13 Things Your Health Insurer Doesn't Want You To Know

Excerpts from Insure.com

~~~~~~~~~~~~

Do you ever feel that when it comes to your health plan the deck is stacked against you? That's because there are many things your health insurer doesn't want you to know.

Here are just 13 of them.

1. It is sometimes cheaper to let you die rather than to treat you for a serious condition.

Health insurers don't deny care, they deny payment which usually amounts to the same thing. Denying payment saves them money, but sometimes cause patients' deaths. Sound outrageous? Consider the statement below. It's an excerpt from the May 30, 1996, testimony given before the United States House of Representatives by Dr. Linda Peeno, a former HMO medical director and medical claims reviewer for Humana and Blue Cross and Blue Shield of Kentucky. Peeno is now a medical-ethics consultant and managed care whistleblower.


Whether it was nonprofit or for-profit, whether it was a health plan or hospital, I had a common task: using my medical expertise for the financial benefit of the organization, often at great harm and potentially death, to some patients. . . . I am the evidence that managed care is inherently unethical, in the areas of both medicine and business. Had my experiences been the result of merely local aberrations, I would not have had anything to do for the past six years. On the contrary, I discovered that my experiences are standard practice and quite ordinary for the managed care business."


2. Health insurers routinely hide benefit exclusions.

Health insurers make their covered benefits as narrow as the market allows and routinely redesign benefits to control their highest costs, according to Peeno. They also use deceitful policy language to hide exclusions.

Some dental plans, for example, cover accidental injury to teeth. If you bite down on a hard candy and your tooth partially crumbles, you believe the insurer will pay to fix it. But when you submit your claim, it's denied weeks later. That's when you discover the policy's "definition of terms" section states in fine print: "Injury to the teeth while eating is not considered an accidental injury."


3. Health insurers don't really want you to understand how your health plan works.

Health insurers use marketing that enhances the attractive elements of a plan, but they don't disclose potential plan problems. Most group health insurance members have no idea of their exact coverage limits or a plan's rules until they received a benefit booklet after the open enrollment period.



4. Health insurers employ "phantom networks."

Did you ever try to switch primary care physicians within your plan's provider network only to find out that many of the doctors named on the provider list are not accepting new patients? Then you have fallen prey to a health insurer that uses a "phantom network," a directory filled with doctors who are no longer with the plan or who are not taking new patients. Health insurers leave the names on the list to make it look as if they have a large number of available doctors.


5. Health insurers can make you "split" your pills.

You may be surprised one day when you fill your prescription and discover a pill splitter inside the bag along with a bottle of larger-dose pills that you must cut in half. Mandatory pill splitting has been condemned by the American Medical Association (AMA), the American Society of Consultant Pharmacists (ASCP), and the American Pharmaceutical Association (APhA) due to the health risks involved. These include the chance that patients will divide the pills unevenly and wind up taking incorrect doses or, because some suffer from cognitive impairments, they may forget which pills should be split.


6. Health insurers will go after your auto insurance settlement.

It's legal in most cases for health insurers to place a lien on any third-party settlement money you get from an auto insurer after an accident. This practice, known as "subrogation," simply means "substituting one for another."

Health insurers are allowed to recoup the cost of your medical care from the settlement you receive from the person who injured you. For example, if your auto accident medical expenses total $5,000 and you win a $10,000 settlement, your health insurer can take half — but only if its "rights of recovery" are spelled out in your plan agreement or summary of benefits. There have been many court cases over this practice, and the issues aren't clear-cut. You do have the option of hiring an attorney (at your own expense) to fight your health insurer's subrogation demands.

7. Health insurers purposefully delay paying claims in order to maximize their profits.

Although 46 states have prompt-pay laws, those laws apply only to "clean claims," or claims submitted to them without any missing or wrong information. The problem is, according to Peeno, health insurers create a maze of payment-submission rules that guarantee there will be many "technical" denials for missing information or failure to follow the convoluted claims-submission procedures.

Why do insurers drag their feet on paying claims? When you pay your insurance premium, it is invested in interest-bearing accounts. An insurer delays your claim payment until the interest in these accounts is sufficient to pay the company's accumulated claims without cutting into its profit margin.

