Author Archives: Susan

Stress Solutions

by Susan Andrews, PhD

“The greatest weapon we have against stress is our ability to choose one thought over another.” William James

This reminds me of a saying I once saw on a T-shirt: “Meditation: It IS what you think.” Of course, William James is taking for granted that most people are capable of controlling their minds well enough to actually choose to think about one thing and NOT to think about something else. Obviously, if everyone could do that, the world would be a much more relaxed and stress-free zone. The trouble seems to be coming from 2 possibilities: (1) many people do not realize that stress can be managed by controlling what they are thinking about and (2) too many people in the world today lack the ability to control what they are thinking.

Stress is absolutely a function of what we think. It is our thoughts about what is happening in the moment that actually trigger stress. And, as James points out, humans can choose to think about something that would normally cause them stress whereas nonhumans do not have that choice. For example, mice can be exposed to chronic stress in a laboratory a number of ways, such as by keeping them in a small space for 21 days. Mice, thus treated, show behavioral and brain cell changes in the amygdala associated with anxiety and depression1.

Research indicates that “reappraising” our situation – i.e., changing the way we think – can actually improve our body’s physiological and cognitive reactions to a stressful event. A team of Harvard and UC San Francisco researchers1 tested this theory by simply instructing participants in a reappraisal condition to think about their physiological arousal during a stressful task as “functional and adaptive.” There were two control conditions: attention reorientation and no instructions.

The participants instructed to “reappraise” their physiological arousal by thinking of the arousal as being more adaptive or functional showed measurably better cardiovascular stress responses (in terms of increased cardio efficiency and lower vascular resistance) and decreased attentional bias. Thus, changing our thoughts and thereby our perception can significantly improve the effects of stress on our body.

The suggestion to reappraise how we are looking at a stressful situation so that we think of it as somehow benefiting us or helping us do something better may be a much easier way to help people learn to control what they are thinking. Often when clients are instructed to try to control what they are thinking and NOT to think of the “X” that is upsetting them, they respond by saying they cannot control what they are thinking. Thus, using the suggestion of “reappraising” or reframing how they think about something may be much more successful at getting a stressed client to think differently – and feel less stressed.

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1 T Lau, B Bigio, D Zelli, B S McEwen, C Nasca. Stress-induced structural plasticity of medial amygdala stellate neurons and rapid prevention by a candidate antidepressant. Molecular Psychiatry, 2016.
2Jamieson, J. Nock, M. and Mendes, W. Brief Report: Mind Over Matter: Reappraising Arousal Improves Cardiovascular and Cognitive Responses to Stress. 2012. Journal of Experimental Psychology: General 2012, 141, 3, 417-422.

Three Identical Strangers: A Review

by Alvin G. Burstein

This is a powerhouse film, deeply stirring emotionally, and raising profound questions about morality and the nature of truth.

Three Identical Strangers is an indie film by Neon/CNN, produced by Tim Wardle. It won raves at this summer’s Sundance Film Festival, and is now beginning general release. I will do my best to outline how it achieves its impact while avoiding spoilers that would dilute its impact.

It begins with one of the three identical twins that are its focus addressing the camera, documentary style. He describes to the viewer his arrival for his freshman year on campus. Puzzled by the warmth and familiarity with which he is greeted, he shortly learns he is being taken for another student who had attended the year before, but had not returned. A buddy of that predecessor realizes that the newcomer must be an identical twin, and immediately barrels the twins into a meeting. The publicity around the surprising encounter leads a third identical triplet to emerge.

What ensues is an account of how it happened that, at six months of age, these male triplets had been placed by a Jewish adoption agency with three different sets of parents and of their lives subsequent to the reunion.

It emerges that they were subjects of a research project conducted by the noted child psychoanalyst, Peter Neubauer, who wanted to study the effects of varying parenting on similar children, and who had arranged with the agency to facilitate his study of identical twins—and triplets—with different families.

Either by design or intentionally, the three adoptive families differ, with a focus on fathers that is clear, though not explicit. That of the triplet that opens the film, Bobby, is middle class. The father, described as very warm, runs a small retail store. Eddy, his brother, is placed in a different setting. His father is a teacher, described as stern and demanding. The third triplet, David, has a new family headed by prosperous but very busy physician.

The film documents the boys’ lives subsequent to the astonishing and joyful reunion with an artful mix of narration, photos, home movies and re-enactment. The three become media celebrities, diving into a 60’s farrago of highlife and hijinks.

The documentation includes contemporary interviews with some of those originally involved—surviving members of the families, Neubauer’s former research assistants and Neubauer himself—burnishing the authority of the re-enactments. But some of the reconstructions, for example a celebratory toasting by the adoption agency staff, seem doubtful.

As the film goes on, the mood darkens and the emotional reaction of the three brothers to what they have learned becomes more complicated. In addition, the very striking physical similarity of the three brothers develops a subtle psychological counterpoint.

