Guest Commentary

By: Guest Bloggers

Opinions, observations and ideas by occasional contributors to

Psychiatry to the rescue? Maybe.

Dec 19, 2012

We’ll never know what better psychiatric care could’ve prevented at Sandy Hook Elementary – especially if we aren’t willing to invest in it.

By Dr. Scott Bienenfeld, M.D.

The recent events in Newtown, Conn., are shocking, horrific, difficult to come to terms with and unfortunately becoming familiar. While mass shootings remain extremely rare events – lightning strikes, really – the magnitude of their impact on society is huge, both physically and mentally, especially when the details of the event are so gruesome as to include the death of helpless, innocent children and the families that have lost so much.

Newtown, Conn.In addition to the mass-trauma that the world is experiencing, there is also a massive public dialogue taking place. From anonymous tweets all the way up to executive levels of government, questions are arising as to what can be done. The most common and logical questions in the wake of an event like Newtown are: ‘Why did this happen?’ and ‘How can we prevent it from happening again?’ The answers we hear in the media always seem to be the same: gun control, prevention through improved mental health care and better security. 

As a practicing psychiatrist, the problem of lone-gunman mass-killings is particularly vexing. To put it bluntly: the world understandably looks to me and my field for answers and, to be brutally honest, I struggle to find them. We psychiatrists are taught early on that we have a legal responsibility to assess risk and then to both warn and protect identifiable targets of patients we believe are at high risk for acting violently. Failure to do so can result in claims of medical malpractice.

That said, it is tempting in hindsight to look at the little we already know about Adam Lanza and say that it’s obvious that this troubled young man should have been under more intensive psychiatric care and that someone should have been worried to the point of alarm that he was imminently going to slaughter innocent children.

Unfortunately, the truth is that we know very little about why those who commit mass killings do it, even when there is evidence of mental illness. For every Adam Lanza with the psychiatric profile he had, there are thousands with the same profile who never act out violently, even among the severely mentally ill. That fact, combined with the extreme rarity of events like what happened in Newtown, make it especially difficult for psychiatrists to predict the type of person that is likely to commit such horrible acts. The bottom line is: There are many “troubled” people in the world and most are not violent.

However, just because we as psychiatrists are limited if not unable to reliably predict who among our potentially dangerous patients will go on to commit mass-murder, we are relatively good at evaluating, diagnosing and treating people with mental illness. This is an important point because while mental illness on its own is by no means a meaningful predictor of violence, allowing people better access to ongoing mental health and addiction treatment, with an emphasis on mental illness as a chronic, public health crisis, could reduce the chance that the next Adam Lanza goes on to kill.  

Regarding the relationship between mental illness and violence, here is the little we do know: According to the 2011 article “Explaining Rare Acts of Violence” by Dr. Jeffrey W. Swanson, Ph.D., in the journal Psychiatric Services,“The ‘absolute risk’ message is that the vast majority of people with mental illness in the community are not violent. The ‘relative risk’ message is that people with serious mental illness are, indeed, somewhat more likely to commit violent acts than people who are not mentally ill. And the ‘attributable risk’ message is that violence is a societal problem caused largely by other things besides mental illness (ready availability of guns, for example).”

Untreated and under-treated mental illness continues to be one of, if not the biggest public health problems we face, yet the costs of the problem show up far more often as lost employment dollars (in the billions), broken families, chronic medical illnesses, addiction etc… rather than, as many people erroneously assume, as mass killings. But mass killings do occur, and the perpetrators are usually males with a history of being “troubled” if not suffering with diagnosed mental illness.

Dr. Scott Bienenfeld, M.D. is an Addiction Psychiatrist board certified in General and Forensic Psychiatry and certified by the American Society of Addiction Medicine as well as The American Board of Addiction Medicine. 

Bienenfeld serves as the medical director at the New York Center for Living. He maintains a private practice in Manhattan and has previously held positions as clinical director of the Community Orientation and Re-Entry Program (CORP) Unit at Sing-Sing Correctional Facility and consulting psychiatrist to the student counseling center at Pace University in New York.


