15 on a treadmill, and then I hold my hand weights, and I watch Game of Thrones or Housewives.” McCarthy said she also boxes while she walks uphill. “That’s all I can do for 45 minutes a day,” she added. “That’s all I have left in me.”

Exercise has known mental benefits including a decreased risk of experiencing symptoms of anxiety and depression, per the Mayo Clinic. But does working out in front of the TV — which so many people do — cancel out those benefits? It’s unlikely, experts say.

“There’s really no steadfast ruling on this,” women’s health expert Jennifer Wider, MD, tells Yahoo Lifestyle. The distraction that TV can give you during a workout can help the time go faster and may even prompt people to work out longer, she says, pointing out that that has “obvious physical benefits.” Research has shown the people who listen to music while exercising release endorphins that can help combat stress and depression, but this hasn’t been studied with TV, Wider says. “But certainly, if someone responds positively to them, it is likely to have the same mental benefits,” she adds.

If you were planning to watch TV anyway, getting in some exercise at the same time is definitely preferred to just sitting there, Susan Besser, MD, a primary care physician at Mercy Medical Center in Baltimore, tells Yahoo Lifestyle. Just keep this in mind, per Besser: You may not work out as hard if you’re distracted by something on the show.

Of course, working out in front of the TV usually means you’re not working out super strenuously, Albert Matheny, MS, RD, CSCS, of SoHo Strength Lab and Promix Nutrition, tells Yahoo Lifestyle. For those workouts, you really want to disconnect from your screen. “For more intense exercise in any form or lifting weights, you should be 100% focused on the exercise so you put forth a high level of effort and do so safely,” he says.

Still, it’s OK to work out in front of the TV if you’re doing relatively basic exercises like walking, running, or biking at a steady pace, Doug Sklar, a certified personal trainer and founder of New York City fitness training studio PhilanthroFIT, tells Yahoo Lifestyle. “Save more advanced, complex exercises for your non-TV watching workouts,” he says. 

Just know this: It’s a good idea to mix things up and throw in a few workouts sans TV here and there. “You will 100% get better results from your workout, physically and mentally, if you disconnect, engage with your body, listen, and push yourself,” Matheny says.

Read more from Yahoo Lifestyle: 

This mom is being shamed for breastfeeding her daughter until she was 4 years old

Fast food chain Jack in the Box under fire for ad encouraging people to ‘check out my bowls’

This girl’s reaction to her first day of kindergarten is insanely relatable

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Experiencing Mental Affliction? Look for Help of Analyst Now

Indeed, even wellbeing specialists accept that in certain wellbeing diseases, prescriptions (interior or outer) are sufficiently not, particularly while treating patients with mental incapacities, irregularity, or unsettling influence. These are the conditions where the patients require more guidance and inspiration than any pills that would only cover the sentiments, agonies, and injuries. The patients feel to converse with someone, someone who can help them beat the issues and inconveniences they face. There is the place we're looking for the help of clinicians comes into the image. 

The individual experiencing mental confusion feels like they can't do anything alone, they feel entangled and believe that there is no port in the tempest. They stress untouched and never discover answers for their questions concerning others it is hard to trust them. Therapists comprehend the issues of the individual experiencing mental aggravation or inadequacy.

The analyst is the person who manages the human mind's failing. Said this, they can spur and treat the patient with no troubles. 

With regards to directing, clinicians assume a significant part. The individual who is discouraged for either reason urgently needs somebody who can reassure and decipher in a positive manner. Therapists do this as far as they might be

concerned very well about how and when to talk about the matter with patients and how to help them beat these issues. By the by, there are numerous sorts of clinicians; for example - youngster analysts, scientific therapists, mechanical authoritative clinicians, school clinicians, guiding therapists, and such. Whoever the therapist, the fundamental key is to spur and decipher the patient with hopeful methodology. 

Counseling or employing analysts for various reasons is anything but a simple undertaking as it requires utter regard for who to enlist. Said this, the individual should comprehend the necessity of an analyst. For example, if your child is experiencing a mental issue, you look for a young clinician and not a scientific therapist. Additionally, the therapists are liked to remain or rehearsing close by. This is on the grounds that clinicians can contact you any time you need, particularly if there should be an occurrence of crises where a crazy person or mental assaults come with no warning. 

Looking for therapists is a serious simple errand in any case. Simply a straightforward inquiry on internet searchers would get you a rundown of qualified and enlisted clinicians close by your space. For example, in the event that you live in Baltimore, you can look for analysts in Baltimore, MD. When fixed the analyst, you can book an arrangement and examine your case.

For More Info:- clinical associate psychologist in India

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Sabine Müller, Body Integrity Identity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethically Justified?, 9 Am J Bioethics 36 (2009)

Abstract

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image.

People suffering from body integrity identity disorder report that a particular limb does not belong to them, and that they feel “over complete” and want to have the alien limb amputated. In 1997 Robert Smith, a surgeon in Scotland, fulfilled one of his patient's deepest desires: he amputated the lower part of the man's healthy left leg. Smith performed a similar operation on a German retiree two years later, as the British daily news source The Independent reported in 2000. Both patients had told Smith that one of their legs was superfluous and that its mere presence had caused them enduring emotional pain. When Smith planned the third amputation of a healthy leg in 1999, the hospital trust's new chief executive announced a ban on further amputations after a report of the hospital's ethics committee. The BBC's “Complete Obsession—Body Dysmorphia”(2000) made the issue public and induced a debate in the medical and medical ethicist community (Beckford-Ball 2000Beckford-Ball, J. 2000. The amputation of healthy limbs is not an option. British Journal of Nursing, 9(4): 188 [Google Scholar]; Dotinga 2000Dotinga, R. 2000. Out on a Limb Available athttp://archive.salon.com/health/feature/2000/08/29/amputation/index.html(accessed December 7, 2008) [Google Scholar]; Dyer 2000Dyer, C. 2000. Surgeon amputated healthy legs. British Medical Journal, 320: 332 [Google Scholar]; Johnston and Elliott 2002Johnston, J. and Elliott, C. 2002. Healthy limb amputation: Ethical and legal aspects. Clinical Medicine JRCPL, 2(5): 431–435. [Google Scholar]; Munro 2000Munro, R. 2000. Disturbed patients have healthy limbs amputated. Nursing Times, 96(6): 25 [Google Scholar]; Skatssoon 2005Skatssoon, J. 2005. The Ethics of Amputation by Choice. ABC Science Online, News in ScienceAvailable atwww.abc.net.au/science/news/stories/s1395891.htm(accessed November 14, 2008) [Google Scholar]; Smith and Fisher 2003Smith, R. and Fisher, K. 2003. Letter to the editor: Healthy limb amputation: ethical and legal aspects. Clinical Medicine, 3(2): 188 [Google Scholar]).

For such individuals, the wish to cut off a limb is not an idle fantasy but an obsessive need to extricate an alien appendage from their body. Many are distressed by such thoughts, which can disrupt their social life and distract them at work. The disorder can even be deadly: those who cannot afford or cannot find a willing surgeon may mutilate themselves, for example, by shooting into a leg, sawing off a finger or toe, placing the offensive limb in the way of an oncoming train, or packing the body part in dry ice in an attempt to freeze it to death (Bayne and Levy 2005Bayne, T. and Levy, N. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy, 22(1): 75–86.[Crossref], [PubMed], [Google Scholar]; Bensler and Paauw 2003Bensler, J. M. and Paauw, D. S. 2003. Apotemnophilia masquerading as medical morbidity. Southern Medical Journal, 96(7): 674–676.[Crossref], [Google Scholar]; Berger et al. 2005Berger, B. D., Lehrmann, J. A.Larson, G. 2005. Nonpsychotic, nonparaphilic self-amputation and the Internet. Comprehensive Psychiatry, 46: 380–383.[Crossref], [Google Scholar]).