A crucial part of the film’s depth lies in questions about nature vs. nurture. Another issue is that of authenticity and the nature of truth. The film raises questions about Neubauer’s motives for not publishing this study. The film makes no allusion to the 1960’s furor about the Tuskegee study of the course of untreated syphilis and the Willowbrook study of infant hepatitis. Those studies were castigated for failing to involve consent from the subjects. Those familiar with the psychoanalyst’s work know that he sought to contextualize the view that maternal failures—remember the 1950’s shibboleth about refrigerator mothers and autism—with an exploration of paternal contributions. Arguably an important question. But had he obtained informed consent?

And I will end with a combination paradox and teaser. Bobby’s father, about whom the triplets clustered as young adults, had a Yiddish nickname, “Bubeleh”. It means “Little Grandmother.”

State to Reinvest Justice Reform Savings to Reduce Recidivism

Gov. Edwards and the Louisiana Department of Public Safety and Corrections (DPS&C) released the first report outlining savings from criminal justice reform measures passed by the legislature in 2017. The savings, according to the report, have exceeded Pew Charitable Trusts’ projections. Savings for fiscal year 2018 totaled $12.2 million, doubling Pew’s original projections of $6.1 million.

“In 2017, Republicans, Democrats and Independents came together to rethink our criminal justice system,” said Gov. Edwards. “We knew what we were doing just wasn’t working and it was costing us more money. By following the lead of other southern, conservative states, we passed a package of 10 bills that will improve public safety and reduce recidivism.”

“This is great news for the state of Louisiana,” said James M. Le Blanc, Secretary, Louisiana Department of Public Safety and Corrections. “Our goal and our mission with criminal justice reform is to reinvest money we would usually pay for incarceration into programs aimed at better preparing our returning citizens and individuals on probation and parole, and to help victims of crime.”

The Justice Reinvestment bills are anticipated to save the state more than $262 million over the next decade, and 70 percent of the savings will be reinvested into programs to reduce recidivism and support victims.

The Department currently intends to use first-year reinvestment funding in support of the following priorities: Increasing programming for state inmates housed at local jails; Enhancing and expanding Regional Reentry Centers; Increasing Probation and Parole staffing and Day Reporting Centers; Launching a Transitional Housing pilot program; Opening a new Reception Center to conduct assessments for new inmates; and Expanding Specialty Courts.

Grants to Community-Based Services: With the goal of ensuring this funding is spent in the most effective and transparent way possible, DPS&C has created a Community Incentive Grant Program and has issued a Request for Proposals (RFP).

The RFP is intended to elicit proposals from qualified community organizations that are interested in enhancing or expanding coordination of reentry services and community supports to increase prison alternatives and reduce recidivism. Funding will be awarded in the fall of 2018.

Grants to Support Victims’ Services: Louisiana Commission on Law Enforcement (LCLE) currently intends to use first-year reinvestment funding in support of the following priorities:

Supplementing the Crime Victims’ Reparations Fund; Establishing a new Family Justice Center in East Baton Rouge Parish; Improving
electronic notifications for victims by developing an electronic system that will interface with all 64 parish clerks of court; and Providing funding to the Louisiana Bureau of Investigations for a dedicated forensics server for their Cybercrimes Unit.

Prior to the passage of the Justice Reinvestment Initiative (JRI) legislation, Louisiana was leading the nation in imprisonment, with a rate nearly double the national average.

Dr. Susan Tucker, psychologist with the DPS&C has been working on programs to reduce incarceration rates. In 2016 legislators pointed to multimillion dollar cost savings to the state because of shorter incarceration times of those offenders who participated in the psychological programs designed and delivered by Tucker and her team at the Bossier Sherriff’s Office, Medium Correctional Facility, located between Benton and Plain Dealing, Louisiana. Dr. Tucker has been working on reducing the rates through her comprehensive, innovative, and evidenced-based programs, to improve lives, families and community safety.

“I am very proud of our program and that we accomplish two goals which save taxpayer money but also provide rehabilitation to the substance abuse incarcerated offenders as well as their families,” Dr. Tucker told the Times.

Governor Appoints Dr. Gormanous to Psychology Board

In a July 10 press release the Governor announced that he appointed Greg Gormanous, PhD, of Alexandria, to the Louisiana State Board of Examiners of Psychologists (LSBEP).

Dr. Gormanous will fill the position opened by Dr. Phillip Griffin, who has completed his term. Vice Chair Dr. Jesse Lambert was elected to theChair at last month’s meeting and Dr. Koren Boggs will serve as Vice Chair.

Dr. Gormanous previously served on the board twice, the first time in 1981 to 1984, and then from 1986 to 1989. He is Professor Emeritus of Psychology, LSU Alexandria, and earned his PhD from the University of Southern Mississippi in General Psychology in 1976. He has been a member of Association of State & Provincial Psychology Boards (ASPPB), the Federation of Associations of Regulatory Boards, the American Psychological Association, the Society for Industrial & Organizational Psychology (APA Div. 14), the Society of Consulting Psychology Louisiana is Heading in Right Economic Direction Says Governor Edwards in July (APA Div. 13), and the Association for Psychological Science. He is also a veteran of the United States Army.