8. Your doctor isn't calling the shots.

Do you know whose guidelines your health insurer follows when approving the length of your hospital stay? Your doctor, right? Wrong. Your insurer is most likely using guidelines developed by an actuarial consulting firm such as Milliman & Robertson.

The use of Milliman & Robertson data to limit patients' care (and increase revenue) is just one of the allegations brought forth in a lawsuit filed by the state medical associations of California, Georgia, and Texas in U.S. District Court in Miami that accuses a nine health plans (Aetna Inc. and its Prudential unit, CIGNA Corp., Coventry Health Care Inc., Foundation Health Systems, Humana Inc., PacifiCare Health Systems, United Health Group, and WellPoint Health Networks) of violating federal racketeering laws.


9. You don't have to pay out-of-network charges when they're not your fault.

Even when you've followed all the HMO rules, you still sometimes end up with a bill for out-of-network charges. But is it your responsibility to pay the doctor's fee for an out-of-network radiologist who read your hospital X-ray because no in-network radiologist was available?

No, you most certainly do not. A patient can select an in-network primary care physician and in-network hospital. Other than that, you have no control of who else gets involved with your care within the hospital setting.

If this happens to you, raise an uproar. Appeal the insurer's payment decision. File an official complaint with your state insurance department.

10. Health insurers make a fine distinction between "emergency" and "urgent" care.

Your health insurance policy probably contains a clause stating you will not be billed for emergency room services if those services are eligible under "The Prudent Layperson Standard" for emergency room visits. These visits have been defined as medical, maternity, or psychiatric emergencies that would lead a "prudent layperson" (an average person) to believe that a serious medical condition exists or the absence of immediate medical attention would result in a threat to the person's life, limb, or sight. This includes situations where an individual is in severe pain.

But in some health plans, conditions such as a broken hip are not classified as conditions that require emergency care. They are classified as "urgent" conditions and you must call your primary care physician to get authorization to visit the emergency room.

"The devil is in the details," says Robert D. Finney, a former manager for health-care cost containment at the Hewlett-Packard Co. and author of HMO Hardball, a consumer self-help book. "HMOs hide the details in incomprehensible self-serving contracts written by HMO lawyers to take advantage of sick and disabled patients."

11. Health insurers don't want you to know how they come up with their prices.

Would you shop at a grocery store where none of the merchandise had price labels? Of course not, but many health insurers use a pricing practice known as "UCR," which stands for "usual, customary, and reasonable," to determine how much of a claim they will pay. As the name says, these charges are supposedly the "going rate" health care providers in your area charge.
But a consumer can't get UCR prices to dispute a claim payment or to compare plans. Even court orders have done little to force insurers to supply the formulas that they say they use to devise UCR rates, claiming it's proprietary (or secret) business information.


12. Health insurers don't want you to take your grievance outside the health plan.

Every health plan has an internal grievance process, but insiders say many are reluctant to let you know that many states have also implemented laws governing external appeals that in certain cases give you the right to a review by an independent board of qualified experts. If the appeal is determined in your favor, your insurance company cannot deny your claim.

Additionally, insiders say few health insurers let you know that if you file a grievance with your state insurance department, insurance regulators are bound by law to investigate all consumer complaints that fall under their jurisdiction.


13. Health insurers don't want you to know that some of their practices violate laws.

Although 46 states have prompt-pay laws, insurers still violate them flagrantly enough to set off lawsuits and insurance department investigations that often lead to fines. The majority of these are settled quietly. Insiders say what health insurers really fear are the massive class action lawsuits that ask the courts to force the insurers to repay all the money they have gained from these practices.

London Bombings: Trauma and Recovery

Today during the morning rush hour, terrorists attacked the United Kingdom with orchestrated detonations that blasted three London subway systems and a crowded double-decker bus. Once again, we find ourselves gripped with a sense of horror. How do others live and breathe this hatred? Why are innocent people killed? Understanding evil and the motives of terrorism can help you move forward and heal.

