Chapter 16. Psychopathology: Biological Basis of Behavior Disorders
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by Tom Siegfried SAN DIEGO — Society’s record for protecting public health has been pretty good in the developed world, not so much in developing countries. That disparity has long been recognized. But there’s another disparity in society’s approach to public health — the divide between attention to traditional diseases and the resources devoted to mental disorders. “When it comes to mental health, all countries are developing countries,” says Shekhar Saxena, director of the World Health Organization’s department of Mental Health and Substance Abuse. Despite a breadth of scope and depth of impact exceeding that of many more highly publicized diseases, mental illness has long been regarded as a second-class medical concern. And modern medicine’s success at diagnosing, treating and curing many other diseases has not been duplicated for major mental disorders. Saxena thinks that neuroscience research can help. He sees an opportunity for progress through increased interdisciplinary collaboration between neuroscience and mental health researchers. “The collaboration seems to be improving, but much more is needed and not only in a few countries, but all countries,” he said November 12 at the annual meeting of the Society for Neuroscience. |© Society for Science & the Public 2000 - 2016.
By Alice Klein How can you stop old anxieties from resurfacing? An injection of new neurons may help, a study in mice suggests. Post-traumatic stress disorder (PTSD), anxiety and other fear-related disorders are difficult to treat, and many people who seem to get better later relapse. A similar phenomenon occurs in rodents. Adult mice can be conditioned to fear a sound by giving them an electric shock every time they hear it. Playing the sound repeatedly without the shock gradually wipes out the fear – a process known as extinction training. However, the fear often returns spontaneously if the mouse hears the sound later on. Baby mice, on the other hand, do not seem to relapse as much. Yong-Chun Yu at Fudan University in China and his colleagues wanted to know if they could treat fearful adult mice with brain cells from mouse embryos. The transplants did not prevent the mice developing new fears, nor help them overcome existing ones – at least not by themselves. But coupled with extinction training, the embryonic cells did help wipe out existing fears and prevent the mice relapsing. First, the researchers injected live brain cells from mouse embryos into the amygdalae of adult mice – the parts of the brain involved in fear. Other mice were implanted with dead embryonic brain cells as a comparison. © Copyright Reed Business Information Ltd.
Maanvi Singh "I lost more than 80 percent of my university friends," recalls Jagannath Lamichhane. After silently struggling with depression for two decades, Lamichhane published an essay in Nepal Times about his mental illness. "I could have hid my problem — like millions of people around the world," he says, but "if we hide our mental health, it may remain a problem forever." Many of his friends and family didn't agree with that logic. In Nepal — as in most parts of the world — there's quite a lot of stigma around mental illness. That was eight years ago. Now 35-year-old Lamichhane is a mental health advocate, working to challenge the stigma around depression. "People believe that depression is the result of personal weaknesses and the result of bad karma in a past life," he says. Even worse, they don't believe they can be helped, he says — so they don't seek treatment. The problem isn't unique to Lamichhane's community. An estimated 350 million people are affected by depression, and the vast majority of them don't get treatment for their condition either due to stigma or a lack of knowledge, according to a study of more than 50,000 people in 21 countries. The study was led by Graham Thornicroft, a professor of psychiatry at King's College London. He and his team of researchers from King's College London, Harvard Medical School and the World Health Organization found that in the poorest countries, one in 27 people with depression received minimally adequate care for their condition. Even in the richest countries, only one in five people with depression sought care. The data was published Thursday in The British Journal of Psychiatry. © 2016 npr
Link ID: 22945 - Posted: 12.03.2016
Sarah Boseley Health editor A single dose of psilocybin, the active ingredient of magic mushrooms, can lift the anxiety and depression experienced by people with advanced cancer for six months or even longer, two new studies show. Researchers involved in the two trials in the United States say the results are remarkable. The volunteers had “profoundly meaningful and spiritual experiences” which made most of them rethink life and death, ended their despair and brought about lasting improvement in the quality of their lives. The results of the research are published in the Journal of Psychopharmacology together with no less than ten commentaries from leading scientists in the fields of psychiatry and palliative care, who all back further research. While the effects of magic mushrooms have been of interest to psychiatry since the 1950s, the classification of all psychedelics in the US as schedule 1 drugs in the 1970s, in the wake of the Vietnam war and the rise of recreational drug use in the hippy counter-culture, has erected daunting legal and financial obstacles to running trials. “I think it is a big deal both in terms of the findings and in terms of the history and what it represents. It was part of psychiatry and vanished and now it’s been brought back,” said Dr Stephen Ross, director of addiction psychiatry at NYU Langone Medical Center and lead investigator of the study that was based there. © 2016 Guardian News and Media Limited
