Going beyond the norm

Anne Cooke

I’ve been a bit itinerant this year. The response to Understanding Psychosis and Schizophrenia, the report I edited for the British Psychological Society, has been amazing and I’ve been invited to speak about it in Washington, New York, Seville, Dublin and most recently Milan. So it was great to get an invitation to do something nearer home last month, in our local town of Tunbridge Wells.  I was part of a panel at the annual Critical Voices event. Critical Voices? To tell the truth I wasn’t totally clear about it either. It describes itself like this:

‘The space of medicine, health and wellbeing is one we all inhabit. It is at once complex, often highly technical and grounded in power, politics and debate. It is a space where we have made life changing advances. Yet it is also where we are at our most vulnerable, where our most intimate times of birth, illness, treatment, life and death are played out. Critical in every sense.  Critical Voices provides an opportunity for conversations that explore the voices in this space as we strive to bring together doctors, surgeons, psychologists, patients, carers, campaigners, researchers and academics - intertwined with the expressive insights from film, music, poetry and literature.’

As you might expect, it was a mighty interesting day.  I did a ten minute double-act with my friend and colleague Peter Kinderman, talking about our vision for the future of psychological health care when we stop dividing people into ‘normal’ and ‘mentally ill’. A video of the event is embeded below or you can watch it on Youtube here. 

Robin Williams, depression and the complex causes of suicide

While many people who kill themselves have been experiencing the extreme distress we might think of as depression, that’s not always the case and is rarely the whole explanation. 

This article originally appeared on the Guardian Science Website on the 18th of August 2014 and is reproduced here with permission.

Anne Cooke, Angela Gilchrist and John McGowan

Photo: Eva Rinaldi

As the tributes to the actor and comedian Robin Williams continue, so too do the arguments over the meaning of his death. Suicide is a profound act that touches many, and it would be surprising if it didn’t raise strong feelings. On the one hand we have Shep Smith of Fox News calling Williams a “coward” (he has since apologised). On the other we have a range of articles defending the star, usually along the lines of “don’t blame the guy – he had a mental illness.”

Most of the coverage has encouraged us to see his anguish as a symptom of a sickness as real and biologically based as measles or a broken leg. Just like those afflictions, we’re told, depression can strike anyone out of the blue. A piece by Guardian science blogger Dean Burnett offered a variation on this theme, asserting that depression is an illness and attacking any suggestion that suicidal acts might involve anything but desperation and a wish to escape. While we’re sure that the piece was written with the intention of defending someone in pain, we worry that it contains ways of thinking about mental health that oversimplify complex issues and can be unhelpful.

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

Peter Kinderman and Anne Cooke

Can talking therapies be a realistic response
to psychosis and schizophrenia?
Photo: minds2mend.com

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.

Is Life a Disease?

Anne Cooke and John McGowan

The DSM makes a handy lectern
Photo: Maciej Janowicz

As regular readers of this blog know, we are very interested in the pros and cons of psychiatric diagnosis. We try to discuss this issue in an accessible way and reach as broad an audience as possible. It was a great pleasure, therefore, to be invited by Lewes Skeptics (a Sussex branch of the Skeptics in the Pub network) to give a talk about mental illness, diagnosis, and some of the controversies raised by the new version of the psychiatric classification manual DSM-5. We've since been asked to make the talk available more widely, so we've posted it below. It's a video of the slides, accompanied by a soundtrack recorded on the night.

It was interesting to see that the event sold out in a few days. Since we’re hardly big names, we hope this says something about the level of public interest in mental health. The same happened the last time that the Skeptics put on a mental health-related talk (by psychiatrist Joanna Moncrieff), so something clearly strikes a chord. On the night of our talk the room was jammed, the temperature was hot and the controversy even hotter! Actually that last bit isn’t true. The debate was conducted in the most civil and decorous manner - not always easy when passions on this topic can run high.