Explaining the Amputation Desire

In the medical literature, several cases of the amputation desire have been described (Bensler and Paauw 2003Bensler, J. M. and Paauw, D. S. 2003. Apotemnophilia masquerading as medical morbidity. Southern Medical Journal, 96(7): 674–676.[Crossref], [Google Scholar]; Berger et al. 2005Berger, B. D., Lehrmann, J. A.Larson, G. 2005. Nonpsychotic, nonparaphilic self-amputation and the Internet. Comprehensive Psychiatry, 46: 380–383.[Crossref], [Google Scholar]; Braam et al. 2006Braam, A. W., Visser, S., Cath, D. C. and Hoogendijk, W. J. G. 2006. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology, 39: 32–37. [Google Scholar]; Bruno 1997Bruno, R. L. 1997. Devotees, pretenders and wannabes: Two cases of factitious disability disorder. Journal of Sexuality and Disability, 15(4): 243–260.[Crossref], [Web of Science ®], [Google Scholar]; Everaerd 1983Everaerd, W. 1983. A case of apotemnophilia: A handicap as sexual preference. American Journal of Psychotherapy, 37(2): 285–293. [Google Scholar]; First 2004First, M. B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 34: 1–10.[Crossref], [Google Scholar]; Money et al. 1977Money, J., Jobaris, R. and Furth, G. M. 1977. Apotemnophilia: Two cases of self-demand amputation as a paraphilia. Journal of Sex Research, 13(2): 115–125.[Taylor & Francis Online], [Web of Science ®], [Google Scholar]; Skatssoon 2005Skatssoon, J. 2005. The Ethics of Amputation by Choice. ABC Science Online, News in ScienceAvailable atwww.abc.net.au/science/news/stories/s1395891.htm(accessed November 14, 2008) [Google Scholar]; Storm and Weiss 2003Storm, S. and Weiss, M. D. 2003. Self-inflicted tourniquet paralysis mimicking acute demyelinating polyneuropathy. Muscle & Nerve, : 631–635. May 27 [Google Scholar]; Wise and Kalyanam 2000Wise, T. N. and Kalyanam, R. C. 2000. Amputee fetishism and genital mutilation: Case report and literature review. Journal of Sex & Marital Therapy, 26: 339–344. [Google Scholar]). As bizarre as such attempts may seem, people with BIID are not delusional—which would be an exclusion criterion—but some psychiatrists think that these patients have a monothematic delusion akin to anorexia nervosa or the Capgras syndrome (Skatssoon 2005Skatssoon, J. 2005. The Ethics of Amputation by Choice. ABC Science Online, News in ScienceAvailable atwww.abc.net.au/science/news/stories/s1395891.htm(accessed November 14, 2008) [Google Scholar], 594).

Psychologists, psychiatrists, and neurologists offer quite different explanations for the amputation desire: They discuss whether it is a neurotic disorder, an obsessive-compulsion disorder, an identity disorder like transsexuality, or a neurological conflict between a person's anatomy and body image, which could stem from damage to a part of the brain that constructs the body image in map-like form.

Psychology

Paraphilia—Apotemnophilia

Since the late 1800s, physicians have written about men and women who pretend to be or would like to become disabled. In 1977 the late sex researcher John Money and his colleagues at Johns Hopkins University (Baltimore, MD) described two individuals who wanted to become amputees because they were sexually aroused by this idea. Money defined their condition as apotemnophilia, a sexual deviation, or paraphilia, in which a stump, pair of crutches, or wheelchair is eroticized. He concluded that people seek amputation to attain sexual fulfillment (Money et al. 1977Money, J., Jobaris, R. and Furth, G. M. 1977. Apotemnophilia: Two cases of self-demand amputation as a paraphilia. Journal of Sex Research, 13(2): 115–125.[Taylor & Francis Online], [Web of Science ®], [Google Scholar]). Males seem to be more likely affected from BIID as from most paraphilias than females (Braam et al. 2006Braam, A. W., Visser, S., Cath, D. C. and Hoogendijk, W. J. G. 2006. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology, 39: 32–37. [Google Scholar], 33); especially homosexuals and transsexuals are affected (Berger et al. 2005Berger, B. D., Lehrmann, J. A.Larson, G. 2005. Nonpsychotic, nonparaphilic self-amputation and the Internet. Comprehensive Psychiatry, 46: 380–383.[Crossref], [Google Scholar]; Dyer 2000Dyer, C. 2000. Surgeon amputated healthy legs. British Medical Journal, 320: 332 [Google Scholar]; First 2004First, M. B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 34: 1–10.[Crossref], [Google Scholar]; Lawrence 2006Lawrence, A. A. 2006. Clinical and theoretical parallels between desire for limb amputation and gender identity disorder. Archives of Sexual Behavior, 35(3): 263–278.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]; Money et al. 1977Money, J., Jobaris, R. and Furth, G. M. 1977. Apotemnophilia: Two cases of self-demand amputation as a paraphilia. Journal of Sex Research, 13(2): 115–125.[Taylor & Francis Online], [Web of Science ®], [Google Scholar]). In some cases, BIID could be a compensation for rejected homosexuality; in some cases, the amputation of a limb might prevent the amputation of a transsexual's penis. Amputation desire and amputation fetishism seem to be strongly correlated. This theory is supported by findings of psychiatrist Michael First of Columbia University from 2004, who reports that 87% of 52 people with BIID felt sexually drawn to amputees, and nearly one-third had at least one further paraphilia (transvestism, fetishism, masochism, pedophilia) (First 2004First, M. B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 34: 1–10.[Crossref], [Google Scholar]). But sexual urges do not fully explain the disorder.

Factitious Disability Disorder

In 1997, Richard L. Bruno, a specialist in brain-body disorders at the Englewood Hospital and Medical Center in New Jersey, published a classification of apotemnophiles: 1) wannabes (would-be amputees) whose desire for an amputation was not primarily driven by erotic fantasies but rather by disability itself; 2) pretenders who simulate physical disability, for example, by wrapping bandages around a limb and using a wheelchair or crutches; 3) devotees who are sexually attracted to amputees and are thrilled by the idea of being an amputee. Wannabes and pretenders, Bruno (1997)Bruno, R. L. 1997. Devotees, pretenders and wannabes: Two cases of factitious disability disorder. Journal of Sexuality and Disability, 15(4): 243–260.[Crossref], [Web of Science ®], [Google Scholar] argues, are looking for recognition and sympathy more than sexual gratification. He theorized that many of the afflicted lacked attention and love in childhood—when the disorder typically originates—and are looking to get these emotional supports through disability and dependency on others. In support of this theory, Bruno found that some pretenders came from households they described as cold, rigid, and asexual. Many reported that, as children, they felt jealous of the attention received by people in wheelchairs and fantasizing, sometimes obsessively, about being cared for while disabled. According to Bruno, apotemnophilia is a factitious disorder (American Psychiatric Association [APA] 2000American Psychiatric Association (APA). 2000. Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV). , 4th ed., Washington, DC: APA. [Google Scholar], 300.19), i.e. a psychological disease, in which a disability is seen as a way to gain attention that was lacked in childhood.

In my opinion, the psychological explanations of the desire for amputation are not convincing because it is too specific, too irrational, and less capable of being influenced to be explained alone by a lack of love in childhood.

Psychiatry

Body Dysmorphic Disorder (BDD) and Obsessive-Compulsion Disorder

Arjan Braam et al. (2006)Braam, A. W., Visser, S., Cath, D. C. and Hoogendijk, W. J. G. 2006. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology, 39: 32–37. [Google Scholar] theorize that apotemnophilia is a combination of an obsessive-compulsion disorder, a body dysmorphic disorder, and an identity disorder (Braam et al. 2006Braam, A. W., Visser, S., Cath, D. C. and Hoogendijk, W. J. G. 2006. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology, 39: 32–37. [Google Scholar]). Persons suffering from body dysmorphic disorder (BDD) show a preoccupation with an imagined or slight defect in appearance and marked impairment in social areas of functioning resulting from the appearance preoccupation; occasionally it is hold with delusional intensity. BDD frequently occurs with other psychiatric disorders; the most typical comorbid diagnoses are mood and anxiety disorders, obsessive-compulsive disorders, substance use disorders, eating disorders, and personality disorders. Cosmetic medical treatments typically produce no change or, even worse, an exacerbation of body dysmorphic disorder symptoms (Crerand et al. 2006Crerand, C. E., Franklin, M. E. and Sarwer, D. B. 2006. Body dysmorphic disorder and cosmetic surgery. Plastic and Reconstructive Surgery, 118(7): 167e–180e.[Crossref], [Google Scholar]; Dyl et al. 2006Dyl, J., Kittler, J., Phillips, K. A. and Hunt, J. I.2006. Body dysmorphic disorder and other clinically significant body image concerns in adolescent psychiatric inpatients: prevalence and clinical characteristics. Child Psychiatry and Human Development, 36: 369–382.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]).

There are two important differences between BDD and BIID patients: first, the latter in general do not think that the limb which they want to get rid of is ugly (Baynes and Levy 2005Bayne, T. and Levy, N. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy, 22(1): 75–86.[Crossref], [PubMed], [Google Scholar], 78); second, they are not interested in becoming handsome but in becoming disabled in order to become more authentic (Bridy 2004Bridy, A. 2004. Confounding extremities: Surgery at the medico-ethical limits of self-modification. Journal of Law, Medicine and Ethics, 32(1): 148–158.[Crossref], [Google Scholar], 152).