By DAVE PHILIPPS CHARLESTON, S.C. — After three tours in Iraq and Afghanistan, C. J. Hardin wound up hiding from the world in a backwoods cabin in North Carolina. Divorced, alcoholic and at times suicidal, he had tried almost all the accepted treatments for post-traumatic stress disorder: psychotherapy, group therapy and nearly a dozen different medications. “Nothing worked for me, so I put aside the idea that I could get better,” said Mr. Hardin, 37. “I just pretty much became a hermit in my cabin and never went out.” Then, in 2013, he joined a small drug trial testing whether PTSD could be treated with MDMA, the illegal party drug better known as Ecstasy. “It changed my life,” he said in a recent interview in the bright, airy living room of the suburban ranch house here, where he now lives while going to college and working as an airplane mechanic. “It allowed me to see my trauma without fear or hesitation and finally process things and move forward.” Based on promising results like Mr. Hardin’s, the Food and Drug Administration gave permission Tuesday for large-scale, Phase 3 clinical trials of the drug — a final step before the possible approval of Ecstasy as a prescription drug. If successful, the trials could turn an illicit street substance into a potent treatment for PTSD. Through a spokeswoman, the F.D.A. declined to comment, citing regulations that prohibit disclosing information about drugs that are being developed. © 2016 The New York Times Company
By Louisa J. Steinberg “You've got to be kidding me, Doc. I can barely keep my eyes open as it is, and you want me to pull an all-nighter?” I smiled. “Yes, exactly that. Maybe even two or three.” It started out benignly enough. Jodi (not the patient's real name) had been feeling more stressed between meeting the growing demands of her high-stakes job in business management and shouldering more chores while her husband was away on business trips. Strapped for time, she started neglecting her usual self-care routines—eating healthy, exercising, taking time to relax. Not surprisingly, her mood was poor. Things soon grew worse. She no longer enjoyed activities that were usually the highlight of her day: story time with her children, chatting on the phone with her mom, reading a book. Although she was constantly exhausted, she could not get a good night's sleep; she would toss and turn and still feel tired even when she slept in. Her performance at work had also been suffering; she began missing days because she just couldn't get out of bed. Jodi knows she should have recognized these warning signs sooner. She had experienced major depression twice before, once in college and again in her late 20s after a breakup. Now in her late 30s, she had been off antidepressants for years. Yet she found herself back in that dark place, barely eating and unable to concentrate enough to read even a short paragraph. Her thoughts circled around the same unpleasant memories and nagging fears. She felt hopeless and guilty. © 2016 Scientific American
By Nicole Ireland, CBC News Ten years ago, litigation lawyer Michele Hollins was a "perpetually happy person," with twin daughters and a partnership in her Calgary law firm. Then, depression struck. For a while, Hollins was able to hide her illness at work, then go home and "become a complete automaton," she says, unable to eat or even muster the energy to get ready for bed. At its worst, the depression crippled her at work, to the point where Hollins would walk into her office, say hello to her assistant and then "close the door and lay on the floor and cry for hours." At her lowest point, she says she would "spend most of the day trying to figure out how to collect myself enough to get to my car and get home." That raw vulnerability doesn't match the general impression society has of lawyers as tough and ambitious. But research suggests that they are at much higher risk of depression, anxiety and substance abuse issues than people in the broader population — and may even be more susceptible than those in other high-stress professions, such as medicine. A U.S. study published in the Journal of Addiction Medicine last February found the rate of problem drinking among lawyers was between two and three times higher than among other highly educated professionals, including physicians. The study was funded by the American Bar Association and the Hazelden Betty Ford Foundation. The rate of depression was about three times higher than the general population in the U.S., according to lead researcher Patrick Krill, who will be presenting his research to lawyers and law students in Toronto on Monday at a professional development session hosted by the Law Society of Upper Canada. ©2016 CBC/Radio-Canada.