The two sides of life and death

Apr 25, 2012

Renew reader Trish DiMaggio Zander, in her sixth year of recovery, says she felt inspired to channel her feelings of past addiction into a poem after feeling moved by a piece of art — the painting “Letting Go” by Richard Grieco.

From the painting, and from Grieco himself, DiMaggio Zander says she finally felt encouraged to write about her experiences through poetry. Here is her piece, The two sides of life and death.

The two sides of life and death

By Trish DiMaggio Zanger

I woke up one morning sad and confused
My soul had been beaten and battered and bruised
I went to the mirror and I saw your face
You screamed back at me "You're a pathetic disgrace"
You told me that I no longer had a choice
With my head in my hands I relinquished my voice

Time went by slowly, year after year
Consumed with my pain and ruled by my fear
Somehow I managed to walk through the door
Screamed out please help, I can’t take any more

They told me the truth and revealed your lie
They said please come back, we don't want you to die
They looked in my eyes and said I had worth
They told me I did have a place on this earth

You thought you could win; you thought you were clever
You made me believe you would own me forever
You now have been conquered, admit your defeat
Kindness and Love have got you beat

I woke up today and saw clear blue skies
Where I once used to look and see my demise
Now here we stand in our final hour
Take a good look - now I own the power

I'm done with this trip and through with this ride
The fact is, this story has more than one side
I will never allow you take my last breath

Because I've now seen the two sides of life and death

Image courtesy stock.xchng.

Finding Foundation in Yoga and Recovery

Apr 09, 2012
By Kristen Black

I recently completed my 200 yoga teacher training. I didn’t quite know what I was getting into! What surprised me the most were the many parallels between yoga and recovery. Many times I felt like the teachers were talking like we do in AA.

Like recovery, yoga is a journey, not a destination. You do not get to a point where you have learned all you need to learn and graduate. You will have good and bad days; you may seek help from a teacher that has gone on before you, much like we seek help from our sponsors. There are some days I can’t hold a basic pose for the life of me and other days I am rocking in a crazy pose I have never been able to do before. In AA, I am not always perfect, or in a good place or not on the “beam,” as they say. Then there are the days I am skipping in the Sunlight of the Spirit! 


Photo courtesy of stock.xchng.

Foundation is important in AA and yoga.  On page 75 of the Big Book it talks about foundation. After we complete the 5thStep we return home to be quiet and reflect: Is our work solid so far? Are the stones properly in place? Have we skimped on the cement put into the foundation? In yoga, teachers talk a lot about the foundation of poses, rooting down to the earth, your feet strong and solid; you don’t have a pose if the foundation isn’t strong. AA is the foundation for my life much like I have a foundation for my yoga practice.

When I get on my mat, I am on my mat. I am in the moment, focused on the present and the practice.  The same thing happens when I sit down across from another alcoholic. I can be so self-absorbed on what is going on in my life that I may think I have nothing to offer, until I sit down and the magic, God’s power, starts to come alive. After working with another alcoholic, all the obsessions and problems that I had before lose their power. Everything just doesn’t feel like that big of a deal, I am back to the present and everything is alright. My heart opens up to love again for my fellows and myself.

One of the biggest misconceptions of yoga is that it is a religion. Sometimes AA gets this label as well or sometimes even worse, it is referred to as a cult. Like AA, yoga is a spiritual practice. Both were created in countries that have different, dominant religions and, of course, those religions have a strong influence.

I think what scares people the most, which is the case in all forms of fear, is the unknown. Think about your first AA meeting; maybe it felt like the people in the room were talking in a foreign language. What about all the laughing at what most people would consider an inappropriate time? In yoga, the music is different and the words most often used are in a foreign language we are not familiar with. However, all of us use words in English that have the same meaning. Also, faith and your belief system are meant to be brought into all areas of life. Just like in AA, I bring my beliefs to my yoga practice. Sometimes they are like yours and sometimes they are not but we can embrace the differences and not the judgment. AA and yoga encourage people to live the fullest expression of their life and to be connected — body, mind and spirit.

Kristen Black is an employee and an alumni of La Hacienda treatment center.

She Loved Me Until I Could Love Myself

Sep 14, 2011
On June 11, Sandra Huffman set off on a journey by foot from her home in Fort Lauderdale to The Meridian Home for Girls in Royersford, Penn., from which she had run away in 1981 when she was only 15. Huffman has one message for the girls who are there today: don't take the path I did. She has another one for everyone she meets and greets along the way: recovery works.