Identity Disorder

Michael First (2004)First, M. B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 34: 1–10.[Crossref], [Google Scholar] characterizes the disorder less as a desire for disability than as an identity disorder. In his survey, almost two-thirds of the subjects said they wanted an amputation primarily to establish their “true identity” (First 2004First, M. B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 34: 1–10.[Crossref], [Google Scholar], 4). For instance, one subject said, “I felt like I was in the wrong body—that I am only complete with both my arm and leg off on the right side” (4). First likens BIID to gender identity disorder (GID), in which patients are similarly uncomfortable with part of their anatomy because it is at odds with their internal sense of self. Both BIID and GID typically originate in childhood, are often expressed by the imitation of the desired identity (pretending or transvestism), induce a paraphiliac sexual arousal, and are sometimes successfully resolved with surgery. In fact many of the people who utter the desire for the amputation of a healthy limb are man-to-woman-transsexuals (Berger et al. 2005Berger, B. D., Lehrmann, J. A.Larson, G. 2005. Nonpsychotic, nonparaphilic self-amputation and the Internet. Comprehensive Psychiatry, 46: 380–383.[Crossref], [Google Scholar]; Braam et al. 2006Braam, A. W., Visser, S., Cath, D. C. and Hoogendijk, W. J. G. 2006. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology, 39: 32–37. [Google Scholar]; Dyer 2000Dyer, C. 2000. Surgeon amputated healthy legs. British Medical Journal, 320: 332 [Google Scholar]; First 2004First, M. B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 34: 1–10.[Crossref], [Google Scholar]; Money et al. 1977Money, J., Jobaris, R. and Furth, G. M. 1977. Apotemnophilia: Two cases of self-demand amputation as a paraphilia. Journal of Sex Research, 13(2): 115–125.[Taylor & Francis Online], [Web of Science ®], [Google Scholar]). Such similarities suggest, according to First (2004)First, M. B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 34: 1–10.[Crossref], [Google Scholar] that BIID is an identity disorder and should be classified as such in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Furth and Smith (2000)Furth, G. M. and Smith, R. 2000. Apotemnophilia: Information, Questions, Answers, and Recommendations About Self-Demand Amputation, Bloomington, IN: 1st Books. [Google Scholar] have translated the definition of GID (APA 2000American Psychiatric Association (APA). 2000. Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV). , 4th ed., Washington, DC: APA. [Google Scholar], 302.85) 1:1 into the definition of body (integrity) identity disorder—they just have replaced “male” by “able-bodied” and “female” by “disabled” (87 f.). BIID support groups use the neologism transabled in analogy of the successful term transgender and explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment (Amputee Web Site 2003; Body Integrity Identity Disorder 2008; Transabled.org 2008).

Nevertheless, the definition of BIID as an identity disorder in analogy to the gender identity disorder is only a descriptive classification but no explanation. Emphasizing the identity component may suggest a causal explanation, although it is proven neither psychologically nor biologically (Braam et al. 2006Braam, A. W., Visser, S., Cath, D. C. and Hoogendijk, W. J. G. 2006. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology, 39: 32–37. [Google Scholar], 36). The same applies for the gender identity disorder.

Neurology

Such an identity disorder most likely has a neurological basis. Fisher and Smith (2000)Fisher, K. and Smith, R. 2000. More work is needed to explain why patients ask for amputation of healthy limbs. Letters. British Medical Journal, 320: 1147 [Google Scholar] and Furth and Smith (2000)Furth, G. M. and Smith, R. 2000. Apotemnophilia: Information, Questions, Answers, and Recommendations About Self-Demand Amputation, Bloomington, IN: 1st Books. [Google Scholar], the leading exponents of the identity disorder thesis, suppose a neurological disorder when they explain the amputation desire as the mirror picture of phantom limbs. Some researchers theorize that BIID results from a distortion or deletion in one of the map-like representations of the body in the cerebral cortex (the so called homunculus). The body image is a consciously accessible representation of the general shape and structure of one's body. It is derived from several sources, including visual, proprioceptive, and tactile experience. The body image structures one's bodily sensations, and forms the basis of one's beliefs about oneself (Bayne and Levy 2005Bayne, T. and Levy, N. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy, 22(1): 75–86.[Crossref], [PubMed], [Google Scholar], 76). An injury or aberration in one particular spot in the map would effectuate a specific amputation desire in a precise location, e.g. of the left leg above the knee. Peripheral or central bugs can disturb the body image (Sacks 1984Sacks, O. 1984. A Leg to Stand On., New York, NY: Simon & Schuster. [Google Scholar]; Lurija 1993Lurija, A. R. 1993. Romantische Wissenschaft. Forschungen im Grenzbereich von Seele und Gehirn, Reinbek, , Germany: Rowohlt. [Google Scholar]).

Peripheral Disturbances

In some instances, BIID might result from a peripheral injury. In 1974 neurologist Oliver Sacks severely injured his left thigh in an encounter with a bull in the mountains of Norway. After the wound healed, he felt no connection to his thigh and occasionally wished to have the leg amputated. Amputation, he wrote in A Leg to Stand On, would “relieve me of having to drag around a totally useless, functionless, and indeed ‘defunct’ limb” (Sacks 1984Sacks, O. 1984. A Leg to Stand On., New York, NY: Simon & Schuster. [Google Scholar], Chapter 2). Sacks theorized that such bodily harm might in some circumstances interrupt communication between the limb and the brain.

Some BIID patients similarly recall childhood injuries involving the limb that they shortly thereafter became obsessed with amputating. In approximately one-fifth of the subjects in First's 2004 study, a disability such as a limp or broken leg provided the impetus for their amputation desire (see also Bensler et al. 2003Bensler, J. M. and Paauw, D. S. 2003. Apotemnophilia masquerading as medical morbidity. Southern Medical Journal, 96(7): 674–676.[Crossref], [Google Scholar]; Bruno 1997Bruno, R. L. 1997. Devotees, pretenders and wannabes: Two cases of factitious disability disorder. Journal of Sexuality and Disability, 15(4): 243–260.[Crossref], [Web of Science ®], [Google Scholar], case 2; Money et al. 1977, cases 1 and 2). Some persons who believed that a disability would provide them with love and attention may have induced a manifest disturbance of their body image by regularly wrapping bandages around a limb.

During World War II, Leontjew and Zaporožec (1960)Leontjew, A. N. and Zaporo[zbreve]ec, A. V.1960. Rehabilitation and Hand Function, London, , UK: Pergamon. [Google Scholar] have already described a syndrome which they called an “inner amputation”—they noticed that approximately 200 soldiers with injured and surgically rebuilt hands perceived their hands as alien or cloned. Sacks (1984)Sacks, O. 1984. A Leg to Stand On., New York, NY: Simon & Schuster. [Google Scholar] diagnosed sensations of strangeness or of sudden vanishing of limbs in hundreds of patients whose limbs had been fixed for a longer period of time as well as in approximately 50 patients with severe peripheral neuropathies or medulla injuries. The alienation of limbs seems to be complementary to the phenomenon of phantom limbs: Whereas, in the first case, the limb is existent, although the patient lacks the awareness for it, in the second case, the patient is aware of a limb that is missing. The body image is not static and ‘hard-wired’, but continuously modified in dependence on the usage of the parts of the body. When a limb has been paralyzed, has lost its innervation, or amputated, its corresponding part of the body image will be ‘erased’, and its former place will be occupied by its neighbors (Sacks 1984Sacks, O. 1984. A Leg to Stand On., New York, NY: Simon & Schuster. [Google Scholar]; Lurija 1993Lurija, A. R. 1993. Romantische Wissenschaft. Forschungen im Grenzbereich von Seele und Gehirn, Reinbek, , Germany: Rowohlt. [Google Scholar]; Merzenich et al. 1984Merzenich, M. M., Randall, J. N.Stryker, M. P.1984. Somatosensory cortical map changes following digit amputation in adult monkeys. Journal of Comprehensive Neurology, 224(4): 591–605.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]). Sensory systems that have been removed from the body image can only be reintegrated when they are used. An appropriate aid for this is music that can trigger movements of limbs that have lost their innervation (Sacks 1984Sacks, O. 1984. A Leg to Stand On., New York, NY: Simon & Schuster. [Google Scholar]).

Congenital Mismatch Between the Physical Body and the Body Image

Some cases of BIID could stem from congenital aberrations in neural pathways, with injuries or other environmental factors playing a secondary role. Smith and Fisher (2003)Smith, R. and Fisher, K. 2003. Letter to the editor: Healthy limb amputation: ethical and legal aspects. Clinical Medicine, 3(2): 188 [Google Scholar] theorize that in BIID patients a physical limb has developed without the sensory consciousness for it, i.e. that there could be a congenital mismatch between the physical body and the body image generated in the somatosensory cortex.

Pötzl Syndrome

Body-image distortions are known to result from tumors or strokes in the parietal lobe, which contains the body image that is derived from sensory inputs. Patients suffering from Pötzl syndrome suddenly ignore (parts of) their body's left half or perceive them as alien, unreal, or even as part of another person's body. Otto Pötzl has described grotesque cases, e.g., a patient who asked the nurse to take along not only the tray but also his leg, and a patient on a train journey, who demanded his neighbor to take away his hand from his leg and thereby pointed at his own hand. Sacks (1984)Sacks, O. 1984. A Leg to Stand On., New York, NY: Simon & Schuster. [Google Scholar] described a young man who woke up to discover that someone else's leg was in bed with him; the man assumed it stemmed from a corpse. In an attempt to throw it out of the bed, he himself landed on the floor. The leg was attached to him, but it seemed to be a counterfeit of his own, which mysteriously had vanished. Physicians discovered a tumor above the patient's right parietal lobe that had begun to bleed during the night. Sacks posited that the tumor was corrupting the patient's body map in the brain, and that the bleeding had “erased the leg centre”. After tumor resection the leg “came back”.