Dr. Gormanous was the sole candidate to selfnominate for the current position and was nominated by the Louisiana Psychological Association.

Dr. Gormanous noted several goals of his service. “My view for regulating psychology in Louisiana is helping the board become more effective and efficient in protecting consumers of psychological services, while simultaneously ensuring due process, irrespective of particular staff, board members, issues and personalities.”

He wants, “To proactively enhance effectiveness, collegiality and transparency with administrative, legislative, media, professional, psychological & public stakeholders in order for the LSBEP to ensure statutorily that consumers have access to qualified providers of psychological services and to ensure enforcement of ethical standards of practice to which providers are required to adhere, with appropriate over sight of the Board’s function by the state of Louisiana.

When applying to serve, he listed six specific issues:

“1. Revising the “complaint” rules, procedures and practices by focusing on two equally important objectives: protecting consumers of psychological services AND ensuring due process for all.

“2. Achieving more effective outcomes for the expenditure of legal fees – presumably underway now.

“3. Staying a pace with changes in education and training. For example, other jurisdictions will be moving toward eligibility for candidates to sit for the EPPP 1 after doctoral course work is completed.

“4. Adjusting to implementation of the competency model (EPPP 1 Knowledge and EPPP 2 Skills) by other jurisdictions and considering what is best for consumers in LA.

“5. Revisiting Generic versus Specialty Credentialing. Does the board stay with its “opportunity for registering…within a limited list of recognized specialties…” or does it implement the health service psychologist (HSP) & general applied psychologist (GAP) categories recognized by APA and ASPPB?

“6. Exploring any ramifications of implementation of the ASPPB’s PEP for LA.”

In a 2010 Times feature article (“Close-Up,” Vol. 2. No. 1.) Dr. Gormanous said that his heart was in teaching.

“Teaching is my drug of choice,” he said “I was one of those people who, in the Ericksonian sense, was late in forming my identity. I wanted to be a college professor. It was English, then math, and then I stumbled across psychology. I realized it was the field where I could discover myself, and discover my need to teach. I love to teach and help develop people, and we have students who want to learn and develop, and so it’s been a perfect fit.”

At that time, Dr. Gormanous has remained involved in his community through efforts with the Alexandria Zoo, Business Incubator, the Rapides Parish Primary Health Care Center, the Syra-Meric Club, and the Alexandria Mardi Gras Association, where he started a new parade – Classic Cars & College Cheerleaders. He also started the Krewe of Kolbi Bow-Wow with the Animal Shelter and the Alexandria Zoo. This is a dog Krewe that advocates for pet adoptions. He has been active with the Chamber of Commerce, Rotary Club of Alexandria, and the Convention and Visitors Bureau.

While his heart might be in teaching, his soul is in the blues. A special project, “Psychology of the Blues,” where he applied psychological principles to songs and singers, and how they have been molded into who they’ve become, has captured his imagination for many years.

“Psychology of the Blues” involves four musicians as he explained–Otis
Redding, Steve Cropper, Grady Gaines, and the great B.B. King.

“I’ve had the privilege of knowing, and sort of informally and unofficially traveling with B.B. King since 1983,” he said. In 1983 Dr. Gormanous attended an event memorializing the slain civil rights leader Medgar Evers. “Charles Evers and B.B. King
wanted to keep the spirit of Medgar alive,” he said.

“BB King and his band played free so that music could be the language to bring people together to overcome racism.” He realized then that music was a vehicle to change the world and it inspired him to be involved.

Louisiana Psychological Assn to Host Evolutionary Psychology Legend, Professor Robert Trivers

Times Magazine listed him as one of the 100 Greatest Thinkers of the 20th Century. Richard Dawkins calls him “A uniquely brilliant scientist.” Science named him “One of the most influential evolutionary theorists alive today.”

Stephen Pinker, Professor of Psychology at Harvard and author of How the Mind Works, said, “I consider
Trivers one of the great thinkers in the history of Western thought. It would not be too much of an exaggeration to say that he has provided a scientific explanation for the human condition: the intricately complicated and endlessly fascinating relationships that bind us to one another.”

He is Professor Robert Trivers, the man who pulled back the curtain on key concepts of evolved preferences, and produced a major redirection in social and evolutionary psychology. He will speak at the Louisiana Psychological Association workshop on November 9, in New Orleans.

In a series of brilliant papers beginning in the 1970s, he laid out the evolutionary logic and foundational theory for major areas of human social interaction. His combining of psychology and evolutionary biology opened the door to a better understanding of the deep connections of love, cooperation, competition and the unconscious conflicts that accompany them.

In 1971, with, “The evolution of reciprocal altruism,” Dr. Trivers put the heart back into the psyche: Being moral, good, and fair, had in fact, evolved right alongside our purely selfish traits.

The model is where “friendship, dislike, moralistic aggression, gratitude, trust, suspicion, trustworthiness, aspects of guilt, and some forms of dishonesty and hypocrisy” could be explained as important adaptations to regulate the reciprocalaltruistic system, sensitive to developmental variables and selected to their specific social environment.

