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.”

An open letter to President Obama about suicide prevention | frank talk about mental health | episode 9

November 14th, 2016

Dear President Obama,

Beau Biden was my captain on the tennis team in high school, and Hunter and I nearly won a football state championship together back in 1988.  As a self-declared brother of their father, you are undeniably an honorary member of our extended Archmere family.

I remember the moment during the early morning hours of August 23rd back in 2008 when I got the text message announcing that Joe Biden was your running mate, and I will never forget the moment later that year when you were elected president.  It was that night that I committed myself to getting into a position to leverage my personal connection with Vice President Biden, before you both left office, to the benefit of an important but underserved cause in this country:  suicide prevention.

My namesake and paternal grandfather died in a mysterious explosion at the factory where he worked two days after Christmas in 1951.  Within a year my fourteen year old father-to-be was working two jobs, and giving $40 a month (about $350 in 2016) to his mother to help support her and his two younger sisters.  He joined the Army after graduating from high school where he learned how to be a land surveyor.  After returning from his tour in Europe, he met my mother-to-be, bought a small land surveying firm in Delaware, and started a family.  My father ran the business while my mother ran just about everything else at home.  My parents, two high school graduates, paid for every penny of their four children’s education, which included private grade schools, the same private high school attended by the Bidens, and the colleges of our choice.  Good luck, hard work and love have made the story of Judy and Franco Bellafante an unequivocal example of the American Dream.

I enrolled at the University of Notre Dame in the fall of 1989.  Archmere and AP tests gave me a 30 credit head start, and I earned a Bachelor of Arts in just three and a half years, graduating Magna Cum Laude with a Phi Beta Kappa Honor Society induction to boot.  Mr. Tom Brokaw closed his commencement address to the class of ‘93 in South Bend like this, “It’s easy to make a buck; it’s harder to make a difference.  We need your help.  Go Irish!”  Four years later I became the youngest Principal out of 350 staff at a financial IT consulting firm located a couple of blocks from Wall Street.  I was 26 years old, and my bill rate was $250 an hour.  I won’t deny that I worked hard, but Mr. Brokaw was right.  The advantages afforded me had made it easy for me to become someone who billed in excess of half a million dollars a year in consulting fees.  Back then being successful at my job was paramount to me, while “making a difference” had been temporarily relegated to a distant backburner.

Less than a year later and a few weeks before being accepted into UCLA’s Anderson School of Management, a foreman at a warehouse arriving for work in Secaucus found me clinging to life inside of a running rental car that I’d turned into a makeshift carbon monoxide gas chamber the night before.  I had a near death experience in the ambulance on the way to the hospital, and I woke up a couple of days later in the ICU.  Suffice it to say that my suicidal crisis stemmed from an unshakeable belief that I had become unable to live up to expectations I had for myself as a result of being the beneficiary of so many advantages and so much privilege.  Countless hours of introspection and study over the ensuing years have made me a “lived experience expert” regarding how some young people, with no prior trauma and with many apparent advantages, feel so self-loathing and so hopeless that they become suicidal.

In April of 2015 I left my day job in IT to work full-time in suicide prevention and mental healthcare advocacy.  I became a volunteer in the speakers bureau of the Greater Philadelphia Chapter of the American Foundation for Suicide Prevention.  I began to share some of the lessons I’ve learned since my suicidal crisis by giving talks at Philadelphia area schools and businesses aimed at lowering the suicide rate and reducing the stigma surrounding mental illness.

In June of this past summer, I was on Capitol Hill with hundreds of volunteers from the AFSP advocating for more federal funding for suicide prevention.  Thanks to Hunter and an assistant of the Vice President, I was poised to introduce the executive leadership of the AFSP to the Vice President and his policy staff when the mass shooting in Orlando derailed our plans to meet.  

You are taking questions from the press for the first time since the election as I write this message to you, and I’m compelled to share the following as if I was at the presser and you had just called on me.

Based on 2014 CDC statistics, about 58 Americans die from self-inflicted gunshot wounds every single day—a death toll nine lives greater than the deadliest mass shooting in U.S. history.  Annually that’s 21,334 lives lost to suicide via a firearm.  Comparatively just half as many Americans died by homicide via a firearm in that year, and only 18 Americans died in mass shootings in all of 2014 according to Mother Jones reporting. Imagine that at 12:00 noon tomorrow, 58 Americans simultaneously die by suicide via a firearm.  Imagine that twenty four hours later it happens again—58 simultaneous suicides via a firearm occur at 12:00 noon. Twenty four hours later it happens yet again.  

Am I right to assume that if this slight and absurd modification to the details surrounding the daily tragedy of firearm inflicted suicide occurred in reality, that you would be compelled to say and do things to try to prevent suicide that you have yet to say or do?

If so, why not consider adding more achievements to your team’s list of accomplishments in suicide prevention before leaving office?

There is still time for you to try to change what this picture looks like in order to bend the rising U.S. suicide rate curve.

research-chart

You are an elocutionary potentate and a transformational leader of humanity.  I imagine that you have inspired millions of Earthlings to serve the public’s interest in ways that they might not have without your influence.  I am grateful to include myself in this group.  Your vision for the future of this country inspired me to do the hard work to try to make a difference for others by being the change that I wish to see in this world.

With the election behind us, I’m happy to report that I am in the process of rescheduling the meeting between the AFSP executive leadership and Vice President Biden.  I will be sure to share the time of that appointment with you and your staff once it’s scheduled just in case you might be available to join us.

Thank you for all that you have done to prevent suicide and to improve mental health care in this country.  Thank you for being a constant reminder of the positive difference that someone can make in the lives of others.

Sincerely,

Francesco Bellafante
American Foundation for Suicide Prevention, Greater Philadelphia Chapter Board of Directors
Zero Suicide Champion
frank talk about mental health ~ leveraging the genius of Einstein to stop suicide and to maximize well-being
iameinstein.com

Suicide attempt reason reveal 18 1/2 years later | frank talk about suicide | episode 7 preview

I was named after my paternal grandfather who died in a mysterious explosion at the fireworks factory where he worked two days after Christmas in 1951. My father to be was 13 years old. Within a year, he was earning $15 a week to help support his mother and two younger sisters delivering newspapers and working in a drugstore as a stock boy and soda jerk.

He was bringing home $400 a month, in today’s dollars, to help support his family.

He was 14 years old.

Music:

Father
by Estes Shane Whalen