Alien Hand Syndrome

In my opinion, the alien hand syndrome—for which only 50 cases have been documented to date—bears a striking similarity to BIID (Biran and Chatterjee 2004Biran, I. and Chatterjee, A. 2004. Alien hand syndrome. Archives of Neurology, 61(1): 292–294. [Google Scholar]; Pappalardo et al. 2004Pappalardo, A., Cianeio, M. R., Reggio, E. and Patti, F. 2004. Posterior alien hand syndrome: Case report and rehabilitative treatment. Neurorehabilitation and Neural Repair, 18: 176–181.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]; Scepkowski and Cronin-Golomb 2003Scepkowski, L. A. and Cronin-Golomb, A.2003. The alien hand: Cases, categorizations, and anatomical correlates. Behavioral and Cognitive Neuroscience Reviews, 2: 261–277.[Crossref], [PubMed], [Google Scholar]). This syndrome sometimes appears after strokes, bleedings, or tumors in the corpus callosum or in the medial frontal cortex. The patients perceive their left hand as alien and often cannot identify it as their own hand. Sometimes an alien hand becomes anarchic and acts against the intentions of the patients; in some cases, it needs to be fixed to the body. Kurt Goldstein has described a stroke patient whose hand grasped her own neck so tight that two men had to tear it off in order to save the patient's life (Pappalardo et al. 2004Pappalardo, A., Cianeio, M. R., Reggio, E. and Patti, F. 2004. Posterior alien hand syndrome: Case report and rehabilitative treatment. Neurorehabilitation and Neural Repair, 18: 176–181.[Crossref], [PubMed], [Web of Science ®], [Google Scholar], 176). Neuropsychological rehabilitation can support the healing process of the alien hand syndrome (Pappalardo et al. 2004Pappalardo, A., Cianeio, M. R., Reggio, E. and Patti, F. 2004. Posterior alien hand syndrome: Case report and rehabilitative treatment. Neurorehabilitation and Neural Repair, 18: 176–181.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]).

Dysfunction of the Right Parietal Lobe

Likening BIID to such cases of somatoparaphrenia after a stroke in the right parietal lobe, in which patients deny that a part of their body is theirs, neuroscientists Vilayanur Ramachandran and Paul McGeoch (2007)Ramachandran, V. and McGeoch, P. 2007. Can vestibular caloric stimulation be used to treat apotemnophilia?. Medical Hypotheses, : 250–252. February 8 [Google Scholar] of the University of California, San Diego, suggested that parts of the parietal lobe might also be damaged in BIID patients. Such damage could presumably decouple a specific part of the body from the body map in that lobe. Patients with somatoparaphrenia are convinced that one of their limbs (mostly the left arm) belongs to someone else. Ramachandran's and McGeoch's thesis is based on the left-sided preponderance for the desired amputation, on the emotional rejection of the affected limb, and on the specificity of the desired amputation. Ramachandran and McGeoch suppose that this disorder is effectuated by an uncoupling of the construct of one's body image in the right parietal lobe from how one's body physically is. Their hypothesis would be amenable to testing by response to cold-water vestibular caloric stimulation, which is known to temporarily treat somatoparaphrenia. They now want to test it on people with BIID. Additionally they propose functional magnetic resonance imaging (fMRI) and skin conduction investigations of BIID patients (Ramachandran and McGeoch 2007Ramachandran, V. and McGeoch, P. 2007. Can vestibular caloric stimulation be used to treat apotemnophilia?. Medical Hypotheses, : 250–252. February 8 [Google Scholar]).

In contrast to patients with the Pötzl syndrome or the alien hand syndrome, most BIID patients suffer since childhood from the sensation of an alien limb. This finding would suggest a congenital malformation in the brain (e.g., a blood vessel anomaly), an early brain trauma (e. g., shaken baby syndrome) or an incomplete development of nerves in the sensomotoric cortex or in the corpus callosum. Because of the early onset of the disturbance of the body image, BIID patients cannot remember a life in which the affected limb was integrated into the body image. In contrast to stroke or brain tumor patients suffering from a body image disturbance, BIID patients do not suffer a loss of a limb, but perceive this limb as mere ballast. This difference may explain why one and the same symptom is perceived as a disturbance by stroke or brain tumor patients, but as a part of their identity by BIID patients. This difference is comparable with the difference between persons with late-onset deafness and congenital deafness. From the latter group, many regard deafness as a part of their identity, not as a disability. In BIID patients, the identity disturbance therefore could be effectuated by an early-onset body image disturbance.

Therapies

The consequence of the controversy about the causes of BIID is a controversy about its therapy. Traditional psychotherapy has so far had little effect on the desire for amputation (Bayne and Levy 2005Bayne, T. and Levy, N. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy, 22(1): 75–86.[Crossref], [PubMed], [Google Scholar], 83; Bensler and Paauw 2003Bensler, J. M. and Paauw, D. S. 2003. Apotemnophilia masquerading as medical morbidity. Southern Medical Journal, 96(7): 674–676.[Crossref], [Google Scholar]; Braam et al. 2006Braam, A. W., Visser, S., Cath, D. C. and Hoogendijk, W. J. G. 2006. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology, 39: 32–37. [Google Scholar], 36; First 2004First, M. B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 34: 1–10.[Crossref], [Google Scholar], 8; Storm and Weiss 2003Storm, S. and Weiss, M. D. 2003. Self-inflicted tourniquet paralysis mimicking acute demyelinating polyneuropathy. Muscle & Nerve, : 631–635. May 27 [Google Scholar]). Antidepressants, such as selective serotonin reuptake inhibitor (SSRI), and behavioral therapy could sometimes soften the compulsory thoughts, but not suppress them (Braam et al. 2006Braam, A. W., Visser, S., Cath, D. C. and Hoogendijk, W. J. G. 2006. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology, 39: 32–37. [Google Scholar]; Wise and Kalyanam 2000Wise, T. N. and Kalyanam, R. C. 2000. Amputee fetishism and genital mutilation: Case report and literature review. Journal of Sex & Marital Therapy, 26: 339–344. [Google Scholar]).

Sacks (1984)Sacks, O. 1984. A Leg to Stand On., New York, NY: Simon & Schuster. [Google Scholar] helped many of his patients with movement therapy, eventually supported by music. Such therapy is thought to reintegrate the estranged body part with its representation in the brain. Such simple cures may work to reinvigorate atrophied neural connections between body and brain, but they may not be effective, if the foreign part of the body has actually been deleted from the brain's body map.

The method proposed by Ramachandran and McGeoch (2007)Ramachandran, V. and McGeoch, P. 2007. Can vestibular caloric stimulation be used to treat apotemnophilia?. Medical Hypotheses, : 250–252. February 8 [Google Scholar]—rinsing an ear canal with warm and then cold water to stimulate the parietal lobe opposite the treated ear—temporarily alleviated somatoparaphrenia in stroke patients and possibly could alleviate BIID.

If the method helps such patients, physicians might try repetitive magnetic stimulation (rTMS), which can improve the tactile discrimination performance and enlarge the corresponding cortical somatosensory maps (Tegenthoff et al. 2005Tegenthoff, M., Ragert, P.Pleger, B. 2005. Improvement of tactile discrimination performance and enlargement of cortical somatosensory maps after 5 Hz rTMS. PloS Biology, 3(11): 2031–2040. [Google Scholar]). Another possibility might be the implantation of stimulation electrodes into the affected brain area. If a benign brain tumor or an arteriovascular malformation is the cause of BIID, microsurgery or radiosurgery might be efficient therapies.

The most drastic measure, amputation, has apparently helped in some cases. But there is reason for hope that scientific advances will lead to ways of correcting the underlying neurological problem, quenching the thirst for amputation before it leads to disability.

Ethical Discussion About Elective Amputations

Ethicists disagree on whether surgeons should grant the wishes for amputation under any circumstances. The medical ethicists Tim Bayne, University of Oxford (UK), and Neil Levy, University of Melbourne (Australia), deduce that: “If the desire for amputation is long-standing, the patient is not psychotic, and he is well aware of the risks and consequences, surgery is ethically permissible because it will prevent many BIID patients from injuring or killing themselves” (Bayne and Levy 2005Bayne, T. and Levy, N. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy, 22(1): 75–86.[Crossref], [PubMed], [Google Scholar], 79)

The philosophers Annemarie Bridy (2004)Bridy, A. 2004. Confounding extremities: Surgery at the medico-ethical limits of self-modification. Journal of Law, Medicine and Ethics, 32(1): 148–158.[Crossref], [Google Scholar] and Floris Tomasini (2006)Tomasini, F. 2006. Exploring ethical justification for self-demand amputation. Ethics & Medicine, 22(2): 99–115. [Google Scholar] share this point of view, but Tomasini's argumentation is based exclusively on the BBC report (2000), and the book of the surgeon Robert Smith, and the BIID sufferer Gregg Furth (2000). In contrast the medical ethicists and philosophers Arthur Caplan, Josephine Johnston, Carl Elliott as well as some physicians and politicians argue vehemently against elective amputations (Bensler and Paauw 2003Bensler, J. M. and Paauw, D. S. 2003. Apotemnophilia masquerading as medical morbidity. Southern Medical Journal, 96(7): 674–676.[Crossref], [Google Scholar]; Dotinga 2000Dotinga, R. 2000. Out on a Limb Available athttp://archive.salon.com/health/feature/2000/08/29/amputation/index.html(accessed December 7, 2008) [Google Scholar]; Johnston and Elliott 2002Johnston, J. and Elliott, C. 2002. Healthy limb amputation: Ethical and legal aspects. Clinical Medicine JRCPL, 2(5): 431–435. [Google Scholar]).