Understanding Evil

As I have written before (Serani, 2004), the main conscious motive of terrorism is to destabilize a society and evoke mass reactions. Because terrorists are unable to achieve their goals by conventional means, they choose a chilling and merciless way to get the recognition they are seeking. Equally important to the effectiveness of the terrorist act are those who witness its wake. In this age of technology and 24 hour news programming, the accounts of shocking happenings are delivered with immediacy, and can be viewed, re-viewed, and revisited at the push of a button. Through the horror, the terrorist hopes that your basic security is seized, that your identity to community is shattered and that your coping and belief system will be gravely compromised (Butterworth, Clothier & Mellman, 2001; Everly & Lating, 1995; Herman, 1992; Hudson, 1999).

The unconscious aim of terrorism is to destroy objects, others and entities because they are sources of unbearable feelings of envy. The terrorist’s historical rage, grief, hopelessness, envy and dread congeal into the need to annihilate. The terrorist engages in violent acts as a result of experiencing hostility and helplessness over the lack of alternatives in his life. Feelings of inadequacy and deprivation that were intitially felt are now diminished because the terrorist finds a sense of potency, social status, potential wealth and a sharing of fanatical points of view in the terrorist group. Fueling the hatred and annhilation are other fanatical contructs: prejudice, authoritarianism, an unwillingness to compromise, a disdain for other alternative views. When the terrorist act occurs and victims are put through anguish, horror, cruelty and unspeakable loss, the terrorist transcends his own pain. The terrorist will deform ethics of religion, culture and society and will employ any evil means to reach such goals (Grand, 2000; Serani, 2004; Young, 2001). In doing this, the terrorist uses the defense of splitting (black-or-white thinking) so that he sees himself as altogether right, sanctioned by God, and the other as altogether wrong.

How to Cope

Well-being begins with psycho-education. Understanding what psychological trauma is and how it bears down on your biological, chemical and psychological makeup is the first step toward recovery. Psychological trauma is the unique individual experience of events or enduring conditions where you feel emotionally, cognitively, and physically overwhelmed. If you need to rest or detach in some way, do so. If you feel the need to be active and busy, do so. Whatever will help your body awareness and sensory awareness to slow down hyperarousal and reinstate safety and security is recommended.

Once the traumatic event is over it does not mean that your reaction to it will be over. The intrusion of the past into the present is one of the main problems confronting anyone who witnesses or experiences trauma. This is often referred to as re-experiencing. The re-experiencing may present as distressing intrusive memories, flashbacks, nightmares, or overwhelming emotional states. It is also important to know that witnessing crimes against humanity may raise anticipatory anxiety, where you are not only reeling from the trauma that just occurred, but are perched in a state of anxiety of what may come next. Though many of these symptoms are normal in the recovery process, if your trauma reaction does not abate within a few weeks, it would be wise to seek an outside consultation for further review.

News programming has moved from providing citizens with the information they need to be free and self-governing to programming that attracts ratings by exploiting their vulnerabilities. Drawing viewers to fear-based material is a marketing strategy as big ratings mean big revenues (Altheide, 2002; Glassner, 1999). Knowing that most news organizations work within this notion will help you realize that factual information may be clouded by sensationalism in news reports. Therefore, it would be wise to get information about current events by gleaning headline news blurbs, or reading updates on a home page or newspaper. Avoiding being glued to the television or engaging in high intensity group discussions as they may only serve to elevate anxiety and lengthen the arc of your traumatic reaction. The goal here is to find a sense of balance of what has occurred, where real facts counter unsubstantiated fear-promoting beliefs. Placing the terrorist act in a frame that allows you to stay connected to people and things, both locally and globally will help you flourish once again (Serani, 2004).


Interventions and Teachable Moments

Now that you have some understanding about terrorism, there comes the task of helping children understand it. Whenever a tragedy occurs children, like many people, may be confused or frightened --- and any time children are eager to ask a question, it is an opportunity for us to make it a teachable moment. It is important to know that when they ask questions, they are seeking two things -- understandable information and realistic reassurance.

As a parent, your answers should meet your child’s intellectual needs and emotional needs. The following recommendations are modified from the National Association of School Psychologists (2001):

1. Model calm and control. Children take their emotional cues from the significant adults in their lives. Avoid appearing anxious or frightened.

