Thursday, 10 April 2014

A national scandal: psychological therapies for psychosis are helpful, but unavailable

Can talking therapies be a realistic response
to psychosis and schizophrenia?
For years, drugs were it. If you felt paranoid, heard voices or were diagnosed with schizophrenia, the only thing likely to be on offer was ‘antipsychotic’ medication.  Like all drugs, these have a number of different effects on our nervous system. Some of the effects can be helpful, for example calming us down or making our experiences less intense or distressing.   Others may be less desirable. The unwanted effects – euphemistically called ‘side’ effects – of these particular drugs can be seriously distressing.  For some people, they can be more disabling than the original problem.  Despite the drug industry hype, it’s been a fine balance for many people, and worrying evidence is now emerging that some drugs can cause serious and permanent problems such as brain shrinkage if taken long-term.

Friday, 7 March 2014

Pro-Ana communities: why they draw those starving for sustenance and support

Rosie Gilderthorp

Pro-ana: Less is more
Photo: Gideon Malais
A colleague recently brought to my attention a ‘pro-ana’ thread he had noticed on Twitter. He was horrified by what he read and I can see why. Twitter exchanges and message boards like this, consist of young women swapping tips on how to maintain a dangerously low weight and provide each other with ‘thinspiration’ pictures of sinewy celebrities. Pro-ana networks are a world of women with glossy hair, gleaming skin and sculpted cheekbones. There are no pictures of bad skin, thinning hair or infertility (difficult to photograph I accept), and there are certainly no stories about the death toll of eating disorders.  I, like my colleague, initially recoiled from these groups. It’s hard to avoid concluding that they maintain distorted thinking, fetishise a dangerous aesthetic and uphold judgments of women based on their weight. I started to think about writing a blog about shutting them down. However, when my initial horror abated, I began to wonder why people access them and what needs pro-ana groups seek to fulfil.

Thursday, 20 February 2014

Seduced by biology: The BBC, black dog and biological bias

Sue Holttum suggests that biological explanations for distress may easily be over-emphasised

Do brains turn our heads?
Photo: Helmut Januschka
A couple of mornings ago (Tuesday 18th Feb) there was an item on Radio 4’s Today programme about depression. Specifically, it related to the discovery that teenage boys with mild (non-clinical) depression, and higher-than-usual levels of the stress hormone cortisol, were 14 times more likely to develop clinical depression than other boys of similar age. Presenter, Evan Davis, interviewed respected neuroscientist, Prof Barbara Sahakian, from Cambridge University. Instead of asking the obvious question about why these youngsters are suffering enough stress to raise cortisol levels and be mildly depressed, Mr Davis asked about possibly correcting cortisol levels and whether cortisol was the cause of the depression.

Friday, 14 February 2014

Guest post: What will help prevent tragedies like Mid Staffs happening again? Time for a shift in attention.

Steve Onyett

Care and appreciation. Simple but more
powerful than we realise
Pictue: Deviant Art
It seems to have become fashionable to criticise the NHS – or in newspaper-speak to ‘attack’ it. Of course scrutiny of public services is important, but the relentless focus on blame for failures worries me. In the words of Dr Cliff Mann, president of the College of Emergency Medicine, ‘we want to make sure that we don't end up demoralising the very people that we need to keep our health service going’. This sentiment was echoed in a recent open letter in the Guardian from leaders of ten NHS organisations. I’m encouraged by campaigns like ‘Big Up the NHS’ on Twitter which recognise that, as all parents know, praise and encouragement generally get you much further than relentless criticism.

It’s worth being absolutely clear, though, about the scale of the culture shift needed to restore a sense of meaning and vocation among NHS staff. Can this be achieved? How should we go about it? I’d suggest the solutions are radical but also surprisingly simple.