We’d like to thank Lewes Skeptics (and in particular Eugene Gill) for hosting the event, and for their commitment to promoting public engagement with important topics. If you want to know more follow them @LewesSkeptics on Twitter. We are also grateful to John Warburton man of many parts, two of which were his very strong forearms. The fortitude with which he acted as a human boom for the recording equipment was admirable. Thanks also to the audience. The pub patrons of Lewes are clearly a thoughtful lot.

You can view the video either in the embedded version below or via the direct link on YouTube. 

There is also a recording of the discussion following the talk. The quality is slightly more variable as questioners were sitting in different parts of the room. The Q&A audio is embedded below or you can listen to it directly on Sound Cloud.

When the Ads Don’t Work

Anne Cooke and Dave Harper 

Is your mind made up about mental illness?
This picture may dispel any doubts.
Photo: Giovanni Cassanese 

It’s a sobering thought that, for many people who use mental health services, other people’s reactions cause more distress than their original problems.   And attitudes may even be getting worse.  A recent report from the Department of Health found that whereas in 1997, 92% of people questioned agreed that ‘we need to adopt a more tolerant attitude towards people with mental illness’, in 2011 only 86% thought that we need to be more tolerant.   Worryingly, young people appeared to be the most prejudiced.

Relatively static attitudes to mental health stand in contrast to the changes there have been in attitudes about ethnicity and sexuality (we currently have a conservative Prime Minister advocating same-sex marriage).  It’s even more surprising given the effort that has gone into anti-stigma campaigns.  For example you may have seen the recent tube posters or TV ads from the government sponsored Time to Change campaign.   So what’s the problem?  Perhaps part of the answer is what campaign ads actually say. Or what they don’t. 

I’m sicker than I thought I was

Anne Cooke

DSM: Get your hernia belt
on for the fifth edition.

One thing I like about being a psychologist is that you get the occasional call from journalists asking interesting questions. The one who phoned the other day was making a radio programme about new mental illnesses. She was referring to the soon-to-be released fifth edition of the diagnostic ‘Bible’, the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association). This newest version is set to classify even more experiences and behaviours as ‘mental disorders’ than its predecessors. For example, binge eating is to become a disease, and in future you may also need expert treatment if you spend too long in front of your computer (‘internet addiction’). Each edition of the DSM introduces us to new diseases. The first edition, published in 1952, was 132 pages long. The 1987 edition (DSM III-R) was 569 pages. By the time the current edition was published in 2000, it had swelled to 943 pages. I wonder how many pages long DSM-V will be, and how many strong men it will take to lift it.

What we often lose sight of is that calling certain emotional states, or ways of thinking and acting ‘mental illnesses’ is just one way of thinking about them, rather than the only way. All we really know is that people sometimes feel or act in certain ways. For example, if I feel sad and hopeless, and stay in bed all day staring at the ceiling, I am likely to be diagnosed with depression. I may be told that I have an illness, and this way of understanding my situation does have its advantages. I can go to my GP and hopefully find a sympathetic ear, maybe some tablets to take the edge off things and perhaps be referred on to someone I can talk to. If I’m feeling so bad that I can’t work, I can take time off sick and even claim benefits. So the idea of mental illness definitely has its plus sides: it gives us a way of talking about difficult things and a framework for offering help. However, I often wonder whether overall, the whole enterprise of finding medical labels and drug ‘treatments’ for what are often arguably problems of living, or in some cases lifestyle choices, actually causes more problems than it solves. To continue the example, thinking of myself as mentally ill might well be a huge blow to my self-confidence. I might conclude that there is little I can do to help myself except to keep taking the tablets. Depending on my diagnosis, I might begin to fear turning into people’s image of a mental patient - strange, unable to function and perhaps even potentially violent. Other people who know that I am ‘mentally ill’, might be prejudiced and treat me as inferior or even frightening. I would find it harder to get a job and, as someone once said to me, “I’m mentally ill” is hardly the best chat up line is it?’ I would also lose some of the human rights I had always taken for granted: people with ‘mental disorders’ are the only group that can be locked up without trial and injected with drugs against their will.