Trivers’ theories inspired a staggering amount of research and discussion with bestsellers like E.O. Wilson’s Sociobiology and Richard Dawkins’ The Selfish Gene, and later books like The Adapted Mind, The Red Queen, Born to Rebel, The Origin of Virtue, The Moral Animal, and Evolution of Desire.

As the explosion of research continued, Trivers wrote that some of the ideas had “…almost biblical proportions.” He said, “… you could see how a kind of social heaven and social hell could evolve right here on earth. The social hell was perpetual isolation, perpetual inability to link up with others in a positive way, never being cheated by others to be sure, but at the cost of eternal loneliness. The social heaven was not heavenly in some naïve way, dancing around the mulberry bush together without regard for selfish possibilities. Instead, cooperation required perpetual vigilance to enjoy its fruits, …’”

Together, Trivers’ work helped explain evolved tendencies in romantic relationships between females and males (“Parental Investment and Sexual Selection”) relationships between parents and children, and between siblings (“Parent-offspring conflict”), and how friends deal with friends, acquaintances and strangers (“The evolution of reciprocal altruism”).

In the 1990s, Trivers took another leap and explained an evolutionary logic of self-deception. (“The crash of Flight 90: Doomed by self-deception?” co-authored with Black Panther leader, Huey P. Newton; and “The elements of a scientific theory of self-deception”).

Dr. Trivers has stated that he “… was eager to contribute to building social theory based on natural selection, because a scientific system of social theory must, by logic be based on natural selection, and getting the foundations correct would have important implications for understanding our own psyches and social systems.”

Today, while psychology includes vast amounts of fascinating data and interesting partial theories, it still lacks a foundational, meta-theory, say evolutionary psychologists William Von Hipple and David Buss. In their survey, the two found that almost 90% of social psychologists accept Darwin’s ideas in general, but only about 50% believe that evolved characteristics apply to the human mind and social tendencies.

Trivers himself wrote that he expected his work would be welcomed––he viewed himself to be “on the side of the angels,” he said. Instead, it was labeled “regressive.”

In the past, evolutionary theory may have seemed harsh, and even to be a theory that gives permission for inequality, something psychologists work against. Von Hipple and Buss point to the mistaken idea of “genetic determinism”––the belief that genetic behavior is fixed, and also to the confusion between evolved preferences and actual behaviors in modern humans, as contributing to discomfort with embracing evolution as a metatheory.

Today, a stronger understanding that the expression of these predispositions is plastic, fluid, varying and context-dependent, has worked its way into psychologists’ thinking, along with the acknowledgement that the discipline cannot ignore important science only because it may at times be uncomfortable.

“But Trivers’ ideas are, if such a thing is possible,” said Pinker in an interview with the Edge, an intellectual think tank, “even more important than the countless experiments and field studies they kicked off. They belong in the category of ideas that are obvious once they are explained, yet eluded great minds for ages; simple enough to be stated in a few words, yet with implications we are only beginning to work out,” Pinker said. This may be the case. Trivers Google Scholar citations, now over 44,500, are continuing to increase. Citations for his 10 major papers are much higher now than they were for the first 30 years after publication.

The Louisiana Psychological Association will host the evolutionary theorist at their winter workshop, to be held Friday, November 9, at the Hotel Monteleone in New Orleans.

The one-day event, “Evolutionary Psychology & Ethics,” will address the scientific foundations of self-interest, reciprocal-altruism, cooperation and deception in human relationships, and the evolutionary logic that predicts this complex psychological terrain.

Dr. Trivers will speak on “Ethics and Social Theory: The Evolution of Reciprocal Altruism,” and then on “The Logic of Deceit and Self-Deception.

“I will define natural selection, the basis social traits, then concentrate on altruism and quickly move to reciprocal,” he said, and explain gross and subtle cheating, sense of justice and other traits.

In “The Logic of Deceit and Self-Deception,” he will start with the co-evolutionary struggle between deceiver and deceived, the intrinsic bias in favor of the deceiver, and the invention of self-deception to facilitate deception.

Also presenting and participating as discussants will be Dr. Jack Palmer, from University of Louisiana Monroe, author of Evolutionary Psychology: The Ultimate Origins of Human Behavior.

Dr. Matthew Rossano, from Southeastern Louisiana University, author of Supernatural Selection: How Religion Evolved, will also present.

Dr. Michael Chafetz, known for his extensive work in malingering research, and Dr. Denise Newman, chair of the Louisiana Psychological Association Psychotherapy Interest Area and a psychoanalytic psychologist, and others.

Brilliant and controversial, Robert Trivers has attracted attention for his immensely original thinking and also for his unconventional activities. He currently lives in Jamaica, which he loves, and where he studies body symmetry in elite runners, and where he recently completed an autobiographical memoir––Wild Life: Adventures of an Evolutionary Biologist.