Monday, 27 January 2014

Guest post. The manufacture of madness? Why social construction in psychiatry is not as simple as it seems

Huw Green

Mental health problems: Constructed or discovered?
Anyone who has spent time reading or listening to psychologists recently is likely to have encountered the idea that mental health problems are ‘social constructs’. What is meant by this is that entities such as depression or schizophrenia and personality disorder, which we might ordinarily think of as diseases; are actually descriptions that flow out of our culture and moment in history. There may be good reasons for thinking about mental health in this way. Anybody who claims that there is no social construction involved in the disorders outlined by the American Psychiatric Association (APA) is unaware of the way the manual is written. Prior to 1952 there was no DSM, and every 15 years or so since, a revision has appeared. These updatings are usually chock full of new diagnoses, many of which have been regretted by the very people who helped bring them into existence. Indisputable though this may be, it is a form of description which can stand in the way of understanding the true complexity of such problems. If they are just constructs then why do so many of the people who experience them find the experience so like a disorder; so real? In order to be clearer about this we need to ask exactly what we mean by social construction.

For some commentators, the implication seems to be that if we stopped talking about ‘schizophrenia’ or ‘personality disorder’, then they would more or less disappear. This is the argument which Mary Boyle appears to make in the final chapter of Schizophrenia: A Scientific Delusion? In this line of reasoning, there is much to be gained from demonstrating that life events, social inequality, abuse, and even the mental health system create ordinary, understandable distress, which then gets inaccurately and arbitrarily labelled. It is likely that this depiction is true in a good many cases.

Thursday, 23 January 2014

Athletic identity: Hercules' muscle or Achilles heel?

Izzy Biggin

Being at the pinnacle brings
it's own pressures.
Photo: Alexandre Moreau
Last November England cricket batsman Jonathon Trott departed from Ashes tour of Australia due to a long-standing ‘stress-related illness’. This was a shock for some of the media. Do such things happen to elite cricketers? In contrast, others speculated that cricket has a particular problem. After all, fellow England batsmen Marcus Trescothick and Graeme Fowler have had their own battles with depression. However, with other sporting legends, such as boxer Frank Bruno and Olympic medallists Dame Kelly Holmes and Victoria Pendleton also disclosing struggles with mental health issues a unique place for cricketers seems unlikely. Given the particular set of pressures on elite athletes (fame, wealth, expectation), perhaps it may be more prudent to consider the risks of being at the pinnacle of physical achievement. 

Many of us will suffer from the kinds of distress that gets labelled a mental health problem when dealing with the demands of everyday life.  Is it really surprising that elite athletes, with their pressures to consistently perform, are at risk of developing psychological difficulties too? As icons of physical perfection it may be that we assume that they have equitable superhuman mental strength as well. It’s also worth giving some thought to what happens when an elite athlete is no longer elite. Or what happens when an athlete is no longer an athlete. What happens on retirement, or when an athlete suffers a drop in form, is left out of the team, or is injured? When the elite athlete identity, formed by a lifetime of early morning starts, gruelling training schedules and countless social sacrifices, is no longer applicable, it would be surprising if there were not some consequences for self-esteem and psychological well-being.

Friday, 17 January 2014

Is it time to call time on Community Treatment Orders?

The Mental Health Act 2007:
Alternatives to hospital or
 curtailments of liberty?
Every so often I come across an article on Community Treatment Orders (CTOs). Usually the view expressed is critical and it always produces a stab of disquiet. More on the bad feelings in a second, but before that, it’s worth just establishing what we’re talking about. The norm that people with mental health problems can be given treatment against their will and detained in hospital is well established.  In the United Kingdom the Mental Health Act 2007 extended this principle by allowing people such compulsory treatment at home (i.e. without admission). The twinge of unease comes because I, in the face of a good deal of criticism from colleagues, thought this change was a good idea.

Let’s leave aside whether such compulsory powers are right or wrong. Feelings run high but there is no sense in which the abandonment of enforced treatment is on the table. Let’s also leave aside the idea of confining compulsory treatment to cases where people lack the capacity to consent. Unlike physical health (where any of us has a right to refuse treatment unless we lack capacity) the UK the Mental Health Act allows treatment on the basis of   mental illness While there are powerful arguments that this situation is unjust, these have struggled to gain traction.  Here I want to focus on the narrower question of whether, in a world were compulsion is established, CTOs have been helpful.