By Darryl Hol, Every year, thousands of Canadians sign up to participate in clinical trials, offering their bodies to further the development of important medical advances like new drugs or devices. But the results of many of those trials never see the light of day. A new online tool aims to put pressure on some of the companies and institutions behind the problem. TrialsTracker maintains a list of all the trials registered on the world's leading clinical trials database and tracks how many of them are updated with results. Amid pharmaceutical companies and research bodies from around the world on ClinicalTrials.gov, maintained by the U.S. National Institutes of Health, nine Canadian universities and institutions rank in the top 100 organizations with the greatest proportion of registered trials without results. "It's well documented that academic trialists routinely fail to share results," says Ben Goldacre, who was part of the team from the University of Oxford that developed TrialsTracker. "Often they think, misguidedly, that a 'negative' result is uninteresting — when, in fact, it is extremely useful." The University of Toronto's David Henry says "publication bias," as it's called, is robbing the medical community and patients of important information. "We've been deceived about the truth about treatments that we've used widely over a long period, in very large numbers of individuals, because of the selective publication of results that are favourable to the product," says Henry, a professor of health systems data at U of T's Institute for Health Policy Management and Evaluation. ©2016 CBC/Radio-Canada.
Link ID: 22907 - Posted: 11.25.2016
Shane Fistell When I was 17, my father took me to a juvenile treatment clinic to see if doctors could figure out what was wrong with me. I entered a room. I sat on a chair. I waited for a long while. There was a video camera trained on me. Then I heard voices, the voices of doctors behind a two-way mirror. It was like being in a police interrogation room in the movies. A voice boomed: “So Shane, why do you think you’re acting this way? Do you know what you’re doing?” I didn’t know what to say. What were the right answers? I was born with a neurological disorder that causes involuntary movements, vocalizations and tics — sometimes mild, sometimes wildly disruptive: Tourette’s syndrome. Since my youth, I’ve often been stopped in public by the police and questioned because of my symptoms. Questioned: That sums it up in a single word. My whole life has been questioned. I’m 56 now. I’ve often led a life of self-imposed house arrest. Two months here, three months there. Summer gone, winter over. How many years have I wasted? If people know of Tourette’s, they will often say: “Oh, that’s that swearing disease!” A woman once said to me: ”At least you don’t swear! You would’ve been worse off!” Compulsive swearing is called coprolalia. Each person with Tourette’s is different, and only some swear compulsively. I don’t; but for most of my life I have had to put up with people swearing and cursing at me because of my symptoms. A few years ago a man argued: “There’s no way you have Tourette’s! If you don’t swear you don’t have it! Period. And I know you don’t have it because I’ve seen it on TV!” © 2016 The New York Times Company
Link ID: 22901 - Posted: 11.23.2016
By GRETCHEN REYNOLDS Exercise may be an effective treatment for depression and might even help prevent us from becoming depressed in the first place, according to three timely new studies. The studies pool outcomes from past research involving more than a million men and women and, taken together, strongly suggest that regular exercise alters our bodies and brains in ways that make us resistant to despair. Scientists have long questioned whether and how physical activity affects mental health. While we know that exercise alters the body, how physical activity affects moods and emotions is less well understood. Past studies have sometimes muddied rather than clarified the body and mind connections. Some randomized controlled trials have found that exercise programs, often involving walking, ease symptoms in people with major depression. But many of these studies have been relatively small in scale or had other scientific deficiencies. A major 2013 review of studies related to exercise and depression concluded that, based on the evidence then available, it was impossible to say whether exercise improved the condition. Other past reviews similarly have questioned whether the evidence was strong enough to say that exercise could stave off depression. A group of global public-health researchers, however, suspected that newer studies and a more rigorous review of the statistical evidence might bolster the case for exercise as a treatment of and block against depression. So for the new analyses, they first gathered all of the most recent and best-designed studies about depression and exercise. © 2016 The New York Times Company
Link ID: 22874 - Posted: 11.16.2016