In the following I will discuss the ‘pros and cons’ of elective amputations with regard to the broadly accepted principles of medical ethics of Tom L. Beauchamp and James F. Childress (2001)Beauchamp, T. L. and Childress, J. F. 2001. Principles of Biomedical Ethics, Oxford, , UK: Oxford University Press. [Google Scholar]: respect for the patient's autonomy, nonmaleficence, beneficence, and justice.

Respect for Patient's Autonomy

Human beings act autonomously when they act: 1) with intention, 2) with insight into the situation and 3) without external controlling or coercive influences. The principle of autonomy emphasizes the independence of individuals against (medical) authorities. It demands from the physicians to respect the autonomy of the patients and to bring it forward.

Not only many BIID sufferers but also the medical ethicists Bayne and Levy (2005)Bayne, T. and Levy, N. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy, 22(1): 75–86.[Crossref], [PubMed], [Google Scholar] deduce from the principle of respect for the patient's autonomy that elective amputations are ethically permissible if the patient is not psychotic and well-informed. Bridy (2004)Bridy, A. 2004. Confounding extremities: Surgery at the medico-ethical limits of self-modification. Journal of Law, Medicine and Ethics, 32(1): 148–158.[Crossref], [Google Scholar] and Tomasini (2006)Tomasini, F. 2006. Exploring ethical justification for self-demand amputation. Ethics & Medicine, 22(2): 99–115. [Google Scholar] advocate the right of autonomous decision about body modifications. But generally, the obligations to respect autonomy do not extend to persons who cannot act in a sufficiently autonomous manner because they are immature, incapacitated, ignorant, coerced, or exploited (Beauchamp and Childress 2001Beauchamp, T. L. and Childress, J. F. 2001. Principles of Biomedical Ethics, Oxford, , UK: Oxford University Press. [Google Scholar], 65). Examples of patients with substantial lacks of autonomy are mentally sick, delusional, and drug-dependent persons. Beauchamp and Childress argue that in such cases the principle of respect for autonomy cannot be applied because no substantial autonomy exists (Beauchamp and Childress 2001Beauchamp, T. L. and Childress, J. F. 2001. Principles of Biomedical Ethics, Oxford, , UK: Oxford University Press. [Google Scholar], 183). Therefore the principles of beneficence and nonmaleficence have to be adopted (Beauchamp and Childress 2001Beauchamp, T. L. and Childress, J. F. 2001. Principles of Biomedical Ethics, Oxford, , UK: Oxford University Press. [Google Scholar], 65, 70–77, 176–194). To fulfill the desire for a bodily harm of a patient with a substantial lack of autonomy is a severe violation of the medical fiduciary duty and of the principle of nonmaleficience. An example is a stomach stapling operation in an anorexic patient. In individual cases, the diagnosis of a psychiatric disorder and of a loss of autonomy may be controversial, but it has to be made by psychiatrists, not by surgeons. In all cases of BIID that have been investigated by psychiatrists, the diagnosis states that the amputation desire is obsessive or results from a monothematic delusion, comparable to anorexia, Capgras syndrome or anankastic counting. Therefore a surgeon must not rely on the patient's ‘autonomous decision.’

Not only in the psychiatric field, but also in terms of analytical philosophy, BIID needs to be differentiated between free decisions and obsessive desires. Peter Bieri (2001)Bieri, P. 2001. Das Handwerk der Freiheit, Frankfurt am Main, , Germany: Hanser. [Google Scholar] defines—in Kant's tradition—that the freedom of will is given only if the will is determined by the own rational judgment: for example, “I could wish something else if I would judge in a different way!”. My will is free when I have the power to wish what I regard as good. The free will is—according to Bieri (2001)Bieri, P. 2001. Das Handwerk der Freiheit, Frankfurt am Main, , Germany: Hanser. [Google Scholar]—the approved will. The will is unfree, when it affronts its own judgment: for example, “I cannot want something else, although my judgment advises something else!”. Examples of an unfree will are drivenness, hypnosis, brainwashing, conformism, obedience, lack of self-control, obsession, and addiction. For the differentiation between a free and an unfree will Harry Frankfurt's concept of higher-order volitions is useful: first-order volitions refer directly to certain objects or conditions; second-order volitions refer to first-order volitions; for example, a smoker's desire to smoke is a first-order volition; if the smoker wants to give up smoking, the desire not to smoke is a second-order volition. A person is free when first-order volitions are concordant with higher-order volitions (Frankfurt 1971Frankfurt, H. 1971. Freedom of the will and the concept of a person. Journal of Philosophy, 68: 5–20.[Crossref], [Google Scholar]). Accordingly, in BIID patients, the amputation desire is a first-order volition; the wish to have no amputation desire is a second-order volition. The latter could be fulfilled in principle in two different ways: first by amputation, second by eliminating the amputation desire. If the patient believes that only an amputation could eliminate the amputation desire, his first-order volition is stabilized by his second-order volition, and he must try to get an amputation. But if he believes that his amputation desire could vanish without an amputation, the second-order volition will produce an inner resistance against his first-order volition, and the patient may search for a treatment of the amputation desire (like a smoker who uses nicotine patches). Furthermore, the amputation desire is conflicting with other desires, especially those for health, painlessness, mobility, and social acceptance, which BIID patients also have in general.

According to the principle of autonomy, patients have the right to choose between different medical therapy options regarding their different chances and risks as well as their personal situation and individual values. If amputations would be an accredited BIID therapy, patients would have the right to choose between psychological therapy, psychopharmacologic therapy, neurorehabilitation, amputation and possibly transcranial magnetic stimulation or electrical brain stimulation. But whether amputation is a medically accredited therapy for BIID is not an issue of patients' autonomy. Patients do not have a demand to receive therapies by physicians that contradict medical principles (Beauchamp and Childress 2001Beauchamp, T. L. and Childress, J. F. 2001. Principles of Biomedical Ethics, Oxford, , UK: Oxford University Press. [Google Scholar], 191). Whereas Bayne and Levy (2005)Bayne, T. and Levy, N. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy, 22(1): 75–86.[Crossref], [PubMed], [Google Scholar] as well as Smith and Fisher (2003)Smith, R. and Fisher, K. 2003. Letter to the editor: Healthy limb amputation: ethical and legal aspects. Clinical Medicine, 3(2): 188 [Google Scholar] and Furth and Smith (2000)Furth, G. M. and Smith, R. 2000. Apotemnophilia: Information, Questions, Answers, and Recommendations About Self-Demand Amputation, Bloomington, IN: 1st Books. [Google Scholar]propagate the amputation as a medical therapy for a psychiatric disorder—as a sort of psychotherapy via scalpel—Bridy (2004)Bridy, A. 2004. Confounding extremities: Surgery at the medico-ethical limits of self-modification. Journal of Law, Medicine and Ethics, 32(1): 148–158.[Crossref], [Google Scholar] argues for the right of arbitrary decisions about body modifications amputations without any psychological indication. She speaks out for the right to design one's own body and puts elective amputations into a continuum of nose corrections and breast enlargements. Like those surgeries, amputations should be accepted as legitimate means in the search for happiness and authenticity. Cosmetic surgery patients aspired to beauty as an end in itself, apotemnophiles analogously aspired to disability (Bridy 2004Bridy, A. 2004. Confounding extremities: Surgery at the medico-ethical limits of self-modification. Journal of Law, Medicine and Ethics, 32(1): 148–158.[Crossref], [Google Scholar], 152). Bridy uses the obsolete term apotemnophile (amputation lovers) of Money et al. (1977)Money, J., Jobaris, R. and Furth, G. M. 1977. Apotemnophilia: Two cases of self-demand amputation as a paraphilia. Journal of Sex Research, 13(2): 115–125.[Taylor & Francis Online], [Web of Science ®], [Google Scholar], which describes the amputation desire as a paraphilia. Bridy (2004)Bridy, A. 2004. Confounding extremities: Surgery at the medico-ethical limits of self-modification. Journal of Law, Medicine and Ethics, 32(1): 148–158.[Crossref], [Google Scholar] rejects the hypothesis that this desire is irrational because it purposes a “disability”; for that, she refers to the social difference model of disability (Koch 2001Koch, T. 2001. Disability and difference: Balancing social and physical constructions. Journal of Medical Ethics, 27: 370–376.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]). 1 1. Koch distinguishes the ‘medical’ and the ‘social difference model of disability’. The first model emphasizes the physical limitations inherent in disability, whereas the latter defines disability primarily as a social condition resulting from society's failure to accommodate the physical differences of the disabled.View all notesIn contrast, Thomas Schramme who pleas for a maximum right of body-modifications wants to exclude BIID patients from this right (2007, 9).

