An open letter to Vynamic CEO Dan Calista: fixing (mental) healthcare

Dear Dan:

I graduated from Archmere Academy in Claymont, Delaware, in 1989 with thirty AP credits, and then headed to Notre Dame.  After three and a half years in South Bend, I graduated Magna Cum Laude with a double major in English and Computer Applications in 1993.  I thought I was going to be a lawyer, eventually, but figured I would work for a while first, so I pursued opportunities in information technology.  I received job offers from Arthur Andersen Tax Technology Group in Chicago, Andersen Consulting in Philadelphia, Price Waterhouse in Washington, D.C. and Ernst & Young in New York City, but I accepted a position with The Travelers in Hartford primarily because their “ACCENT Program”  (accelerated entrance into management) was the hardest job offer to win.  Motivated primarily by the fact that I was “college-sick” after leaving my best friends back at Notre Dame after graduating early, I left The Travelers after just five weeks to become the Director of Information Systems at a fast growing restaurant chain in Delaware — Grotto Pizza.

Four years later in 1997, I was the youngest Principal consultant at American Management Systems’ 1 Chase Plaza office, located just a couple of blocks from Wall Street.  I spent most of ‘96 and part of ‘97 living and working in Zurich for Credit Suisse —  my B2B bill rate was $250 an hour.  Then, on the morning of March 2nd 1998, a warehouse manager in Secaucus, New Jersey, named Norman found me inside of a running rental car that I had turned into a makeshift carbon monoxide gas chamber the night before.  I had a near death experience in the back of an ambulance, enroute to the Jersey City Medical Center, and I woke up a couple of days later in the ICU.

I’m writing to see if you’d be open to having a conversation with me about how we might work together to save lives and reduce suffering by helping to transform mental health care in this country.  I am already doing this work on a volunteer basis on a number of fronts.

I am a board member of the Philadelphia Chapter of the American Foundation for Suicide Prevention, who is working with John Madigan (AFSP VP of Public Policy) to leverage my relationship with Vice President Biden to garner political will for a massive increase in public funding for suicide prevention.  I was high school teammates with both of VP Biden’s sons at Archmere Academy.

I am a Zero Suicide champion working with Dr. Tracy Gaudet, the Executive Director of the National Office of Patient Centered Care and Cultural Transformation at the VHA.  I’m participating in Dr. Gaudet’s panel discussion on Whole Health and suicide prevention in the military in September at the VA’s National Leadership Conference.  Secretary Shulkin is committed to reducing the suicide rate at the VA, and he’s asked Dr. Gaudet to organize a panel of experts to address the VA leadership on the subject.  I’m also working with Dr. Gaudet and David Wright from GetWellNetwork to propagate the Zero Suicide framework via GetWellNetwork’s interactive patient care system.  The VHA already utilizes GetWellNetwork’s platform in over forty facilities. GetWellNetwork’s founder and CEO, Michael O’Neil, is one of my closest friends.  We met at Zahm Hall as freshman at Notre Dame in May of 1989.  

I’m in conversation with Keppler Speakers to begin giving talks nationally at universities and colleges before the end of the year with the aim of reducing the U.S. suicide rate.  Here is a video of me practicing the first half of the talk I will be presenting at my alma mater in South Bend.

As far as I can tell, I am the only person on Earth who is leveraging the genius of Albert Einstein to transform humanity’s understanding of the human condition and “mental illness.” I believe that Einstein left humanity an unheralded prescription for peace that almost no one noticed:  acknowledge that human beings don’t possess free will.  If I am ever invited to speak on the TED Talk stage, I suspect it will be because I am committed to spreading the ideas that I outlined in this piece on Medium.

My writing about suicide prevention and mental health care reform has been published by The Good Men Project and Mad in America, thus far.  Christopher Lane (Guggenheim Fellow and author of Shyness: How Normal Behavior Became A Sickness) and I are wrapping up an interview piece entitled “Creating ‘Mental Illness’” that looks back at a critical event in mental health care history at the center of his book Shyness:  the third revision of the APA’s Diagnostic and Statistical Manual of Mental Disorders or DSM-III.  A work in progress excerpt of that piece is included below.

The attached resume doesn’t include my current consulting engagement.  I was hired to  turnaround a failed client reporting enhancement project at one of the top 10 wealth management firms in the U.S. based on fiduciary assets.  My engagement sponsor is the C-level fixed income officer of the firm responsible for managing a $27 Billion portfolio.

I’ve known Scott O’Neil, CEO of the Philadelphia 76ers, the New Jersey Devils and the Prudential Center coming up on thirty years now.  Scott is Michael’s older brother, by one year, who was at Villanova while we were at Notre Dame.  We met in 1989 when Scott was visiting Michael in South Bend to watch a Notre Dame football game.  I mention this fact because Scott is connected to Mairead Hanna on LinkedIn. I haven’t touched base with Scott about this yet. I was compelled to reach out to you cold first.

If you’re open to having a conversation with me to determine if it makes sense for us to seriously consider joining forces in some way to save lives and go after the triple aim in HIT together, please just let me know.  I would greatly appreciate the opportunity to speak with you.