By Arlene Karidis As a young teenager, Inshirah Aleem was sure she’d be heading to Harvard Law School in a few years. But the straight-A student went down another road. Within months of her 14th birthday, the quiet girl was telling outrageous lies, running away from home and stealing. She eventually landed in front of a judge and later was sent to foster care, where she lived in a basement, her belongings stuffed into a trash bag. It would be a year before Aleem, now a 38-year-old schoolteacher living in Greenbelt, was diagnosed with bipolar disorder. The brain condition is characterized by high (manic) moods and low (depressed) moods as well as by fluctuating energy levels. These unstable states are coupled with impaired judgment. The diagnosis explained her racing, disjointed thoughts and almost completely sleepless nights. And it explained her terrifying hallucinations, which were followed by a catatonic state where Aleem couldn’t move or talk. About 2.6 percent of adults and about 11.2 percent of 13- to-18-year-olds have bipolar disorder, according to the Substance Abuse and Mental Health Services Administration. The disorder can be hard to recognize and harder to treat. Combining medications often brings substantial improvement, but some patients experience side effects and show minimal improvement. Researchers, who have found that bipolar disorder is inherited more than 70 percent of the time, hope to identify drugs to target the 20 genetic variations known to be associated with the disorder. © 1996-2016 The Washington Post
Link ID: 22864 - Posted: 11.14.2016
By Esther Crawley We know almost nothing about chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME). And yet it causes misery and suffering for hundreds of thousands of people, including many children. One in a hundred teenagers in the UK miss a day a week or more of school because of it, and 2 per cent are probably missing out on the normal stuff that teenagers do. Those I see in my clinic are sick with disabling fatigue, memory and concentration problems, and terrible pain. On average, they miss a year of school, on top of which mothers give up work and siblings suffer. Yet progress on this illness is being hampered by controversy, with some people disputing both its cause and treatment. Some still dismiss it as a non-illness; others decry attempts to treat it with psychological therapy. The result is that few patients are offered treatment and there is almost no research on the condition. This illness is more common than leukaemia and more disabling than childhood arthritis, but few specialists treat it. How have we arrived at a position where the biggest reason for teenagers to miss school long-term is rarely studied and society allows so few to receive treatment? Part of the difficulty is that CFS/ME is not a single illness. Both children and adults have different clusters of symptoms that may represent different illnesses with different biology, requiring different treatments. This may explain why treatments only work for some – and is a problem for those trying to develop them and for people who don’t get better. © Copyright Reed Business Information Ltd.
Sarah Boseley Health editor Hundreds of children and young people are to get treatment for chronic fatigue syndrome for the first time, to see whether methods that have proved highly successful in the Netherlands can be adopted by the NHS. Up to 2% of young people are affected by CFS, also known as myalgic encephalopathy (ME). But few get any treatment, and attempts to help have sometimes stoked the row over the causes of the condition. Activists on social media frequently denounce doctors who suggest that psychological issues play any part in the disease. Treatment given to young people in the Netherlands has had remarkable results, helping 63% recover within six months and return to school and a normal life, compared with 8% of those who had other care. The children are given cognitive behavioural therapy to understand and overcome the debilitating exhaustion that neither sleep nor rest can help. The sessions are conducted with a therapist over the internet, using Skype, diaries and questionnaires. This means children will be able to get treatment in their own homes in parts of the country where there is nothing currently available to them. Esther Crawley, a professor of child health at Bristol University, said she would argue that the trial she is leading is not controversial. “Paediatric CFS/ME is really important and common,” she said. “One per cent of children at secondary school are missing a day a week because of CFS/ME. Probably 2% of children are affected. They are teenagers who can’t do the things teenagers are doing.” © 2016 Guardian News and Media Limited
Link ID: 22824 - Posted: 11.03.2016
Mo Costandi Stem cells obtained from patients with schizophrenia carry a genetic mutation that alters the ratio of the different type of nerve cells they produce, according to a new study by researchers in Japan. The findings, published today in the journal Translational Psychiatry, suggest that abnormal neural differentiation may contribute to the disease, such that fewer neurons and more non-neuronal cells are generated during the earliest stages of brain development. Schizophrenia is a debilitating mental illness that affects about 1 in 100 people. It is known to be highly heritable, but is genetically complex: so far, researchers have identified over 100 rare genetic variations and dozens of mutations associated with increased risk of developing the disease. One of the best characterised mutations associated with the disease is a microdeletion on chromosome 22, within a region containing dozens of genes known to be involved in the development, maturation, and function of brain circuits. This deletion is found in 1 in every 2,000 – 4,000 live births; all patients carrying it exhibit various psychiatric symptoms and conditions, with just under a third of them developing schizophrenia in adolescence or early adulthood. Manabu Toyoshima of the RIKEN Brain Science Institute and his colleagues obtained skin cells from two female schizophrenic patients diagnosed with the chromosome 22 deletion and two healthy individuals, then reprogrammed them to generate induced pluripotent stem cells (iPSCs), unspecialised cells which, like embryonic stem cells, retain the ability to differentiate into all the different cell types in the body. They then compared the properties of iPSCs obtained from the schizophrenic patients with those from the healthy controls. © 2016 Guardian News and Media Limited