Registration opens August 10 at louisianapsychologicalassociation.org

Munchausen Syndrome by proxy Act 193 Taps into Complex Issues in Effort to Limit Diagnostic Errors

In the 2018 regular session, House Bill No. 145 placed limitations on who may diagnose the disorder known as “Munchausen Syndrome by proxy,” which is known in the DSM-5 as factitious disorder imposed on another or FDIA. The bill, by Representative Kenny Cox, was signed by the Governor and became Act 193.

Formally known as Munchausen syndrome by proxy (MSP), this condition is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. In some cases, illnesses may be actually produced by the caretaker.

Act 193 directs that no physician or other health care provider shall diagnose the condition of factitious disorder imposed on another (formerly “Munchausen syndrome by proxy”) unless he or she meets certain criteria, such as being licensed, qualified by his or her license and training to diagnose, able to provide a certain level of quality in the evaluation, and other stipulations. The new law indicates that the evaluator must review relevant records, history, current clinical conditions, and obtain records from external sources searches schools, childcare providers, and family.

While these quality controls and expectations are standard for psychological evaluation, Representative Cox’s measure suggests that problems have been encountered in the past in this complex area where teasing out the accuracy of claims and symptoms could require a deeper understanding of illness-deception.

The measure was signed by the governor recently and became law as Act 193. However, the real complexities of the matter may still cause issues for those practitioners who are not highly trained to understand nuances and pitfalls regarding illnessdeception.

Dr. Michael Chafetz, a nationally recognized expert when it comes to malingering in forensic and medical
assessments, points to the complexities in understanding these issues.

“Every practitioner who makes a diagnosis has two potential positive outcomes and two potential errors,” said Chafetz. “If the diagnosis is made and is correct, it is a good thing because the patient has the pathology identified and can get appropriate treatment. If the diagnosis is correctly rejected (because no evidence for the pathology could be adduced), it is a good thing because the patient is spared the wrong treatment for pathology that does not exist.”

“The flip side of the positive outcomes involves the errors that are potentially made,” he said. “If the practitioner makes a diagnosis of a condition that the patient does not have, that is a false-positive error. Everyone involved with the case is now acting on false new information about the patient.

“On the other hand, if the practitioner rejects the diagnosis for a condition that the patient does have, that is a false-negative error,” he explained. “This error can be problematic, as no one involved with the case will get on board with the appropriate interventions.”

In decision-making, there is often a trade-off between false-positive and falsenegative errors, and the importance of not making one or the other depends on the relative merits of the outcomes, he explained. “For example, in cancer screening and bomb detection, a false negative error can be more costly than a false-positive error. TSA certainly does not want to miss a bomb, and the radiologist certainly does not want to miss a possible cancer. These false-positive errors may cause some discomfort, but they sure beat the alternatives!”

In Factitious Disorder Imposed on Another, both kinds of errors have realworld consequences. “If the practitioner makes a false-negative error, missing the parental deceptions, the parent does not get diagnosed, which increases the potential for a child to suffer abuse,” Dr. Chafetz said.

“If the practitioner makes a false-positive misdiagnosis of the parent, that parent may face drastic consequences with the possibility of termination of their parental rights.”

He noted that Factitious disorder (FD), like malingering (M), involves deceptive behaviors. In fact, both FD and M are similar in that they both involve deception of others. Malingering involves deception in a medico-legal setting, whereas FD typically occurs in a medical or psychological setting.

The “by-proxy” or “imposed on another” conditions for both disorders are meant to convey that an individual, usually a caretaker, is creating the deception by use of a person under their care.

Dr. Melissa Dufrene and Chafetz have studied these exact issues, in Chafetz, M.D., & Dufrene, M. (2014). Malingering-by-proxy: Need for child protection and guidance for reporting. Child Abuse & Neglect, 38, 17551765.

Both of the by-proxy or imposed conditions can lead to child abuse, he explained. In their guidance article, Chafetz and Dufrene developed guidelines for reporting.

Dr. Chafetz has also discussed these conditions in a physicianeducation article, Chafetz, M.D. (2018). Factitious Disorder Imposed on Another and Malingering by Proxy: Controversies, Recognition, Responsibilities, and Management. American Physician Institute, CMEtoGo, Volume 7, Issue 2.

It is important to recognize that both conditions, M and FD, involve deception of others. Typically, psychological treatments do not take into account the deception, he said.

While Act 193 may help somewhat to make sure qualified professionals are called upon for these complex issues, there could still be a lot of confusion for those that do not have the tools and methods to evaluate these serious issues.

Focus is on Prevention as Suicide Continues to Rise

One of the measures that flew through the House (85 to 0) and then with amendments, through the Senate (32 to 0), in the regular 2018 Legislative session, was Representative Reid Falconer’s “Louisiana Suicide Prevention Act.”

An ambitious plan, Act 450 directs the Office of Behavioral Health to ensure that administrators of all healthcare facilities licensed by state and all licensed healthcare professionals have access to informational resources and technical assistance necessary for implementation of the zero suicide initiative. The initiative carried a price tag of nearly $800,000. Because of the state’s financial picture, an amendment was added requiring that implementation had to be contingent on obtaining grant money.