With regard to autonomy, three groups of amputation seekers have to be differentiated: first, BIID patients who suffer from the alienation of a limb because of a neuropsychological disturbance; second, apotemnophiles who desire an amputation because of paraphilia; third, persons who expect financial or social advantages (e.g., insurance rates, retirement, attention) by an amputation. Even if the principle of autonomy should allow for such grave injuries as amputations, in individual cases it has to be investigated whether the patient decides autonomously or whether this decision is determined by a neuropsychological disease. The latter applies to BIID patients, according to the recent research, but not to persons who are sexually aroused by amputations or who hope for financial or social benefits by an amputation.

Nonmaleficence

According to the principle of nonmaleficence physicians must not perform amputations without a medical indication because amputations bear great risks and often have severe consequences besides the disability (Beckford-Ball 2000Beckford-Ball, J. 2000. The amputation of healthy limbs is not an option. British Journal of Nursing, 9(4): 188 [Google Scholar]; Dotinga 2000Dotinga, R. 2000. Out on a Limb Available athttp://archive.salon.com/health/feature/2000/08/29/amputation/index.html(accessed December 7, 2008) [Google Scholar]; Johnston and Elliott 2002Johnston, J. and Elliott, C. 2002. Healthy limb amputation: Ethical and legal aspects. Clinical Medicine JRCPL, 2(5): 431–435. [Google Scholar]), for example, infections, thromboses, paralyses, necrosis, or phantom pain (Amputation Gliedmaßen, www.chirurgie-portal.de/orthopaedie/arm-bein-amputation.html, accessed December 5, 2008). Even though some physicians perform harmful surgeries as breast enlargement surgeries, this cannot justify surgeries that are even more harmful. Even if amputations would be a possible therapy for BIID, they would be risky experimental therapies that could be justified only if they promised lifesaving or the cure of severe diseases and if an alternative therapy would not be available. At least the first condition is not fulfilled in the case of BIID, and probably the second is not fulfilled either. Above all, an amputation causes an irreversible damage that could not be healed, even if the patient's body image would be restored spontaneously or through a new therapy.

Beneficence

Amputations could be justified according to the principle of beneficence if their benefit for the patient would override their harm. Therefore the following conditions needed to be fulfilled: 1) effectiveness, 2) sustainability of the effect, and 3) non-existence of a less noxious therapy. Bayne and Levy (2005)Bayne, T. and Levy, N. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy, 22(1): 75–86.[Crossref], [PubMed], [Google Scholar], First (2004)First, M. B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 34: 1–10.[Crossref], [Google Scholar], Fisher and Smith (2000)Fisher, K. and Smith, R. 2000. More work is needed to explain why patients ask for amputation of healthy limbs. Letters. British Medical Journal, 320: 1147 [Google Scholar] and Furth and Smith (2000)Furth, G. M. and Smith, R. 2000. Apotemnophilia: Information, Questions, Answers, and Recommendations About Self-Demand Amputation, Bloomington, IN: 1st Books. [Google Scholar] claim that these conditions are fulfilled. But they cannot present scientific evidence for the effectiveness of amputation as a BIID therapy, and refer to only about approximately 10 cases. Furthermore, these cases are collected from patients who looked for a contact to researchers and media because they are happy with their amputations. Additionally, the sustainability of the effect can be doubted: in some cases a symptom shift occurred—resulting in the successive mutilation of several limbs (Berger et al. 2005Berger, B. D., Lehrmann, J. A.Larson, G. 2005. Nonpsychotic, nonparaphilic self-amputation and the Internet. Comprehensive Psychiatry, 46: 380–383.[Crossref], [Google Scholar]; Skatessoon 2005Skatssoon, J. 2005. The Ethics of Amputation by Choice. ABC Science Online, News in ScienceAvailable atwww.abc.net.au/science/news/stories/s1395891.htm(accessed November 14, 2008) [Google Scholar]; Sorene et al. 2006Sorene, E. D., Heras-Palou, C. and Burke, F. D. 2006. Self-amputation of a healthy hand: A case of body integrity identity disorder. Journal of Hand Surgery (British and European Volume), 31B(6): 593–595. [Google Scholar]). The fact that psychotherapy and psychotropics are not very effective to cure BIID is shown only by a few case studies, whereas in some cases SSRI and behavioral therapy slowed down the amputation desire (Berger et al. 2005Berger, B. D., Lehrmann, J. A.Larson, G. 2005. Nonpsychotic, nonparaphilic self-amputation and the Internet. Comprehensive Psychiatry, 46: 380–383.[Crossref], [Google Scholar]). Especially the conclusion that the only possibility to match the physical body and the body image of BIID patients was amputation is wrong: The alternative of adapting the body to the body image is adapting the body image to the body—for example by movement therapy, rTMS, or electrical stimulation of the brain. Hence the prerequisites that could justify amputations according to the principle of beneficence are either not fulfilled or not proved sufficiently.

Nevertheless the principle of beneficence could justify amputations if they could prevent even worse consequences (Beauchamp and Childress 2001Beauchamp, T. L. and Childress, J. F. 2001. Principles of Biomedical Ethics, Oxford, , UK: Oxford University Press. [Google Scholar], 115). This argument is supported by the fact that some BIID patients are so obsessed with having a limb amputated that they take matters into their own hands, by crushing a leg under weights or placing the offensive limb in the way of an oncoming train (Dyer 2000Dyer, C. 2000. Surgeon amputated healthy legs. British Medical Journal, 320: 332 [Google Scholar]; First 2004First, M. B. 2004. Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 34: 1–10.[Crossref], [Google Scholar]; Furth and Smith 2000Furth, G. M. and Smith, R. 2000. Apotemnophilia: Information, Questions, Answers, and Recommendations About Self-Demand Amputation, Bloomington, IN: 1st Books. [Google Scholar]; Skatessoon 2005Skatssoon, J. 2005. The Ethics of Amputation by Choice. ABC Science Online, News in ScienceAvailable atwww.abc.net.au/science/news/stories/s1395891.htm(accessed November 14, 2008) [Google Scholar]). Some cases resulted in death (Bayne and Levy 2005Bayne, T. and Levy, N. 2005. Amputees by choice: Body integrity identity disorder and the ethics of amputation. Journal of Applied Philosophy, 22(1): 75–86.[Crossref], [PubMed], [Google Scholar], 79). The offer of correctly performed amputations could prevent dangerous self-mutilations. This argument implies that amputations would be inescapable for BIID patients and the only question would be who performs them. In another regard, many people with BIID would not harm themselves but could be drawn to a professional amputation.

Justice

Another argument against elective amputations is a socioeconomic one: because of the high costs for medical treatment, rehabilitation, early retirement, and lost working income which would stress the society, elective amputations should not be allowed. Public financing for elective amputations is ethical permissible only if the amputations are strictly necessary to cure a severe disease, but not when they are performed because of aesthetic, erotic, or financial interests. But since amputations cannot be justified as a medical therapy for BIID, they have to be excluded from public financing with regard to the principle of justice.

Amputations require lifelong follow-up costs. According to Richard Alexander (2003)Alexander, R. 2003. Lifecare Planning for the BK Amputee: Future Medical Costs Available athttp://consumerlawpage.com/article/amputee.shtml(accessed November 14, 2008) [Google Scholar], a specialist in personal injury litigation, the annual median cost for goods and services for the survivor of a below the knee amputation is approximately $105,000; possibly lost income not yet regarded. A welfare state has to finance these costs, even for a devotee who signs a waiver declaration before the elective amputation.

Conclusions

BIID probably is a neuropsychological disturbance that includes missing insight into the illness and a specific lack of autonomy. Instead of curing the symptom for the price of an irreversible bodily damage, a causal therapy should be developed in order to integrate the alien limb into the body image.

The crucial question is whether the amputation desire is an autonomous decision or an obsessive desire. If it would be as free as the desire for a piercing or a breast augmentation (which also may result from social pressure), the right for the deliberate design of the own body would even allow for elective amputation, at least if all follow-up costs would be financed privately. But since all psychiatrists who have investigated BIID patients found that the amputation desire is either obsessive or based on a monothematic delusion, and since neurological studies support the hypothesis of a brain disorder (which is also supported by the most influential advocates of elective amputations), elective amputations have to be regarded as severe bodily injuries of patients with a substantial loss of autonomy. As long as the full potential of the available diagnostic methods (especially fMRI and positron emission tomography investigations) has not been tapped, treatments that effect irreversible damages should not be performed.

Even the argument that an amputation would be the only effective BIID therapy does not hold: First, their success has not been proven scientifically but only anecdotally. Second, at least sometimes the success is not sustainable: some amputated patients develop further amputation desires. Third, less invasive and efficient therapies can be expected, e.g. neuropsychological rehabilitation, transcranial magnetic stimulation, and finally electrical stimulation of the affected brain areas. For the latter, a careful benefit-risk-analysis and a participative decision making with the patient would be necessary.