Link ID: 22822 - Posted: 11.02.2016
Emily Sohn After a mother killed her four young children and then herself last month in rural China, onlookers quickly pointed to life circumstances. The family lived in extreme poverty, and bloggers speculated that her inability to escape adversity pushed her over the edge. Can poverty really cause mental illness? It's a complex question that is fairly new to science. Despite high rates of both poverty and mental disorders around the world, researchers only started probing the possible links about 25 years ago. Since then, evidence has piled up to make the case that, at the very least, there is a connection. People who live in poverty appear to be at higher risk for mental illnesses. They also report lower levels of happiness. That seems to be true all over the globe. In a 2010 review of 115 studies that spanned 33 countries across the developed and developing worlds, nearly 80 percent of the studies showed that poverty comes with higher rates of mental illness. Among people living in poverty, those studies also found, mental illnesses were more severe, lasted longer and had worse outcomes. And there's growing evidence that levels of depression are higher in poorer countries than in wealthier ones. Those kinds of findings challenge a long-held myth of the "poor but happy African sitting under a palm tree," says Johannes Haushofer, an economist and neurobiologist who studies interactions between poverty and mental health at Princeton University. © 2016 npr
By David Tuller After living in Oklahoma for 40 years, Nita and Doug Thatcher retired in 2009 to the Rust Belt city of Lorain, Ohio, a Cleveland suburb that hugs Lake Erie. When Nita needed to find a new primary care doctor, a friend recommended someone from the Cleveland Clinic. Nita knew the institution’s reputation for cutting-edge research and superior medical services. But as a longtime patient grappling with chronic fatigue syndrome, a debilitating disorder that scientists still don’t fully understand, she was wary when she learned that the clinic was promoting a common but potentially dangerous treatment for the illness: a steady increase in activity known as graded exercise therapy. The notion that people with chronic fatigue syndrome should be able to exercise their way back to health has enjoyed longstanding and widespread support, and “graded exercise” has become the de facto standard of clinical care. This approach has obvious intuitive appeal. Exercise helps all kinds of illnesses, and it’s a great tool for boosting energy. How could it possibly hurt? British psychiatrists and psychologists developed the graded exercise strategy for treating chronic fatigue syndrome during the 1990s. They offered a straightforward rationale: These patients were not medically sick but severely out of shape (“deconditioned”) from prolonged avoidance of activity. And they avoided activity because they wrongly believed they had a biological disease that would get worse if they overexerted themselves. During treatment, patients were encouraged to question this “dysfunctional cognition,” view any resurgent symptoms as transient, and push through the exhaustion and pain to rebuild their strength. Copyright 2016 Undark
Link ID: 22805 - Posted: 10.29.2016
Alison Abbott Psychiatrist Joshua Gordon wants to use mathematics to improve understanding of the brain. The US National Institute of Mental Health (NIMH) has a new director. On 12 September, psychiatrist Joshua Gordon took the reins at the institute, which has a budget of US$1.5 billion. He previously researched how genes predispose people to psychiatric illnesses by acting on neural circuits, at Columbia University in New York. His predecessor, Thomas Insel, left the NIMH to join Verily Life Sciences, a start-up owned by Google’s parent company Alphabet, in 2015. Gordon says that his priorities at the NIMH will include “low-hanging clinical fruit, neural circuits and mathematics — lots of mathematics", and explains to Nature exactly what that means. What do you plan to achieve in your first year in office? I won’t be doing anything radical. I am just going to listen to and learn from all the stakeholders — the scientific community, the public, consumer advocacy groups and other government offices. But I can say two general things. In the past twenty years, my two predecessors, Steve Hyman [now director of the Stanley Center for Psychiatric Research at the Broad Institute in Cambridge, Massachusetts] and Tom Insel, embedded into the NIMH the idea that psychiatric disorders are disorders of the brain, and to make progress in treating them we really have to understand the brain. I will absolutely continue this legacy. This does not mean we are ignoring the important roles of the environment and social interactions in mental health — we know they have a fundamental impact. But that impact is on the brain. Second, I will be thinking about how NIMH research can be structured to give pay-outs in the short-, medium- and long-terms. © 2016 Macmillan Publishers Limited,