The authors of Act 450 note that according to the 2016 America’s Health Rankings report, the number of deaths due to suicide per one hundred thousand people in the United States rose steadily from 2012 through 2016, and Louisiana’s rate of deaths from suicide is nearly ten percent higher than the national average.

The Center for Disease Control continues to rank suicide as the 10th leading cause of death in the US. The most recent year of data (2015) placed suicide deaths at 44,193 nationwide, more than the number killed in automobile accidents, which was 37,757, or homicides, 17,793, for that same year.

Representative Falconer wrote “While suicide occurs among persons of all ages, ethnic backgrounds, and income levels, it is an especially troubling problem among youth in Louisiana, with suicide ranking as the second-leading cause of death in this state for persons between the ages of ten and twenty-four in 2014, the most recent year for which complete data are available.”

Suicide is a pronounced public health concern among military veterans nationwide and in Louisiana particularly, as Louisiana’s veteran suicide rate is over ten percent higher than that of the nation and of the southern region, write the authors. And, more than half of the people who died by suicide did not have unknown mental health condition, reports the CDC.

The rising rates of suicide has been at the front of the news for some psychologists in the field, and motivated the Louisiana Psychological Association to host suicide prevention expert Dr. April Foreman at their recent state convention.

Foreman is a licensed psychologist serving Veterans as Suicide Prevention Coordinator for Southeast Louisiana Veterans Health Care System. She also serves as Suicide Prevention Lead for Veterans Integrated Service Network 16, a region of Veterans Affairs. She is on the Executive Committee for the Board of the American Association of Suicidology.

Dr. Foreman presented “Suicide Risk Assessment,” at the Louisiana Psychological Association Convention recently, providing an overview of basics of suicide risk assessment, risk levels, and acute vs. chronic risk. She covered the use of safety planning as a follow up to risk assessment, current research innovations pertaining assessment of risk and actual prediction of suicide attempts/deaths, and possible ways this may impact clinical work in the upcoming years.

Dr. Foreman has been working toward this goal for some time. In 2014, Foreman supported Senator Ben Nevers’ effort to ensure that mental health professionals were adequately trained, SB 539. While the mandate was removed, the effort drew attention to the problem.

“This is a public health issue that is squarely in psychology’s wheelhouse,” said Foreman in a previous interview. “Only 9 to 10 percent of mental health professionals can pass a competency exam,” in this topic, said Foreman. “This is a big training deficit.”

Dr. William “Bill” Schmitz, Jr., a licensed clinical psychologist in Baton Rouge, working primarily with the nation’s veterans, and who has served as President of the American Association for Suicidology previously explained the importance. “It is the number one emergency in mental health and the most lethal situation a professional will encounter. But, no one is required to have training,” he said.

Schmitz co-authored a white paper, “Preventing Suicide through Improved Training in Suicide Risk Assessment and Care,” a report of the American Association of Suicidology Task Force, which Schmitz chaired. In the report, authors noted that training for suicide prevention is inconsistent at best. The majority of mental health professionals receive very little, if any formal training in suicide prevention. The exceptions are the psychiatrists; 94 percent have received some training. However, even in this group, only about a quarter of these receive skill development training.

“An hour of didactic training may increase knowledge,” Schmitz explained to the Times, “but it doesn’t do anything to actually change competency.”

Dr. Foreman has also looked carefully into the competency problem. “When the state of Georgia was asking these same questions in 2005,” she said, “they assessed a sample of mental health professionals, and the competency rate was 9 percent. A few hours of training raised the rate to 83 percent,” she said. “That’s a huge difference.”

The rising rates of suicide are a concern. “There are several theories regarding this trend, though a specific and definitive explanation has not emerged,” Schmitz noted. “We do know that suicide attempts, across the lifespan, tend to become more lethal,” explaining that the ratio of suicide attempts to death is 100-200 to one for adolescents and young adults, but for those over 65 the ratio is four to one.

“Coupled with this,” Schmitz said, “I would also add that help-seeking and mental health treatment remain very stigmatized among the older adult populations. There is lingering doubt and fears associated with institutionalization, asylums, and being ‘locked up’ if one divulges any thought of suicide,” he explained. “This is very disconcerting given the clear evidence that even people determined to be at high risk for suicide have been shown to respond to intensive outpatient therapy.

In a previous interview with the Times, Dr. Frank Campbell, a clinical social worker and expert from Lacombe, Louisiana, former Executive Director of the Baton Rouge Crisis Intervention Center, and also Past-President of and American Association for Suicidology, said, “It is important to accept that suicide is a very complex and paradoxical cause of death to develop clear
understandings from. It is an N of 1 and by that I mean each suicide is unique.” Dr. Campbell’s work has been featured in a documentary for the Discovery Channel.