Finally, the ethical question arises whether an amputation or a certain brain therapy is more problematic. In contrary to the amputation, an appropriate therapy of the brain would be a causal therapy, not only a cure of the symptom. It could not only cure the suffering from an alien limb, but furthermore prevent disability.

Notes

Koch distinguishes the ‘medical’ and the ‘social difference model of disability’. The first model emphasizes the physical limitations inherent in disability, whereas the latter defines disability primarily as a social condition resulting from society's failure to accommodate the physical differences of the disabled.

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[brianmalulekeot-blog]

A SHUTTERED ECONOMY WITH UNITED COMMUNITIES

The shift in South Africa’s economy has resulted in adverse change in the lives of South Africans. These changes are mostly beneficial to those with big bellies in the parliament unfavourable to a kid at Kenville with malnutrition and now suffering from stigma and removed from school due to back to back hospital appointments. In the Budget speech 2018/19, our cabinet set out an ambitious agenda for our nation. It lays out a series of interventions that will put South Africa on a bold new path, so they say. But when I entered the Kenville clinic I felt like the speech was for a different nation having to consider the surrounding conditions, whilst Billions and billions are engraved by signatures and allocated to individual pockets.

The determinants of economic growth are inter-related factors influencing the growth rate of an economy (Boldeanu and Constantinescu, 2015). The main factors affecting the economy which I noticed sharply included limited natural resources such as land since there are clustered settlements squeezed to hide heads at night in an uneven and unsafe terrains that can be easily flooded by the summer rain, little physical infrastructure(which was fairly present, such as other proper housing, schools, and a community clinic, crèches), uncontrolled population now reaching to 45 000 residents, technology and law. The country has experienced development in infrastructure, technology and natural resources over the years but there has been areas such as Kenville still set to be at the back of the race track.

The evidence of development and economic changes in the country of South Africa is undeniable, and the budget also indicates how well the figures has been distributed among departments, yet the residents seem to be feeding on the crust. Social development being among the ones of high priority on the budget. The department of social development keep on enforcing new mandates, which are to provide social protection and is working with Non-profit Organisations and faith based organization which is evident at the local clinic. The frameworks focuses on basic services.

The development should regulate substance abuse services and facilities which is not evident at Kenville community, since slot of residents are exposed to highly addictive drugs which are easily accessible and tend to be on the watch for preys. So you better always keep your back watched. Every corner its demarcated by smoking crew and all you can see is smoke breeding from the youngsters souls that seek for help. They busk in the sun as vitamin D penetrates into their skin while some are making a living off washing taxis most spotted topless, it must be a custom, or they can’t bear the heat. This are consequences of decreased  job availability and service provision within South Africa and Kenville has made a culture out of it. There has been little change in the lives of the poor and uneducated population with human capital and labour being one of the factors affecting the economy. Inequality experienced by people with disabilities as they are fighting poverty with their grant and pension money to sustain their families.

We are to keep in mind that the state of the country has direct impact on its inhabitants in a physical, psychological and spiritual level. South Africa’s public health sector is funded by the state and 40% of all expenditure on health comes from the National Treasury. The high levels of poverty and unemployment in the country mean that healthcare remains largely the burden of the state with the National Department of Health holding overall responsibility for health care, with a specific responsibility for the public sector (Jobson, 2015). Delays in provision of health services, shortage of medical personnel’s and scarce resources are direct consequences of the ever-changing economic state of South Africa.

Health services to all should be easily accessible, from caring facilities, based on primary health care approach. The department of health is responsible for such an achievement towards the reducing the burden of the disease and strengthening the health system, yet it’s a tale we might have to discuss some other day. The focus should be pointed towards preventing and treating communicable and non-communicable diseases. Although TB, HIV and AIDS require specific attention. It is important not to see this in isolation from other communicable disease given their cumulative impact, But it’s a prayer Kenville has to plead upon.With this being said, the government in implementing numerous strategies to improve the health and wellbeing of the South African communities despite the state of the economy. The foundation of the public health system is the primary healthcare clinics that are the first line of access for people needing healthcare services (Jobson, 2015).

Consequently, the health and wellbeing of the community affects their overall engagement in occupations of choice that bring meaning to life.  Kielhofner defines occupational participation as “Engagement in work, play, or activities of daily living that are part of one’s sociocultural context and that are desired and/or necessary to one’s well-being” (Kielhofner, 2008). The low economic state of South African communities has placed barriers in occupational participation amongst the people. Physical changes occur as we age, impacting on our overall health, but changes in our mental well-being, roles and occupations also affect health (Young, 2017).

It is therefore the role of occupational therapists to ensure occupational participation of the vulnerable community members. The economy has placed a barrier in the provision of such interventions within the communities with no posts being available for occupational therapy. Furthermore, occupational therapists could assist the community members to be functional within their context and ensure wellbeing through the provision of therapeutic interventions to alleviate barriers to health.

References http://www.treasury.gov.za/documents/national%20budget/2019/enebooklets/Vote%2016%20Health.pdf http://www.treasury.gov.za/documents/national%20budget/2019/enebooklets/Vote%2017%20Social%20Development.pdf http://www.treasury.gov.za/documents/national%20budget/2019/enebooklets/Vote%2025%20Economic%20Development.pdf http://www.treasury.gov.za/documents/national%20budget/2019/enebooklets/Vote%2038%20Human%20Settlements.pdf http://www.treasury.gov.za/documents/national%20budget/2019/enebooklets/Vote%2036%20Water%20and%20Sanitation.pdf http://www.treasury.gov.za/documents/national%20budget/2019/enebooklets/Vote%2016%20Health.pdf

BOLDEANU, F. and CONSTANTINESCU, L. (2015). The main determinants affecting economic growth. Series V: Economic Sciences, 8(57), pp.1-6. Jobson, D. (2015). Structure of the health system in South Africa. [online] Bing.com. Available at: Kielhofner, G. (2008). Model of human occupation. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins, p.122. Pubdocs.worldbank.org. (2018). [online] Available at: http://pubdocs.worldbank.org/en/798731523331698204/South-Africa-Economic-Update-April-2018.pdf [Accessed 19 Jul. 2018]. Young, A. (2017). What Are the Facilitators and Barriers to Participation in Meaningful Occupations of Retired Community Based Older Adults?. [online] Dalspace.library.dal.ca. Available at: http://dalspace.library.dal.ca/xmlui/bitstream/handle/10222/72981/Young-Angela-MSc-OCCU-June-2017.pdf?sequence=1&isAllowed=y [Accessed 25 Jul. 2018].

[studyingbymylonesome]

When the World Health Organization (WHO) decided to include “gaming disorder” in the 11th edition of the International Classification of Diseases(ICD-11) in mid-2018, it did not at all settle the long-standing debate whether electronic gaming — online, by video consoles, or on smartphones— could be addictive enough to be considered pathologic.

Rather, the decision further inflamed the controversy, polarizing researchers who have argued opposite sides and leaving many others trying to make sense of limited evidence.1 At even the most practical level, many researchers note the lack of accompanying guidance for the addition.

“We don’t have the appropriate diagnostic tools, and the WHO did not really bother to define any symptoms,” said Chris Ferguson, PhD, a professor of psychology at Stetson University in DeLand, Florida, who opposed the inclusion. “I think where things went off the rails is focusing on the behavior people are addicted to instead of traits of the individual,” Dr Ferguson told Psychiatry Advisor. Within public discourse, he said, people discuss video games as though they are inherently addictive, yet people overdo a wide range of behaviors.

He offered an example of the absurd: “We do not talk about cat addiction, but almost everything you could say about gaming addiction you could say about cats,” he said. “Stroking a cat tends to release dopamine, and cats have mechanisms to try to keep you petting them.” A quick Google search makes evident the problem of cat hoarding, he noted. “Is it something about video games that makes them different from shopping or exercise or food or sex or other things people can do excessively, or is it that individuals have difficulty regulating a fun thing?”

That was a key question the American Psychiatric Association wrangled with in updating the Diagnostic and Statistical Manual of Mental Disorders-5th edition(DSM-5). Ultimately, the American Psychiatric Association included “Internet Gaming Disorder” as a condition for further study rather than its own diagnosis. “There was not sufficient evidence to determine whether the condition is a unique mental disorder or the best criteria to classify it at the time the DSM-5 was published in 2013,” the organization wrote, but they proposed symptoms and potential criteria (5 or more symptoms within a year) for the disorder.

The WHO, meanwhile, announced in a September 2018 press release that gaming disorder becomes “a clinically recognizable and clinically significant syndrome when the pattern of gaming behavior is of such a nature and intensity that it results in marked distress or significant impairment in personal, family, social, educational or occupational functioning.” Mental health providers remain caught in the debate.

Pushback from Industry and the Profession

Not surprisingly, the Entertainment Software Association pushed back on the WHO’s designation even before its formal announcement. In March 2018, Michael D. Gallagher, president and CEO of the Entertainment Software Association, said, “The WHO’s process lacks transparency, is deeply flawed, and lacks objective scientific support.” The Entertainment Software Association drew attention to “A weak scientific basis for gaming disorder: Let us err on the side of caution,” a paper in the Journal of Behavioral Addictions that responded to an earlier open debate paper on the WHO’s ICD-11 proposal and argued against making gaming disorder its own diagnosis because of the weak evidence base.

