What lurks beneath?

John McGowan

Are nice neighbourhoods all they seem?

As those who check in regularly with this blog know we do occasionally manage a bit of culture (films and books), when it’s related to psychology and mental health. It’s a great pleasure therefore, not only be able to talk about a new novel that goes into both areas, but to interview the author.

Beth Miller is a novelist who used to be a psychologist (she's got a doctorate that doesn't make it to her book covers). Her most recent novel The Good Neighbour is part domestic drama, part psychological thriller, part exploration of some scary places in the human psyche. It starts in a nice street, in a nice town (Hove, actually), with nice neighbours. We initially see this through the eyes of Minette, a rather bored stay-at-home mum, who makes friends with Cath: older, feistier and coping incredibly with her son Davey’s illness. Under Cath’s spirited influence Minette also becomes a different sort of friendly with the hunky fellow down the road.

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. 

Is supporting populist political parties a mental disorder?

John McGowan makes the case

Commitment? Or sign of illness?

It’s just over a month until the UK general election and many Brits seem to have lost trust in their traditional politicos. Whether it’s the UK Independence Party (UKIP) scapegoating the European Union and immigrants, a rise in nationalism (the Scottish National party), or  Russell Brand’s teenage anarchism, faith in facile, and sometimes ugly, solutions is on the march.  It’s a huge relief, therefore, to hear that the editors of the DSM (the main reference book for psychiatric classification), are considering a new category of disorder to cover this condition. Clearly many critical things have been said about the burgeoning amount of psychiatric diagnosis, here and elsewhere. However, I’ve just looked at the DSM draft entry (reproduced below), and think that this time, the American Psychiatric Association might really be onto something. In fact, all I can say is bring it on. 

Electroconvulsive Therapy: Whose decision is it?

@steweatherhead & @THEAGENTAPSLEY

What does consent to treatment mean?

Lisa is a 42 year-old woman. She has had a difficult life. She has experienced multiple traumas and has at times struggled with her emotions. Lisa has a few close family members and a small social circle, though she does at times feel a bit oppressed by them. In 2010 Lisa contracted HIV. She has been treated medically and was stable for some time, however in 2013 she started to deteriorate. She was seen by a psychologist as well as by medics. After a further twelve months she had had enough of interventions and decided she wanted to live the remainder of her life in her own way. Her family and friends objected as they could see she would rapidly deteriorate. However with support from professionals, Lisa utilised the Mental Capacity Act (MCA) to set some advanced directives. She was found to be capable of making these decisions under the MCA, and was legally allowed to refuse further intervention. Lisa did indeed deteriorate, and died a few months later in her own home with her family and friends around her.

Guest post: 'Schizophrenia then and now'

Continuing our recent reflections on how things in mental health have changed Richard Hallam and Michael Bender take the long view of schizophrenia

The cuckoo's nests have closed. What
else has changed in mental health?

The theme of this year’s World Mental Health Day on 10th October is Living with Schizophrenia. For those of us of a certain age, and with a historical bent, it’s also an opportunity to compare services now with those provided when we started out in the 1960s. Recently we’ve had the privilege of editing the diaries and letters of a young man, David, a patient in the mental health system five decades ago. The resulting book offers, we think, a window into the social attitudes of the time and the way mental health problems were treated.

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.

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.

Is it time to call time on Community Treatment Orders?

John McGowan

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.