“For me the most comprehensive micro or individual answer to any death by suicide,” he said, “is that it happens as a result of a self-defined crisis where the individual’s ability to cope with the precipitating event which brings on the crisis response––decline in coping and possible increase in maladaptive coping––was unable to keep that person safe from suicide,” Dr. Campbell said.

“Data is helpful in awareness but each death impacts the community in ways that are unique and little research has been conducted on the impact suicide has on generating additional causalities both in the short term or long term for a community.”

“The macro response would include considering the impact of social and economic changes in the past 10 years,” Campbell said, “because economic conditions have historically correlated with upward trends in suicide.”

Also, “… a growing number of citizens who are veterans of military service––mostly men––which are estimated to equal one out of each five deaths by suicide,” he said.

Dr. Schmitz pointed out that there is growing evidence supporting various approaches that help those at risk. “There are treatments that work, there are warning signs and basic skills of suicide assessment and management that should be core clinical competencies,” said Schmitz.

“Unfortunately, the majority of mental health professionals do not obtain this training in either their graduate studies or continuing education,” he said.

“Providers that are not engaging their patients in active discussions about means restriction and crisis response planning really terrify me,” he said.

Dr. Campbell said, “Managing transitions in life if not easy and when health and loneliness are isolating factors along breakdown geographically of the family and health care challenges it is a lot to manage. Generational expectations are not always shared or expressed clearly to family who might be wanting to help but just don’t know how.”

“My thought is that if we had the number of folks who die by suicide each year drowning then we would train more lifeguards to stand by those in the water.

“The river of suicide is large in this country and it is up to all of us in our communities to become trained as lifeguards. One such training that is for all care givers is the two-day ASIST (Applied Suicide Intervention Skills Training) that helps anyone help another at risk from the river to safety for now.”

Lawmakers Finally Make a Budget Deal

After a total of seven special sessions since 2016, and three special sessions this year, Governor Edwards and legislators finally wrestled the budget into some type of order by the passage
of an extra .45 percent sales tax, in down to the wire negotiations that ended last week. The move sidesteps drastic cuts to public health and higher education and provides several years
of stability.

The new tax will raise an estimated $463 million to plug holes in the budget hat if left unresolved, had threatened to bring dramatic cuts in health care services and what the Governor called
“a catastrophic cut” to higher education.

The new sales tax, a partial renewal of an expiring one percent sales tax, is said to give the lawmakers some respite from the yearly battles with the budget. The .45 brings the state sales
tax to 4.45.

“The fiscal cliff is now gone and we have predictability ahead of us,” the Governor said after the agreement passed in this year’s third special session.

In the special sessions lawmakers were attempting to deal with the state’s budget crisis when more than $1 billion in taxes would expire on June 30, 2018. The two earlier special sessions
floundered after the House repeatedly rejected increased taxes. The House passed a budget that made dramatic cuts to TOPs, universities and state agencies, and then that was vetoed by
the Governor.

Allowing the new arrangements, this week Moody’s Investors Service changed Louisiana’s rating to “stable.”

Gov. John Bel Edwards said, “Today’s action by Moody’s validates what we’ve been saying about the need for budget stability,” said Gov. Edwards.

“Thanks to the bipartisan compromise achieved during the last special session, Louisiana is no longer on the negative watch list. By working together, for the first time in a long
time, Louisiana’s budget will have the kind of stability and predictability we need to bring new business opportunities to our state and grow our economy. As a result, not only are the
credit rating agencies taking notice, but we are positioned to generate greater savings for our state that will enable us to continue on our path toward prosperity.”

Consumer Member to be Added to Psychology Board New Legislation Brings Change to State Boards

In his effort that has been ongoing for three years, Senator Fred Mills’ measure was signed into law as Act 515, requiring boards such as the state psychology board to make several changes, including adding a consumer member.

Act 515 transfers the healthcare professional licensing agencies, boards, commissions, and like entities to the La. Department of Health (LDH) and deletes repealed and obsolete citations and references.

The new law adds at least one consumer member to each healthcare professional licensing board that did not previously have one and provides standardized eligibility criteria for such
consumer members.

The new law also requires the governor to ensure that his appointments to healthcare professional licensing boards demonstrate diversity with respect to race, gender, ethnicity, and geography.

New law also authorizes all licensing boards and commissions created and provided for in prior law to develop a process to issue a license, permit, or certificate outside the national
examination for those individuals with a disorder which is recognized by the Americans with Disabilities Act.

An effort to take professional associations out of the direct loop for board nominations was amended out of Senator Mills’ measure.

Some of the intent by Senator Mills’ efforts found its way to Act 623, the Occupational Board Compliance Act, authored by Representative Connick. The goal is to help boards use the least
restrictive regulation necessary, in regard to market competition and other factors, in their efforts to protect consumers from present, significant, and substantiated harms that threaten public health and safety.

Act 623 creates the Occupational Licensing Review Commission, comprised of the governor, secretary of state, commissioner of agriculture, commissioner of insurance, and the state treasurer, or
their respective designees, who are responsible for active supervision of state executive branch occupational licensing boards.