2. Reassure children that they are safe and (if true) so are the other important adults in their lives. Depending on the situation, point out factors that help insure their immediate safety and that of their community.

3. Remind them that trustworthy people are in charge. Explain that the government emergency workers, police, firefighters, doctors, and the military are helping people who are hurt and are working to ensure that no further tragedies occur.

4. Let children know that it is okay to feel upset. Explain that all feelings are okay when a tragedy like this occurs. Let children talk about their feelings and help put them into perspective. Even anger is okay, but children may need help and patience from adults to assist them in expressing these feelings appropriately.

5. Observe children’s emotional state. Depending on their age, children may not express their concerns verbally. Changes in behavior, appetite, and sleep patterns can also indicate a child’s level of grief, anxiety or discomfort. Children will express their emotions differently. There is no right or wrong way to feel or express grief.

6. Look for children at greater risk. Children who have had a past traumatic experience or personal loss, suffer from depression or other mental illness, or with special needs may be at greater risk for severe reactions than others. Be particularly observant for those who may be at risk of suicide. Seek the help of mental health professional if you are at all concerned.

7. Tell children the truth. Don’t try to pretend the event has not occurred or that it is not serious. Children are smart. They will be more worried if they think you are too afraid to tell them what is happening.

8. Stick to the facts. Don’t embellish or speculate about what has happened and what might happen. Don’t dwell on the scale or scope of the tragedy, particularly with young children.

9. Keep your explanations developmentally appropriate. Early elementary school children need brief, simple information that should be balanced with reassurances that the daily structures of their lives will not change. Upper elementary and early middle school children will be more vocal in asking questions about whether they truly are safe and what is being done at their school. They may need assistance separating reality from fantasy. Upper middle school and high school students will have strong and varying opinions about the causes of violence and threats to safety in schools and society. They will share concrete suggestions about how to make school safer and how to prevent tragedies in society. They will be more committed to doing something to help the victims and affected community. For all children, encourage them to verbalize their thoughts and feelings. Be a good listener!

10. Monitor your own stress level. Don’t ignore your own feelings of anxiety, grief, and anger. Talking to friends, family members, religious leaders, and mental health counselors can help. It is okay to let your children know that you are sad, but that you believe things will get better. You will be better able to support your children if you can express your own emotions in a productive manner. Get appropriate sleep, nutrition, and exercise.

11. Focus on your children over the week following the tragedy. Tell them you love them and everything will be okay. Try to help them understand what has happened, keeping in mind their developmental level.

12. Limit your child’s television viewing of these events. If they must watch, watch with them for a brief time; then turn the set off. Don’t sit mesmerized re-watching the same events over and over again.

13. Maintain a “normal” routine. To the extent possible stick to your family’s normal routine for dinner, homework, chores, bedtime, etc., but don’t be inflexible. Children may have a hard time concentrating on schoolwork or falling asleep at night.

14. Spend extra time reading or playing quiet games with your children before bed. These activities are calming, foster a sense of closeness and security, and reinforce a sense of normalcy. Spend more time tucking them in. Let them sleep with a light on if they ask for it.

15. Consider praying or thinking hopeful thoughts for the victims and their families. It may be a good time to take your children to your place of worship, write a poem, or draw a picture to help your child express their feelings and feel that they are somehow supporting the victims and their families.

References
Altheide, D. (2002). Creating fear: News and the construction of crisis. New York: Walter de Gruyter.

Butterworth, R., Clothier, J., & Mellman, T. (2001). America’s state of mind – Confronting PTSD, depression and anxiety in the wake of terrorism. Medical Crossfire, 2, 2-15.

Everly, G.S. & Lating, J.M. (1995). Psychotraumatology: Key papers and core concepts in post-traumatic stress. New York: Plenum.

Glassner, B. (2000). The culture of fear: Why americans are afraid of the wrong things. New York, Basic Books.

Grand, S. (2000). The reproduction of evil: A clinical and cultural perspective. New Jersey: Analytic Press.