Dr Ferguson was among the 36 authors who acknowledged the potential for video gaming to interfere with people’s lives but argued for an “extremely high burden of evidence and the clinical utility…because there is a genuine risk of abuse of diagnoses.” They described what additional research was needed to legitimize a diagnosis.

One central issue is whether gaming is a disorder unto itself or a manifestation, in the form of a coping mechanism or self-medication, of another mental health issue, such as anxiety, depression, attention-deficit/hyperactivity disorder or other established diagnoses. Neurobiology research does not clarify this question, according to Michelle Colder Carras, PhD, one of Dr Ferguson’s coauthors on the opposition paper and a postdoctoral fellow at Johns Hopkins Bloomberg School of Public Health in Baltimore.

“The way [many existing] studies are designed, we don’t have a way of telling the way the brain changes from video games compared to other pleasurable things, so it’s like we are comparing sex to drugs instead of comparing sex to some other decent thing that’s fulfilling,” Dr Carras told Psychiatry Advisor.

Dr Ferguson pointed out exaggerations regarding gaming’s effects on the brain. It’s true that gaming involves an anticipatory dopamine release in the brain — but so does “looking forward to going on a trip, having sex, or eating a pizza,” he said. “It sounds more ominous than it actually is.” The dopamine release associated with gaming is similar to those activities, whereas cocaine or methamphetamine release 3 and 12 times more dopamine, respectively.

The Framing Problem of “Addiction”

Another issue is the addiction paradigm itself: Is there a better way to frame problems of excessive use of a substance or excessive behaviors than saying the brain is addicted to that substance or behavior? Research suggests the underlying cognitive psychology of internet gaming disorder is complex and poorly understood.2

Dr Carras said she and colleagues have advocated for “broader category that could encompass different behavioral problems” when people lose control and excessive behaviors have a negative impact on their lives, although she acknowledged they lack a name for such a thing. “Compulsion” is an ego-dystonic behavior and hence not quite accurate: “You do not want to do it; you have to do it,” she explained.

Vladan Starcevic, MD, PhD, also an opposition paper coauthor and an associate professor of psychiatry at the University of Sydney in Australia, agreed, noting that compulsion “refers to having an urge to do a certain activity because you are afraid if you stop, there will be negative consequences.” Although people who cannot continue gaming may feel “restless, angry, or frustrated,” those are psychological symptoms, not physical withdrawal symptoms, which current evidence has not revealed so far.

For gamers, however, negative consequences exist in the form of lost status in the game, such as lost points or reduced rankings relative to other players, according to a presentation that Barbara Craig, MD, a child abuse pediatrician from Walter Reed National Military Medical Center in Bethesda, gave at the American Academy of Pediatrics annual meeting in November 2018. She agreed with gaming disorder as its own diagnostic problem and described pediatric abuse and neglect, including deaths, resulting from parents’ spending 12 or more hours a day playing games.

Still, is that behavior actually “addiction” per se? Dr Starcevic agrees with Dr Carras that “using the addiction paradigm is wrong” and called for caution in applying that label. “When you cross that boundary and something becomes a disorder, it has implications,” such as the stigma attached to any psychiatric diagnosis, Dr Starcevic told Psychiatry Advisor. He worries about making a pathological reason for excessive indulgence in everyday activities, such as shopping or sexual activity, while existing diagnoses already face challenges.

“There is not much support for many of our existing diagnoses,” Dr Starcevic said. “We are struggling to defend some of the existing diagnoses, and now we are introducing yet another that is difficult to defend.”

That does not mean problematic levels of gaming — or other behaviors — do not exist. However, boundaries distinguishing excessive or problematic gaming are not well defined, Dr Starcevic said, and these blurry boundaries can lead to stigma.

“There is a lot of literature on so-called moral panic and stigma associated with diagnostic labels,” Dr Starcevic said, which can be exacerbated without a “clear boundary of what could still be a variant of normal behavior.”

Supporters Recognize Risks Too

Even those who do believe gaming disorder should be its own diagnosis are cognizant of the risks. Petros Levounis, MD, MA, chairman of the psychiatry department at Rutgers New Jersey Medical School in Newark, believes gaming disorder does need its own diagnosis and told the New York Times that one positive consequence of the WHO’s ICD-11designation is the potential ability to get reimbursed for treating people. No pharmacologic treatments exist presently, he told Psychiatry Advisor, so treatment consists of psychotherapy, such as cognitive behavioral therapy, motivational interviewing, or 12-step programs, albeit without much evidence.3 Yet he agreed with being cautious.

“The issue in psychiatry is that there is so much stigma associated with mental illness that before you call something a disorder, you had better have your ducks in a row and know what you are talking about,” Dr Levounis said. However, stigma of other diagnoses — including psychiatric issues that potentially contribute to excessive gaming — may supersede stigma associated with gaming as a disease.

“Maybe the internet gaming is a response to the underlying condition,” Dr Levounis said. “It could be that it is easier for parents and young kids to formulate their troubles in terms of internet gaming instead of saying it maybe a sexual or gender or depression issue.”

That brings things full circle to whether making gaming disorder official runs the risk of leaving those problems undiagnosed and/or untreated. Dr Carras takes a pragmatic approach to this question in a way that breaks somewhat with her skeptical colleagues.

“If the behavior is leading to significant life problems — children not getting to school, not going to work,a spouse is going to leave you — then regardless of whether it is because of a disorder or addiction, it makes sense to treat the behavior,” Dr Carras said, agreeing that the stigma associated with treating gaming might be lesser than when treating other conditions.

Research Gaps Remain

The problem remains that the evidence on excessive gaming is spotty, with too many open questions.4Both Dr Carras and Dr Ferguson pointed out the problem of adequate measurement, for example.5Even vocabulary presents problems — including even whether gaming should be discussed within the context of the internet, as an offline technology, or both.6

“We need a way of defining technology-related problems that is able to keep up with changes in society,” Dr Carras said. She and Dr Ferguson pointed out the research base’s glaring lack of voices from gamers themselves and the industry, which can only worsen generational problems with characterizing the disorder. Dr Ferguson pointed out that most of the WHO researchers pushing for gaming disorder’s inclusion in ICD-11 are likely over age 50 and not familiar with gaming in general.

“They really missed an opportunity to get a more diverse view of this issue,” he said. “If all people who do not like video games came up with a mental health diagnosis, this would be it.” Dr Ferguson also brought up the complexities of cultural differences in perceptions of gaming and mental health and suspected the WHO felt pressure from some countries in Asia to make gaming disorder official.7

Jeffrey Snodgrass, PhD, a psychiatric anthropologist at Colorado State University in Fort Collins who has researched problematic gaming behaviors, told Psychiatry Advisor that the evidence does suggest “symptoms vary somewhat cross-culturally, pointing to a place for culture-specific ‘problem’ gaming that is not well captured by the ‘addiction’ frame.” Immersed in the research, he goes back and forth on the issue.

“I go where the data take me, and that varies from analysis to analysis,” he said, noting that even 2 of his most recent papers came to different conclusions on whether to support the addiction model.8,9 In fact, it is because Dr Snodgrass follows the data that he felt he was not the best person to offer a full-throated defense of either position in a point-counterpoint discussion. Perhaps that his research has not pointed solidly in one direction or another is a testament itself to how much more research is needed before a real consensus can begin to emerge.

Disclosures: None of those interviewed had disclosures.

[addictionrecoveryassistance]

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The Renfrew Center of Baltimore. Renfrew Baltimore Eating Disorder Treatment Center. 1122 Kenilworth Drive Suite 105. Towson, MD 21204. 1-800-RENFREW  …

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High-End rehab centers supply effective, exclusive alcohol treatment to customers in a private, upscale setting. In Baltimore, high-end alcohol rehabilitation and ultra luxury is the most high-priced, ranging between $20,000 and $80,000 monthly.

United States: Fort Worth

15 Stoddard Ct, Sparks Glencoe, MD 21152. 5 star resort living in the heart of Sparks. Truly inspired cooking space connects to stunning great room with a dramati… Unique opportunity to own in coveted sparks/glencoe for an affordable price!

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Oldfields School in Sparks Glencoe, Maryland serves 180 students in grades 8-12, PG. Tel: (410)472-4800. 1500 Glencoe Road Sparks Glencoe, MD 21152. Located in Maryland`s horse and hound country, Oldfields provides an environment where girls feel comfortable, supported, and…

Abbottstown, Pennsylvania Entertainment and leisure directory. Find the best nightspots, restaurants, bars, and shopping in Abbottstown. … Sparks Glencoe, MD 21152 Read Reviews, Map it! Kustom Kuts (410) 795-9044 6416 Rdg Rd Eldersburg, MD 21784 … Abbottstown, Pennsylvania Convention and Banquet Centers: Altland House – Hebron Masonic Lodge …