Thanks a lot for your time and consideration.

Sincerely,
Francesco

Francesco Bellafante
American Foundation for Suicide Prevention Philadelphia Chapter Board Member
Zero Suicide Champion
Theory of Mind ~ leveraging the genius of Einstein to end suicide and to maximize well-being
iameinstein.com

Excerpt from:

Creating “Mental Illness”

By Christopher Lane and Francesco Bellafante

How does someone know if they have a mental illness?  How does their doctor know?  Psychiatrists don’t utilize blood tests or brain scans to diagnose their patients.  Instead, they necessarily rely on subjective observations about how their patients seem.  That, plus they listen to stories told by their patients, and others, in order to identify symptoms of mental disorders.  Given our relative ignorance about how the most complex object in the known universe functions, how does a psychiatrist know that a particular feeling, behavior or pattern of thinking and behaving is a symptom of mental illness?

The human brain is made up of about 86 billion neurons that interact in complex ways with one another and with other neurons throughout the central nervous system.  Absolutely no one can cogently explain how a human being’s neurons interact with the rest of its body and the world that body inhabits to give rise to subjective, conscious awareness of that world. Consciousness remains an enduring mystery.  Given these facts, how does anyone objectively draw a dividing line between mental wellness and mental illness?  What amount, degree, or kind of neurosis, psychosis or distress is a natural part of the human condition? How do we know when a person’s behavior or their psychological and emotional state is indicative of psychopathology?

What is mental illness?  Is it a disease like any other resulting from a defective or malfunctioning organ or system of the body?  Or is mental illness too often a phrase used to mistakenly pathologize and stigmatize the human condition itself?

Two influential books that shape humanity’s understanding of what it means to be mentally ill are ones that most people have never heard of let alone ever read. They are the International Classification of Diseases and the American Psychiatric Associations’ Diagnostic and Statistical Manual of Mental Disorders.  Hundreds of nuanced descriptions of different patterns of thinking, feeling and behaving define the bounds of what constitutes “mental illness” or “disorder” for billions of people.  While some question the inclusion of certain kinds of behavioral disorders within the pages of any catalogue of medical diseases, the stories told by psychiatrists citing the conditions defined in these nosologies are respected as scientifically-validated, unquestionable medical truths by many others, in large part thanks to billions of direct-to-consumer advertising dollars spent propagating this narrative.  Exceptionally effective professional storytelling tactics are employed by for profit enterprises marketing powerful mind altering substances to people experiencing anything from a lack of ease in life to paralyzing distress or despair.

I grant that attempting to assuage people’s distress and despair with psychopharmacological treatments may be well-intentioned, but evidence abounds that giving people powerful mind-altering drugs serves to increase people’s suffering in many cases.  In fact, some psych meds prescribed for mental disorders can cause death by inducing something called Neuroleptic Malignant Syndrome.  I was given an injection of Haldol once, without my consent, that could have induced this potentially fatal syndrome within me.  I am grateful I was not informed of the life-threatening nature of the “health care” I was receiving before I was involuntarily injected with a substance that could have killed me.  I share what I’ve learned about these books with the hope that more people will think more critically more often when they speak and write about “mental illness” and “mental disorders.”

The story behind how the ICD and the DSM came to include certain mental disorder descriptions is a fascinating one.  It was 1893 when the International Statistical Institute adopted the International List of Causes of Death.  By the end of 1949 the World Health Organization published the sixth edition of the International Classification of Diseases or ICD-6.  This version was the first to contain a section for mental disorders.  Three years later, in 1952, the American Psychiatric Association’s (APA) Committee on Nomenclature and Statistics published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).  As the APA’s DSM History page on its website explains, “It contained a glossary of descriptions of the diagnostic categories and was the first official manual of mental disorders to focus on clinical use. The use of the term ‘reaction’ throughout the DSM reflected the influence of Adolf Meyer’s psychobiological view that mental disorders represented reactions of the personality to psychological, social, and biological factors.”

(Source:  https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm)

Thirteen years later, in 1965, Sir Aubrey Lewis, a British psychiatrist responsible for the mental disorder section revisions of ICD-8 removed the word “reaction” from the mental disorder names.  This seemingly insignificant nominal change represented a seismic shift in defining mental illness. Christopher Lane from Northwestern University, a 2005 Guggenheim Fellow, wrote about this seminal event in Shyness:  How Normal Behavior Became a Sickness (Yale, 2007).

“The revisions to ICD-8 were bold, even cavalier, and had lasting consequences.  Consulting few outside experts, a situation unimaginable a generation later, the person appointed to update the manual quietly eliminated the term reaction from many diagnostic labels.  As a result, diagnoses like schizophrenic reaction, which in DSM-I had referred to sporadic psychiatric incidents, evolved almost overnight into schizophrenia, even if the person’s symptoms were rare or not especially violent.  The same was true for terms like paranoid reaction, which the DSM-II task force determined henceforth would be known simply as paranoia.  When I asked Robert Spitzer about these revisions, he confirmed my suspicions, ‘ICD-8 was written by one person, [Sir] Aubrey Lewis at the Maudsley [Institute of Psychiatry, London], and he didn’t have the word ‘reaction’ in the eighth edition, so DSM-II didn’t either. ‘No,’ Spitzer added, ‘there was no discussion at all’ on the  DSM-II task force about the viability or consequence of adopting these changes.  Turning phrases like ‘schizophrenic reaction’ into simple nouns (‘schizophrenia’) may seem insignificant.  But as Spitzer concedes, it was a ‘major shift’ in approach, because it altered at a stroke the very meaning of illness for clinicians and patients.