Herman, J. (1992). Trauma and recovery: The aftermath of violence – From domestic abuse to political terror. New York: Basic Books.

Hudson, R. (1999). The sociology and psychology of terrorism: Who becomes a terrorist and why? Washington, DC: Library of Congress.

National Association of School Psychologists: http://www.nasponline.org/

Serani, D. (2004). Expanding the frame: Psychoanalysis after 9-11. Bulleting of the Menninger Clinic, 68(1): 1-8.

Young, R. M. (2001). Fundamentalism. Paper presented at the Centre for Psychoanalytic Studies, University of Sheffield, England.

Cutting: The Quiet Epidemic

What is Cutting?

Cutting falls under the umbrella of Self-Injurious Behaviors (SIB). Other forms of SIB include burning, skin-picking, wound-picking, skin puncturing and flaying. This paper, however, will focus specifically on cutting behaviors in individuals who are not psychotic or brain damaged.

Cutting can range from severe tissue damage to minor skin scratches. Cuts can take form in delicate lines, swirls, patterns and initials. “Like a tattoo,” one patient revealed. Cutting can be smooth from beginning to end, suggesting a slow, steadied hand doing the deed. Cuts can occur in haphazard slashes, revealing a fury in the strokes. Cutting wounds can present in a rippled manner, where blood spills intermittently through the skin, giving the lesion a bumpy, prickly look. Redness can accompany cuts, as can bruising. Cuts can be thick, deep and long, and as one patient discovered, can get infected and require hospital attention. Cutting is usually assigned to hidden places, not readily visible to the casual observer. With regard to moderate and mild cutting, clothing conceals them, bracelets hide them, band-aids cover them. More severe cutting may be noticeable in the way a person carries his/her posture (limping, hobbling or recoiling).

The style of cutting will be as individual as the person. So, too, will be the instrument chosen for accomplishing the act. Tools for cutting can be items specifically designed to cut: scissors, knives, razors. Ordinary items can be employed: pins, paper clips, needles, pen caps, forks, broken glass…anything that can break the skin.


Translating Cutting in Psychological Terms


The cutting, carving and scratching of skin in is an attempt to control overwhelming emotions, feelings of helplessness, and for some is a way to manage anger or shame. Cutting is a way to manage self-punishment, self-hate or self-nurturance. In its simplest form, cutting is a physical solution to a psychic wound. It is a deliberate, private act that can be habitual or isolated in occurrence. It is not attention seeking behavior, not meant to be manipulative, nor is it a conscious attempt to end one’s life. (Azar, 1995; Carll, 2003; Froeschle & Moyer, 2004; Kress White, 2003; Levenkron, 1999; Strong 1999).

Symbolically speaking, cutting is viewed psychologically as a method to communicate what cannot be spoken. The skin is the projected canvas, an encasement of sorts, where aspects of the psyche reside. Anzeiu’s (1989) theory of skin-ego best describes this, and is compelling reading for professionals. “Mutilations of the skin are dramatic attempts to maintain the boundaries of the body and the Ego, and to re-establish a sense of being intact and cohesive” (Anzeiu, 1989, p.20). It is important for psychologists to understand the skin’s symbolic representation in the act of cutting and the ego organization that is being attempted by the individual. Talk is always preferred over action in therapy. So the goal here is to help the patient translate verbally what is occurring physically.

Who is Cutting?

At present, little is known regarding etiology, course, diagnosis, assessment and appropriate treatment interventions for cutting. The data available focuses on self-injury behaviors as a whole.

Statistically speaking, approximately 4% of the population in the United States uses self-injury as a way of coping (Briere & Gil, 1998). Individuals who self-injure are represented in all SES brackets in the United States (Brier & Gil, 1998; Dieter et. al., 2000). The behavior usually has its origin in adolescence, and has been shown to continue for some into adulthood (Kress White, 2004). Girls and women tend to self-injure more than boys and men, but this maybe represented by the fact that females tend to turn to professional help more than males.