In a related measure, Act 655 allows that a person who has a disciplinary action brought against him or her by the La. State Bd. of Dentistry or the La. Auctioneers Licensing Bd. to elect to have the matter moved to the division of administrative law for a disciplinary adjudication by an administrative law judge. The measure also directs boards to develop process for different exams for those with disabilities, and submit quarterly reports to the legislative oversight committee about complaints regarding board actions.

Act 696 Allows Behavioral Health Providers to See Clients at School

Act 696 by Representative Pierre, allows a behavioral health provider to provide behavioral health services to a student at school during school hours if requested by the student’s parent or legal guardian.

The Act defines “Behavioral health provider” as a provider who is licensed by the Louisiana Department of Health or a health profession licensing board including but not limited to a psychiatrist, psychologist, medical psychologist, licensed specialist in school psychology, marriage and family therapist, professional counselor, clinical social worker, or a behavioral health provider organization licensed to provide behavioral health services in Louisiana.

According to the digest of the bill, services include individual psychotherapy, family psychotherapy, psychotropic medication management, community psychiatric support and treatment, and crisis intervention. Also, “Evaluator” shall mean a licensed psychiatrist, psychologist, medical psychologist, licensed specialist in school psychology, professional counselor, marriage and family therapist, or clinical social worker who is certified by the respective board of examiners in Louisiana to provide necessary evaluations and who is not an employee of the public school governing authority or the state Department of Education.

Behavioral health services shall be permitted during school hours if the student’s parent or legal guardian presents a behavioral health evaluation performed by an evaluator chosen by the parent or legal guardian and the evaluation indicates that the services are necessary during school hours to assist the student with behavioral health impairments that the evaluator determines are interfering with the student’s ability to thrive in the educational setting.

The Act says that a behavioral health evaluation presented by the parent or legal guardian of a student shall not be construed as an independent educational evaluation for purposes of determining if a student meets the criteria established for eligibility for special education and related services.

The cost of all behavioral health services provided to a student shall be the sole responsibility of the parent or legal guardian.

The parent or legal guardian of a student receiving services from a behavioral service provider shall be required to execute a “consent to release information form” between the provider and the public school governing authority. And a public school governing authority shall not enter into a contract or an exclusive agreement with a behavioral health provider that prohibits the parent or legal guardian from choosing the behavioral health provider for the student.

Hereditary: A Review

by Alvin G. Burstein

It may have been Stephen King—and who would be better qualified—who distinguished among terror, horror and shock. Stories evoking these strong unpleasant feelings, paradoxically, can find an avid audience, a fact on which King has capitalized. The distinction is that terror implies a sense of personal fearful involvement; horror is a more distant, almost pornographic, viewing of a fearful situation. Shock, in contrast, generates revulsion along with fear. Along those lines, last month’s review of A Quiet Place noted the terror it evoked. This month’s film, Hereditary, is a shocker.

In some ways the film seems a mix of Heironymous Bosch and Salvador Dali, giving us repugnant details woven into a surreal mesh that generates uncertainty about the nature of reality.

As the film’s title suggests, the tale is multi-generational, dealing with a quirky, just deceased grandmother at the time of her funeral, her troubled daughter, Annie, baffled son-in-law, Steve, and her two grandchildren, a pre-teen girl, Charlie and older grandson, Peter. It may be more of a teaser than a spoiler to point out that the grandchildren’s names are an allusion to the role that maleness will play in the movie’s denouement. That kind of allusiveness abounds in the film—for example, a scene of a walnuts being chopped for a dessert precedes, without explicit linkage, a later anaphylactic attack—contributing to the surreal quality.

The surreal quality emerges early in another way. Annie is an artist who creates tiny miniature rooms. As the film opens, she uses magnifying lenses and special tools to create a bedroom that morphs into Peter’s actual bedroom as his father, Steve, enters to rouse his son for the grandmother’s funeral. And then there are the use of peripheral events, things seen out of the corner of the eye—a figure floating in the corner of the room—or heard in the background—Charlie’s occasional tongue click.

At the funeral Annie describes her fraught relationship with her mother. At a grief group she attends later, she enlarges on the dysfunction of other family members, a schizophrenic brother who committed suicide and a depressed father who starved himself to death. These catastrophes are both a counterpoint to and a motivation for her creation of tiny, controlled simulacra of reality.

The psychoanalyst Adam Phillips sees the family as the place where one learns to deal with conflict. He has in mind the paradox of the family as a source of necessary grounding but, at the same time the font of inevitable conflicts of interests and ambivalences. That kind of drama is painfully expressed when Annie describes her guilt about her troubled past and when she reveals to Peter that she didn’t want to be a mother and had tried to abort his birth.

To detail the repugnant elements would take us into spoiler territory. But few early examples: Charlie beheads a bird. And she gets smeared with chocolate at a party that Peter takes her to.

And there are lots of insects.

I did not find Hereditary frightening. Like Bosch and Dali, it was disturbing in fascinating ways. It was a shocker. But I knew it wasn’t real–luckily.