I graduated!

Palestine has some of the highest rates of mental illness in the world. A quarter of Palestinian adolescents have made suicide attempts; about 23.2% have post-traumatic stress disorder (according to a survey of 1,369 over three years) compared to around 6-9% in the US; and the Palestinian territories have by far the highest levels of depression in the Eastern Mediterranean region. Samah Jabr, chair of the mental health unit at the Palestinian Ministry of Health and one of just 32 psychiatrists in the Palestinian territories, doubts those statistics.

As Brown (1995) and others have pointed out, however, while the world may well look safe to White, heterosexual, able-bodied, middle- and upper-class adult males (e.g., most psychiatrists), it is not so safe for a great many others. In this regard, as theorists such as Brown (1995), Lewis (1999), and Burstow (2003) suggested, women, Blacks, gay men and lesbians, people who are disabled, children, and much of the working class live in ongoing danger of assault.

Moreover, the safe world assumed by most people (including the privileged and including the framers of the DSM) is not so much a reality as an inaccurate albeit serviceable construct maintained by an everyday cognitive practice: People who are not traumatized maintain the illusion of safety moment by moment by editing out such facets as the pervasiveness of war, the subjugation of women and children, everyday racist violence, religious intolerance, the frequency and unpredictability of natural disasters, the ever-present threat of sickness and death, and so on. People who have been badly traumatized are less likely to edit out these very real dimensions of reality. Once traumatized, they are no longer shielded from reality by a cloak of invulnerability.

“Diagnostic manuals such as the DSM were created to provide a common diagnostic language for mental health professionals and attempt to provide a definitive list of mental health problems, including their symptoms.

The main findings of the research were:

• Psychiatric diagnoses all use different decision-making rules

• There is a huge amount of overlap in symptoms between diagnoses

• Almost all diagnoses mask the role of trauma and adverse events

• Diagnoses tell us little about the individual patient and what treatment they need

The authors conclude that diagnostic labelling represents ‘a disingenuous categorical system’.

Lead researcher Dr Kate Allsopp, University of Liverpool, said: “Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.”

The autoimmune disease, it seemed, was a specific biological cause — and potential treatment target — for the neuropsychiatric problems April faced. (Whether her earlier trauma had triggered the disease or was unrelated to her condition wasn’t clear.)

The diagnosis made Markx wonder how many other patients like April had been missed and written off as untreatable.

“We don’t know how many of these people are out there,” Markx said. “But we have one person sitting in front of us, and we have to help her.”

The medical team set to work counteracting April’s rampaging immune system and started April on an intensive immunotherapy treatment for neuropsychiatric lupus. Every month for six months, April would receive short, but powerful “pulses” of intravenous steroids for five days, plus a single dose of cyclophosphamide, a heavy-duty immunosuppressive drug typically used in chemotherapy and borrowed from the field of oncology. She was also treated with rituximab, a drug initially developed for lymphoma.

The regimen is grueling, requiring a month-long break between each of the six rounds to allow the immune system to recover. But April started showing signs of improvementalmost immediately.

As part of a standard cognitive test known as the Montreal Cognitive Assessment (MoCA), she was asked to draw a clock — a common way to assess cognitive impairment. Before the treatment, she tested at the level of a dementia patient, drawing indecipherable scribbles.

But within the first two rounds of treatment, she was able to draw half a clock — as if one half of her brain was coming back online, Markx said.

Following the third round of treatment a month later, the clock looked almost perfect.

Drawing a clock is a common way to assess cognitive impairment. These clocks, drawn by April, show how significantly the treatment regimen was helping her. (Courtesy of Sander Markx) Despite this improvement, her psychosis remained. As a result, some members of the team wanted to transfer April back to Pilgrim Psychiatric Center, Markx said. At the time, Markx had to travel home to the Netherlands, and feared that in his absence, April would be returned to Pilgrim.

On the day Markx was scheduled to fly out, he entered the hospital one last time to check on his patient, who he typically found sitting in the dining room in her catatonic state.

But when Markx walked in, April didn’t seem to be there. Instead, he saw another woman sitting in the room.

“It didn’t look like the person I had known for 20 years and had seen so impaired,” Markx said. “And then I look a little closer, and I’m like, ‘Holy s---. It’s her.’”

It was as if April had awakened after more than 20 years.

Apr 30, ‘23

study diary —

It’s crunch time.

I have finals in Calc 3 and Physics this week and I do not feel prepared (but to be fair, I never do).

Today I’ve just been working through Calc 3 review problems - nothing wild or special. I decided to put this little shelf next to my desk last night because I’ve been running out of space.

I don’t think I’ll keep it there permanently, but it’s been very nice to have somewhere close by to put stuff I’m not actively looking at!