Cutting and the DSM

Cutting is not a separate category in the DSMIV-TR, but researchers in the field are pushing for its inclusion in the DSMV. Pattison & Kahan (1983) have been writing about Deliberate Self-Harm Syndrome for over two decades, urging the recognition of cutting and the other self-injury behaviors as distinct disorders. Favazza & Rosenthal (1993) have supported this as well and have been detailing their research about Repetitive Self-Harm Syndrome for over a decade. For now, cutting can be diagnosed as an Impulse-Control Disorder NOS.

Cutting has been markedly linked to borderline personality disorder (Brodsky, et. al., 1995; Russ et. al., 1995). Akhtar (1995) states that the borderline individual uses cutting as both an attempt at self-delineation and to express a connection (or lack of connection) with others. Cutting has been moderately associated with histrionic and narcissistic personality disorders (Konicki & Schulz, 1989; Kress White, 2003), suggesting that the reactive traits in these disorders raises the likelihood of cutting tendencies. Disorders of the Self have also been companioned with cutting and can be seen in the impairment of a patient’s self-capacity for tolerating strong affect and the maintaining of a sense of self worth (Dieter et.al. 2000). Depression, anxiety, obsessive compulsive disorders and eating disorders have also been associated with cutting as have childhood trauma, sexual abuse, and gender identity, though not statistically linked as previously mentioned.

Research into self injury has revealed that the act can become physiologically and psychologically addictive. Clinical studies to date have attended to the role of endogenous opioids. Endorphins function as natural narcotics or opiates in the body as the self-injury occurs, and an individual learns to associate the act of cutting with the rush from the endorphin release (Azar, 1995; Simeon et al.; 1992; Villalba & Harrington, 2000). This “high” secures the cyclic addiction. Individuals who self injure also report feeling no pain as the cutting occurs. This is similar to "stress-induced analgesia" that wounded soldiers and athletes report experiencing (Hilgard, 1976).


Why is Cutting more Prevalent

Cutting behaviors have been reported for many years and are on the rise, reaching epidemic proportions (Froeshcle & Moyer, 2004), but there is no hard and fast evidence as to why. Concern is at such a fevered pitch that the American Self-Harm Information Clearinghouse named March 1, 2005 as National Self Injury Awareness Day to educate and inform medical and mental health professionals and the general public about the self injury. The United Kingdom and Australia have marked March 1st as National Self-Injury Awareness day in their respective countries as well.

Media contagion seems to be a common theory as to why cutting is on the rise. High profile individuals like Princess Diana, Johnny Depp, Christina Ricci, Fiona Apple, Angelina Jolie, and Courtney Love have revealed that they deliberately cut or self injured. Movies like “Girl Interrupted” and “Thirteen”, depict individuals using cutting behaviors as a means to reduce adversity. This gets translated as a possible option for individuals who are grappling with significant emotional turmoil. Peer contagion is also a factor in school and work settings - If she tried it, maybe this can work for me.

Assessment and Interventions

Kress White (2003) tells us that we are still in need of finding better assessment and intervention tools for cutting behaviors. For now, many clinical practitioners and school psychologists use eclectic approaches when dealing with cutting.

The first step in assessment is to determine if cutting is a suicide attempt. Therefore, a standard suicide assessment is paramount. Once ideation, intent, and plan are ruled out, the inquiry should address the patterns of cutting, the conflicts the teen or adult experiences, as well as inspection of said cuts if given permission to see them. Educating the individual about what cutting is in psychological terms will help start the recovery process.

Duty to warn will be a matter of interest. A breach of confidentiality may be appropriate when cutting occurs. Teens and adults who cut do not want to end their life, but cutting can put one at risk for significant injury and infection, tissue or muscle damage and accidental death.

Exploring family dynamics is another area that should receive great coverage. The person who cuts often feels that h/she doesn’t have the right to assert him/herself, doesn’t feel that thoughts and feelings are respected, or gets punished for his/her expression by family members (Levenkron, 1999; Strong, 1999). The exploring of the family dynamics will reveal that the family constellation is in need of help as well. Family therapy is very essential modality for recovery.

For teens that are not comfortable with family therapy, cognitive and behavioral approaches can be pursued to help address the maladaptive coping schemas. Psychodynamic therapy can also be a considered orientation to uncover the unconscious and symbolic aspects of the cutting.

