Benjamin Herbstman

Measuring mental healthcare quality in the United States: a review of initiatives.

Purpose of review This review article aims to present a systematic overview of the current initiatives assessing mental and/or substance use (M/SU) healthcare quality in the United States. Recent findings The study found 36 initiatives incorporating M/SU indicators with efforts from the federal and state government, health plans, nongovernmental and professional organizations. Summary Although there has been much activity in recent years in the development of M/SU indicators, efforts have lacked coordination, have focused on limited areas of clinical activity, and have not been clearly linked to quality improvement activity. The study recommends that the United States government forms an entity to better coordinate efforts and address these concerns. Clinicians and provider organizations should also increase the use of already developed M/SU indicators to improve quality of care delivered.

Adding a Medicine to the WHO Model List of Essential Medicines

Although the concept of essential medicines is not new, the processes that lead to placement of these medicines on the World Health Organization Model List of Essential Medicines are not well understood. Here, we describe the process by which we added a class of drugs, statins, to the Model List to help combat the growing global epidemic of cardiovascular disease.

Postdischarge suicide: A psychodynamic understanding of subjective experience and its importance in suicide prevention

Recent discharge from a psychiatric inpatient facility is associated with a high risk of suicide. There are multiple factors that may contribute to this increase in risk. Psychodynamic considerations about the patients subjective experience of suicidality, hospitalization, and discharge are often overlooked but are critical to understanding this phenomenon. Qualitative research has begun to provide empirical support for the importance of the psychological aspects of discharge, and the heightened state of vulnerability that patients experience during this time. Review of the literature and careful consideration of clinical experience is helpful in elucidating this experience in a way that can inform effective treatment. This article integrates a psychodynamic understanding of suicidality in the postdischarge period with a review of empirical research and formulates clinical recommendations for suicide prevention.

Superego distortions and self-attack

Some people demand an unachievable level of self-perfection, and experience extremely harsh self-criticism when they inevitably fall short of this impossibly high standard. As a result of early trauma or neglect, patients who have internalized part-objects that are particularly responsive to aggression also appear to lack supportive introjects which could normally serve to counterbalance innate aggressivity. The resultant superego malformations are overly harsh and charged with self-destructive intent. Self-attack may range from guilt-ridden self-loathing to physical assault on the body. Suicide is viewed as restorative and survivable. Treatment interventions include superego analysis as a way to identify internalized self-attack, disentangle organized self-destructive elements and support counter-balancing forces for affect tolerance.

Suicide Studies Today. Where Do We Come From? Who Are We? Where Are We Going?

A mysterious painting hangs in the Boston Museum of Fine Arts. Painted in 1887, Paul Gauguin’s masterpiece “D’ou venons nous? Que sommes nous? Ou allons nous?” is fi lled with enigmatic women, lurking creatures, and brooding color. “Where do we come from? Who are we? Where are we going?” The editor of Crisis has posed some similar if narrower questions to us: How are suicide research and prevention to be perceived today? What has been achieved? What is missing? What remains to be done? What can never be done? The authors of this paper are all clinicians. We come from the background of general psychiatry and clinical psychology. All of us are psychoanalysts, and committed to treatment of suicidal patients. Suicidology, as refl ected by what is published in the major journals, has changed over the years. While something has clearly been gained by an increasing emphasis on empirical research, something also has been lost. It is with this lens, and a wish to correct this imbalance, that we have agreed to offer a comment on the state of our fi eld. Suicide studies expanded rapidly after the establishment of the Los Angeles Suicide Prevention Center in 1958. There are now three active print journals concerned with suicide studies and one on-line journal. Many of the articles published in the 1960s dealt with suicide risk assessment, and to a lesser extent, this trend continues today. A survey of the different sorts of papers now being published refl ects an expanding number of topics and interests. Whereas in the 1960s publications emphasized suicide prevention, now we have more and more articles dealing with broader classes of patients of different types. The populations described have changed. Some years ago the emphasis was on psychiatric and other clinical phenomena, drawn mostly from the US. It is now quite usual to fi nd population reports from around the world. Each type of research into aspects of suicide makes its own contribution, but what interests one group of readers differs radically from what commands the attention of others.