Robert Spitzer was a Professor of Psychiatry on the research faculty at Columbia University in New York City.  In 1974, he became the chair of the APA’s task force responsible for revising  DSM-III.  Spitzer played a major role in leading a faction of psychiatrists on the task force to significantly revise, and add to the number of disorders defined in the DSM-III, swelling the count of conditions contained in the growing catalogue by an eye-popping 46%.

Year          Edition            # of disorders             % growth

1952          DSM-I               106                                      n/a

1968          DSM-II             182                                      72%

1980          DSM-III           65                                        46%

It has been a decade since Lane penned his assiduously researched and insightful account about this transformation of the APA’s Diagnostic and Statistical Manual of Mental Disorders.  His penetrating explanation of how a small group of psychiatrists privately collaborated in the 1970s to revise the organizing document behind their profession is as amusing as it is unsettling.  The incredible but true tale Lane tells about how shyness came to be viewed as an illness is more akin to political farce than erudite debate about how to classify different types of mental disorders, ostensible or otherwise.  Lane gained unprecedented access to the APA’s archives, and found documents detailing disturbing facts about the lack of scientific rigor employed while revising the third edition of this influential document.  He frames this battle over this revision of psychiatry’s diagnostic bible as one driven by deeply-rooted internal conflicts within the field.  Neuropsychiatrists argued for the radical expansion of the diagnostic criteria into many different disorders with specific symptoms while their Freudian colleagues favored a psychodynamic approach with fewer, and more broadly defined categories that recognized the biological, psychological and environmental factors that coalesce into human distress and despair.  While neuropsychiatry clearly won this battle in the pages of DSM-III, Lane’s writing about the inner workings of Spitzer’s task force illuminate how a supposedly scientific process devolved into one guided more by individual personalities, professional agendas and profit potential.

Reflecting on the legacy of Robert Spitzer shortly after his passing in 2015, Lane wrote a post on his blog about a significant exchange between Spitzer and Isaac Marks, involving the inclusion of Panic Disorder in  DSM-III as a stand-alone illness.  Marks “the world-renowned expert on panic, fear and anxiety” was flatly against the inclusion of Panic Disorder as a separate illness.  From Lane’s blog post:

“Though committed to treating and understanding panic, Marks was steadfastly opposed to its being represented as a stand-alone disorder. He was similarly opposed to the formal identification of Social Phobia/Social Anxiety Disorder as a separate disorder, not least after seeing his own research on the subject (pointing to a different conclusion) cited as a reason for the change. The evidence that Social Phobia should be separated off had not been overwhelming and little had been published since that implied otherwise. But on both counts, Marks was overruled. ‘The consensus was arranged by leaving out the dissenters,’ he said to me ruefully, after Spitzer had told him in the men’s room at that key Boston conference that he ‘wasn’t going to win. Panic [disorder] is in. That’s it.’ ‘Never mind about the pros and cons intellectually,’ Marks continued, characterizing Spitzer’s apparently cavalier rejection of his expertise and objections. “Don’t confuse me with the data. It’s in.”

The Boston conference had been paid for by Upjohn Pharmaceuticals, maker of Xanax, a drug that became widely prescribed for Panic Disorder. As the CEO stood up to give his opening remarks, Marks recalled, he admitted quite openly: ‘There are three reasons why Upjohn is here taking an interest in these diagnoses. The first is money. The second is money. And the third is money.’ Despite concern that his research was being misused, to ends he could not support, Marks was, he said, ‘disinvited’ from subsequent discussions. Panic Disorder and Social Phobia/Social Anxiety Disorder weren’t just included in DSM-III, but, as he feared, given such low diagnostic thresholds (including, in 1987, public-speaking anxiety for SAD) that millions of American adults and children became eligible for a diagnosis, with Xanax, Paxil, and other medication among the most frequently prescribed treatments.

After the fact reflections of people involved in the DSM-III task force reinforce the notion that the conditions described by the disorder names defined within the pages of any version of the DSM are certainly unlike other diseases and illnesses that plague humankind in obvious and important ways.  “There was very little systematic research [involved], and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous. I think the majority of us recognized that the amount of good, solid science upon which we were making our decisions was pretty modest,” said a consultant on the revision task force.  Others involved commented that, “The poverty of thought that went into the decision-making was frightening… In some cases, the people revising DSM-III [were] making a mental illness out of adaptive behavior.”  In 1984, four years after DSM-III’s publication, psychiatrist George Valliant warned that the “disadvantages of DSM-III outweigh its advantages,” characterizing the revision as one that “represents a bold series of choices based on guess, taste, prejudice, and hope.”