Interventions that have been used with patients with dissociative disorders have been useful with individuals who cut. Visualization can be used to move through painful thoughts or affects, and keeps the person in-the-moment. Sensory Grounding Skills, holding something soft, listening to soothing music, drawing or writing, for example, can interrupt the trance-like state and can shift the person from engaging in the maldaptive cutting. Cognitive Grounding Skills, like “Who am I really mad at”, ”What is setting me off”, “I am safe and I am in control”, re-orient a person to the here-and-now, and can keep the impulse to cut from emerging.


Conclusions

If cutting is not addressed, a person will not only suffer scarring on a physical level, but will experience poor self-esteem, an inability to tolerate and master conflicts, and constriction in social and intimate relationships, just to name a few. Trust, expression and connection will likely be tentative and tumultuous at school, work and home as well.

Returning to Anne, she reports less frequency in her cutting, and her urges have lessened in intensity. She and I have come to learn that her personality and behavioral traits are dependent in nature. She sees how her need for attachment and the need to not be alone causes her to cut. She has taken very well to journal writing, giving new meaning to the phrase “the pen is mightier than the sword”.



Resources

http://www.selfinjury.info/ - Based in the United Kingdom, this website is volunteer based that raises awareness about self injury worldwide. Many of the contributors are former self injurers.
http://www.selfinjury.org/ - The American Self-Harm Information Clearinghouse website offers articles and resources to inform the general public as well as health professionals about the phenomenon of self-harm.
http://www.selfmutilatorsanonymous.org/ – Using a 12 step program, Self Mutilators Anonymous offers in-person and online fellowships to help in the recovery from self injurious behaviors.
http://www.sidran.org/ - The Sidran Institute, along with Ruta Mazelis, publish The Cutting Edge Newsletter. Articles are often penned by teens and adults living with self injurious behaviors, and there are empirical articles and clinical papers from professionals in the field who treat patients who engage in SIB as well.

References

American Self Injury Clearinghouse - www.selfinjury.org

Azar, B. (1995). The body can become addicted to self-injury. Supplemental readings from the APA Monitor. Washington, DC: American Psychological Association.

Akhtar, S. (1995). Losing and fusing. Borderline transitional object and self relations. Psychoanalytic Quarterly, 64:583-588.

Anzieu, D. (1985). The Skin-Ego. New Haven: Yale University Press.

Briere, J. & Gil E. (1998). Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68 (4), 609-620.

Brodsky, B., Cloitre, M. & Dulit, R. A. (1995). Relationship of dissociation to self-mutilation and childhood abuse in borderline personality disorder. American Journal of Psychiatry, 152 (12), 1788-1792.

Carll, E.K (2003). Self-injury behavior: Emerging trends. Bulletin of the Psychologists in Independent Practice, 23 (3).

Dieter, P.J., Nicholls, S.S. & Pearlman, L.A. (2000). Self-injury and self capacities: Assisting an individual in crisis. Journal of clinical psychology, 56 (9): 1173-1191.

Favazza, A.R. & Rosenthal, R.J. (1993). Diagnostic issues in self-mutilation. Hospital and Community Psychiatry, 44: 134-140.

Froeschle, J. & Moyer, M. (2004). Just cut it out: Legal and ethical challenges in counseling students who self-mutilate. Professional School Counseling. 7(4), 231-235.

Gardner, A.R. & Gardner A.J. (1975). Self-mutilation, obsessionality and narcissism. British Journal of Psychiatry,127:127–132.

Glassner, B. (2000). The culture of fear: Why americans are afraid of the wrong things. New York, Basic Books.

Haines, Janet, & Williams, Christopher L. (1997). Coping and Problem Solving of Self-Mutilators. Journal of Clinical Psychology, 53 (2), 177-186.

Hilgard, E.R. (1976), Neodissociation theory of multiple cognitive systems. In: Consciousness and Self-Regulation, Schwartz G.E. & Shapiro, D. eds. New York: Plenum Press.