At a press conference announcing the results of the 2010  National Survey on Drug Use and Health in Washington, D.C. last week, Huffman addressed a room packed with media, government officials and recovery advocates. Here's what she had to say:

Hello, my name is Sandra Huffman and I am a person in long-term recovery from addiction to alcohol and drugs, which means on June 19th I celebrated five years of recovery.

I’m here celebrating National Recovery Month after attempting to walk a total of 1,300 miles from Fort Lauderdale to D.C. I came through ear-popping funnel clouds in Myrtle Beach; an earthquake in Temperanceville; in Virginia Beach we were evacuated from a hurricane and ended up in the same hurricane in a Richmond, and now [we're in] the remnants of a tropical storm. So if I figure that if there’s a flood down Pennsylvania Ave., I’ve officially brought the apocalypse to the nation’s capital. contributor Parker Lanier drew a banner for Sandra's Walk and blogged about it here.
My journey isn’t over. Monday morning, I’m leaving for Philadelphia, where I look forward to throwing out the opening pitch at the Phillie’s game on the 20th and walking with thousands of people and [Office of National Drug Control Policy] director [Gil] Kerlikowske on the 24th.

It’s been an incredible journey. People have asked me why on earth would I do this? Let me you a bit about myself and that will help you figure out why.

I was adopted at birth into a family with alcohol and domestic violence issues that were just the beginning of the trauma and the stigma that were to follow—and affect me—over three-quarters of my life. My mom was an RN and worked a lot of late nights at the hospital and I spent most of my time with my grandmother, who drank a lot of what I thought to be iced tea at the time. My mom was married to a doctor at the hospital and life seemed pretty normal from the outside.

We belonged to the country club, went on vacations. But what was not evident was that we were all on prescription medications.

Looking back, my addictive personality traits were evident from age 7, when I can remember making up tummy aches to get more medicine, sneaking downstairs to take more. I have had the disease of "more" since I was 7

Things got chaotic at home, especially with my stepdad. I was staying out all night until eventually Child Protection Services stepped in and took me from the house at 13 and placed me in the Meridian House for Girls in Pennsylvania. 

Long story short, mom and my stepdad divorced after she found recovery. She now has 32 years of sobriety. I am proud to join her 30 years later.

I ran away to Fort Lauderdale and when I was 15. I gave birth to my oldest daughter and was labeled a habitual runaway by Judge Mark Speiser.

Over the next few years, I struggled with my addiction, giving birth to a son and another daughter. Geographical changes never helped.

Finally, I ended up homeless in my late 30s, living under bridges, and I started going to jail. It was jail that actually saved my life because that is where I met Broward County Drug Court judge Marcia Beach, who loved me until I could love my self.

She eventually placed me in the sheriff's 90-day, in-custody jail treatment program.  The time there helped me to save my life.

The last 30 days I did something I had never done before, and that was make a plan. And when released, I hit the ground running.

It included helping to start a kids program at the Fort Lauderdale Police Dept. Today, Judge Speiser—you remember him—comes and speaks for me there.

I stand beside and with Judge Beach, not in front of her.

Today, cops don’t chase me, they call me.

Today, I’m here to let you know that people are looking for help and hope.

While I was walking, I was also meeting Americans from all ways of life. I sat on park benches and talked with families who had lost loved ones to addiction and set up my resource table to get out information about the reality of recovery.

There are many angels who helped me along the way—Donna Cotter from Recovery North Carolina; everyone at the McShin Foundation in Richmond and the Recovery Month Planning Partners, Faces & Voices, Pro-Act’s Walk—all helped me realize my dream of spreading the message of recovery.

It’s no longer church basements, coffee and cigarettes. It’s concerts and comedy shows. People couldn’t believe that there are recovery celebrations going on everywhere.

Today I’m an intern at, the world’s largest recovery website, where hundreds of thousands of people are supporting one another in their recovery.

Today, I am an asset, not a liability.

Today, I am a face and voice in and of recovery.

Thank you for having me.

You can follow Sandra Huffman on her journey here.

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