Suicide as escape from psychotic panic

Suicides of patients in states of acute persecutory panic may be provoked by a subjective experience of helpless terror threatening imminent annihilation or dismemberment. These patients are literally scared to death and try to run away. They imagine suicide is survivable and desperately attempt to escape from imaginary enemies. These states of terror occur in a wide range of psychotic illnesses and are often associated with command hallucinations and delusions. In this article, the authors consider the subjective experience of persecutory panic and the suicide response as an attempt to flee from danger.

Emerging Adults, Identity Development, and Suicidality: Implications for Psychoanalytic Psychotherapy

ABSTRACT Emerging adulthood (approximately ages eighteen to twenty-nine) has been identified as the transitional age between adolescence and young adulthood. People in this phase of life face specific issues and pressures in developing and consolidating various aspects of identity. The process of coming to experience oneself as a coherent, whole person, and learning about one’s own attributes, capacities, and potential for growth can be fraught and vulnerable to developmental disruption. Difficulties with identity development and consolidation can lead to experiences of disconnection, aloneness, despair, and harsh self-attack that heighten vulnerability to suicide. The psychotherapeutic relationship can help the patient achieve a degree of self-recognition that might not otherwise have been possible, decreasing vulnerability to suicidal despair and opening up the potential for ongoing development and growth. Together, patient and therapist have the opportunity to more fully recognize aspects of the emerging adult’s identity that are present but have not been fully realized, and also to renegotiate other aspects of identity that are based on old, maladaptive “scripts.” We present clinical material to illustrate how struggles with identity relate to suicidality, and to highlight the challenges and opportunities of psychodynamic work.

Commemoration of John Terry Maltsberger (1934-2016).

On October 5, 2016, we lost a dear and immensely valued colleague, Dr. John Terry Maltsberger, who passed away due to a rapidly advancing cancer. His devotion to suicidology and to the understanding and treatment of suicidal patients has been invaluable, and his contributions to our field will continue to guide us for the foreseeable future. Dr. Maltsberger began his studies of suicide as a psychiatry resident at the Massachusetts Mental Health Center in the 1960s. Since then, he has contributed many invaluable and informative publications in his roles as psychiatrist, psychoanalyst, researcher, and writer, which all have enhanced our insight into suicide and the experiences of suicidal patients from a psychodynamic perspective. As a teacher and mentor, he guided and encouraged numerous trainees and clinicians in their professional growth and understanding of their struggling patients. His lifelong dedication to the awareness and prevention of suicide has been extraordinary and will remain deeply appreciated. Dr. Maltsberger was born in Texas and trained and pursued his academic affiliation and career at Harvard Medical School and McLean Hospital. He also became a psychoanalyst and has been affiliated to the Boston Psychoanalytic Society and Institute since the late 1960s. Over the past four and a half decades, he has served on and significantly contributed to a number of organizations related to the studies and preventions of suicide, locally, nationally, and internationally. He has been a long-standing member of American Association of Suicidology and served as its president in 1992. He was the secretary on the executive committee for the American Foundation for Suicide Prevention between 1999 and 2005 and was also the founder and president of the New England division of the American Foundation for Suicide Prevention form 1991 to 2005. He co-directed the American Foundation for Suicide Prevention “Suicide Database” Project with Dr. Herbert Hendin from 1990 to 2005, a research effort engaged in the detailed collection of suicide case histories and treating clinicians’ experiences. The results were presented in several exceptionally informative articles that highlighted therapists’ reactions to the suicidal patient, and helped to elucidate the precipitating events and acute affective state most associated with a suicide crisis. In 1993, Dr. Maltsberger founded the McLean Suicide Study Group, which in 2000 developed into the Boston Suicide Study Group. His wisdom and guidance created a deep empathic understanding of patients who struggled with suicide, and his enthusiastic collaboration led to a wide range of joint publications.

News, Announcements, IASP, and Reviewers.

Please note that the nominations for the Executive Committee are underway and members are invited and encouraged to participate in this significant and democratic event. If you did not receive nomination papers, it may be due to the fact that the IASP Central Administrative Office has yet to receive payment for 2014 membership fees. If you have paid your membership fee and not received nomination papers, please contact the IASP Central Administrative Office as soon as possible, email: membership@ iasp.info. A ballot paper will be sent to you immediately. Please note that the nominations for National Representatives are underway in the following countries and members are invited and encouraged to participate in this significant and democratic event: Australia Japan Austria Mexico Brazil Netherlands China Pakistan Estonia South Africa India Sri Lanka Italy United Kingdom