Konicki, P. E. & Shulz, S. C. (1989). Rationale of clinical trials of opiate antagonists in treating patients with personality disorders and self-injurious behaviour, Psychopharmacology Bulletin, 15: 556-563.

Kress White, V.E. (2003). Self-injurious behaviors: Assessment and diagnosis. Journal of Counseling & Development. 81(4), 490-496.

Levenkron, S. (1999). Cutting: Understanding and overcoming self-mutilation. New York: W.W. Norton & Company.

Pattison, E.M. & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140:867-872.

Russ, M.J., Clark, W.C., Cross, L.W., Kemperman, I. Kakuma, T. & Harrison, K. (1995). Pain and self injury in borderline patients: Sensory decision theory, coping strategies and locus of control. Psychiatry Residency, 63: 57-65.

Simeon, D.; Stanley, B.; Frances. (1992).Self-mutilation in personality disorders: psychological and biological correlates. American Journal of Psychiatry, 149(2):221-226.

Strong, M. (1999). Bright red scream: Self-mutilation and the language of pain.
New York: Penguin Books.

Villalba, R.; Harrington, C.J. (2000). Repetitive self-injurious behavior: A neuropsychiatric perspective and review of pharmacologic treatments. Seminars in Clinical Neuropsychiatry, 5(4):215-226.


This paper was published in the 2005 Spring Edition of the Suffolk County Psychological Newsletter and is used with persmission.

Welcome

My name is Deborah Serani, Psy.D. and I am a psychologist who specializes in depression and trauma. I also enjoy writing and serving as a resource for psychologically related issues in magazines, newspapers, radio and television. . . anything that can bring psychology and psychoanalysis to a wider audience. I can be contacted via email at drsera - at- optonline - dot- net

The information provided in this blog is to be used for educational purposes only. It should NOT be used as a substitute for seeking professional care, diagnosis or treatment of any psychological disorders.


Current Academic Position

Adelphi University, New York
Graduate Program School Psychology: Adjunct Professor

Academic Journals

Serani, D. (submission status). Mental illness stigma in television: The good, the bad and the ugly.

Serani, D. (2008). If it bleeds, it leads: The clinical implications of fear-based programming in news media. Psychoanalysis & Psychotherapy, 24(4): 240-250. DOI: 10.3200/PSYC.24.4.240-250.

Serani, D. (2004). Expanding the frame: Psychoanalysis after September 11. Bulletin of the Menninger Clinic, 68(1): 1-8. PMID: 15113030

Serani, D. (2002). The analyst in the pharmacy. Journal of Contemporary Psychotherapy, 32(2/3): 229-241. DOI: 10.1023/A:1020501227827

Serani, D. (2001). Yours, mine and ours: Analysis with a deaf patient and a hearing analyst. Contemporary Psychoanalysis, 37: 655-671.

Serani, D. (2000). Silence in the analytic space, resistance or reverie: A perspective from Loewald's theory of primordial unity. Contemporary Psychoanalysis, 36: 505-519.




Print Interviews

ABC News
All You Magazine

American Psychological Association

APAPractice.org
Associated Press
All Things Medical Blog
Baby Talk Magazine
BlogCritics.org

Campus Life Magazine
Canvas Magazine

Chicago Sun-Times

Empoweringparents.com

Forbes Magazine
Glamour Magazine
Genetics & Health Blog

HealthCentral.com
Hudson Valley Parent Magazine
Long Island Exchange
Medscape

Mint.com
MSNBC.com

MTVi

Newsday
Naked Medicine
Parenting New Hampshire
Psychology Today
Sandusky Register
Scarsdale Magazine
The Free Press - Miami
The Journal Press

Tyrashow.com

USAToday.com
Women's Health & Fitness Magazine



Television

NBC - Law & Order: Special Victims Unit
Technical Advisor

Radio

WHYY Radio: Voices in the Family

"Mental Illness Stigma in Television Media"

http://www.whyy.org/podcast/voices20090720.mp3



Books by Deborah Serani

"My Depression"

Non-fiction

"The Tenth Session"
A psychological suspense fiction novel

This blogpost will be updated as needed