Link ID: 22794 - Posted: 10.27.2016
By NICHOLAS BAKALAR Extremely high or low resting heart rates in young men may predict psychiatric illness later in life, a large new study has found. Researchers used heart rate and blood pressure data gathered at Swedish military inductions from 1969 to 2010, and linked them with information from the country’s detailed health records through the end of 2013. The study, in JAMA Psychiatry, included 1,794,361 men whose average age was 18 at induction. The highest heart rates — above 82 beats a minute — were associated with increased risks of obsessive-compulsive disorder, anxiety disorder and schizophrenia. The lowest, below 62 beats, were associated with an increased risk of substance abuse and violent criminality. Extremes in blood pressure followed similar patterns, but the associations were not as strong. The lead author, Antti Latvala, a researcher at the University of Helsinki, said that the reasons for the association remain unknown. But, he added, “These measures are indicators of slightly different reactivity to stimuli. These people might have elevated heart rates because of an elevated stress level that is then predictive of these disorders.” Still, Dr. Latvala said, a high or low heart rate does not mean future psychiatric disease. “These are very complex illnesses,” he said. “People with high or low heart rate have nothing to worry about because of these findings. This is just a tiny piece of the puzzle.” © 2016 The New York Times Company
By Tori Rodriguez Uric acid is almost always mentioned in the context of gout, an inflammatory type of arthritis that results from excessive uric acid in the blood. It may be surprising, then, that it has also been linked with a vastly different type of disease: bipolar disorder. Elevated uric acid has been observed in patients with acute mania, and reducing uric acid improves symptoms. New evidence supports its potential as a treatment target. Uric acid is a by-product of the breakdown of compounds called purines, found in many foods and manufactured by the body. High levels of uric acid can indicate that these compounds, such as the neurotransmitter adenosine, are being broken down too readily in the body. “Adenosine might play a key role in neurotransmission and neuromodulation, having sedative, anticonvulsant and antiaggressive effects,” says physician Francesco Bartoli, a researcher at the University of Milano-Bicocca in Italy. Bartoli's new study, published in May in the Journal of Psychosomatic Research, examined uric acid levels in 176 patients with bipolar disorder or another severe mental illness and 89 healthy controls. The results show that bipolar disorder was the only diagnosis significantly linked with levels of uric acid. Excess uric acid was found to be linked to male gender, metabolic syndrome, waist size and triglyceride levels. Beyond the too rapid breakdown of adenosine, other potential explanations for increased uric acid include the metabolic abnormalities often present in people with bipolar disorder and frequent consumption of purine-rich foods and drinks, such as liver, legumes, anchovies and alcohol. Fructose consumption can also be a problem because the sugar inhibits uric acid excretion. Dietary interventions may reduce levels, but medication is typically required if dietary changes are insufficient. © 2016 Scientific American
Link ID: 22790 - Posted: 10.26.2016
Andrew Solomon A new virtual-reality attraction planned for Knott’s Berry Farm in Buena Park, Calif., was announced last month in advance of the peak haunted-house season. The name, “Fear VR 5150,” was significant. The number 5150 is the California psychiatric involuntary commitment code, used for a mentally ill person who is deemed a danger to himself or others. Upon arrival in an ersatz “psychiatric hospital exam room,” VR 5150 visitors would be strapped into a wheelchair and fitted with headphones. “The VR headset puts you in the middle of the action inside the hospital,” an article in The Orange County Register explained. “One patient seems agitated and attempts to get up from a bed. Security officers try to subdue him. A nurse gives you a shot (which you will feel), knocking you out. When you wake up in the next scene, all hell has broken loose. Look left, right and down, bloody bodies lie on the floor. You hear people whimpering in pain.” Knott’s Berry Farm is operated by Ohio-based Cedar Fair Entertainment Company, and Fear VR 5150 was to be featured at two other Cedar Fair parks as well. Almost simultaneously, two similar attractions were started at Six Flags. A news release for one explained: “Our new haunted house brings you face-to-face with the world’s worst psychiatric patients. Traverse the haunted hallways of Dark Oaks Asylum and try not to bump into any of the grunting inmates around every turn. Maniacal inmates yell out from their bloodstained rooms and deranged guards wander the corridors in search of those who have escaped.” The Orange County branch of the National Alliance on Mental Illness (NAMI) sprang into action, and Doris Schwartz, a Westchester, N.Y.-based mental-health professional, immediately emailed a roster of 130 grass-roots activists, including me, many of whom flooded Cedar Fair and Six Flags with phone calls, petitions and emails. After some heated back-and-forth, Fear VR 5150 was shelved, and Six Flags changed the mental patients in its maze into zombies. © 2016 The New York Times Company