Friday, 10 January 2014

Time to change for Time to Change?

Flo Bellamy

Does a diagnosis simply confirm
another's weirdness?
Photo: Juan Eduardo Donoso
The Time to Change campaign is the biggest mental health stigma busting campaign in the UK, receiving an estimated £21 million between 2007 and 2011.  Given this level of investment I would hope it made significant differences to stigma surrounding mental health problems.  The truth is that it hasn’t, and in some areas of stigma, prejudice has increased.

In the 2011 ‘Attitudes to Mental Illness’ survey report, many results were worrying.  It appears that the percentage of people who would not want to live next-door to someone who has been mentally ill has risen compared to recent years. Also, more of the general public believe that someone should be hospitalised as soon as they show signs of mental disturbance. It’s also more probable that a woman would be considered ‘foolish’ to marry a man who has suffered from mental illness, even though he seemed fully recovered.

And these are at the tip of the iceberg.  When it comes to measures of tolerance of the general public towards ‘mental illness’, a decrease was found.  The percentage of people who agreed we need to adopt a far more tolerant attitude toward people with mental illness in our society dropped from 91% to 86%. Given the level of investment described in the first paragraph, it’s worth asking why this is happening.

Friday, 20 December 2013

Guest Blog: Dancing with DSM

Psychiatrist Glen Simblett reflects on what DSM diagnosis might mean in the consulting room and offers the unusual metaphor of dance to think about how we might best help people.

Doctor and DSM

Photo: Dino ahmad ali
Bring up the topic of DSM 5 and you are immediately engulfed in controversy. It is an intensely polarising topic with people either challenging the relentless medicalisation and drug treatment that it seems to represent, or conversely pointing to the many examples when people have found DSM diagnosis and drug treatment helpful.
DSM does tend to pull people into particular positions in relationship to it, and in the process, often produces conversations that collapse us all into argument and challenge of the “opposing” viewpoint. Rather than engage in debate about whether DSM is good or bad for people, as a therapist I am a lot more interested in exploring different questions. Here’s a question that has meant more to me:

‘What types of relationships and conditions are needed for DSM knowledge and practices to add to personal agency and assist people in reclaiming their lives from problems?’ 

To answer this, I have to understand some of the dangers that lurk within DSM knowledge and practices. Then, I think I need to develop some different understandings and ways of working in order to counter those dangers. I have to understand how I can dance with DSM in different ways and different styles as a person, a therapist and psychiatrist. 

Monday, 16 December 2013

In praise of Alfie

Rock solid childhood friends
Jordy Theiller
The Big Alfie and Annie Rose Storybook ambushed me the other day. It was sitting in the window of a charity shop while I was on my way somewhere. Sentimentality can get you when you’re least expecting it, especially where the children’s author Shirley Hughes is concerned. One minute you’re thinking about what you need from the chemist, and the next about how long it was since you’ve read to your kids, and why the little pests have to grow up so quickly. But they’re off to chat to their mates online and don’t care that you are left clasping a book with a hopeful expression. It helps – a bit – to know that you’re far from the first to go down this road. Literature and modern culture abound with examples. From Peter Pan to Toy Story, it’s clear that leaving behind childish things can be painful; sometimes for the one growing up, but more often for those around them. Is it possible to watch Jessie the cowgirl being thrown out by her owner, without reaching for the tissues?

A recent exhibition of Shirley Hughes’ art suggests that she is predominantly viewed as an illustrator. She has twice won the prestigious Greenaway Medal for illustration and, a few years ago, was asked by Sarah Brown to design the Downing Street Christmas card. I’m not sure that her artwork, beautiful  though it is, completely accounts for my little crisis en route to the chemist, though. Perhaps a more plausible reason is that, while Hughes’ images are memorable, it’s as a writer that she stays with me; as someone who supremely conjures up a world of childhood joys, fears and transitions.