Tag Archives: mental health

A change of pace

I haven’t posted here for a while. I’ve been busy with other things but now I’m back and I’ll be making a few changes. It’s a new direction… a new road ahead.
I plan to focus more on short, punchy videos instead of the longer ones I’m used to. One or two minutes seems more social media friendly and perhaps easier to fit with peoples’ busy lifestyles.
I hope you enjoy the new style.

Self-harm parents

It’s unfair and inaccurate to pretend that all parents of people who harm themselves are to blame. There are parents who treat their children in horrendous ways and who really do cause long term mental health problems. But they are not the norm.
Most parents, although fallible like everyone else, are ‘good enough’.

Video: Why I’m not anti-psychiatry

Regular followers of my stuff might be forgiven for thinking that I’m opposed to psychiatry and the biological model. After all I regularly complain about the standard medical approach with its reliance upon medication to treat mental disorder – especially relating to antipsychotics for people diagnosed with disorders like schizophrenia and bipolar disorder. But that doesn’t mean I’m ‘antipsychiatry’ – just that I’m cautious. This is especially true where medications are concerned.

The list of side effects (otherwise known as undesirable consequences) that accompany psychotropic drugs can be a major problem but the same is (and has always been) true of all medications from AZT to aspirin. If a particular person suffers side effects from a particular drug then there’s a case for trying a different drug or even a different dose but that, in itself, isn’t really a case for scrapping all antipsychotic medication. All we can really say is that we need to be cautious about medication and avoid the ‘hammer to crack a nut’ approaches of the past.

Medications are biological tools. They are chemical preparations designed to make chemical changes in the physical body. This is because of an assumption that mental disorders are caused by physical (specifically chemical) problems. But is this always true?

Combat veterans are known to develop psychotic disorders as a result of their experiences spending time in active service. It seems ridiculous to assume that all these men and women (who had passed psychological evaluation before entering the battlefield) suffer from organic brain disorders. Yet their symptoms are similar, if not identical to those experienced by many of their civilian counterparts who are diagnosed with major psychotic disorders and treated with chemicals.

Combat veterans suffer a form of psychosis that is caused not by biology but by stress.

For these people I think that there is an excellent case for using medication to treat their distress and to provide a degree of respite from their symptoms but that’s not the same as cure. That’s one thing I do disagree with traditional psychiatry about. I believe that recovery is attainable for many more people than the drug companies would have us believe. Happily though, so do many modern psychiatrists. People like me who advocate recovery aren’t so much joining the mainstream as the mainstream is catching up. That’s a nice feeling.

There are, of course many people who argue vehemently that psychiatry is flawed and that medication should never be ‘used on’ mentally ill people. However, sincere though I’m sure these people are, they may well fall into the same trap as the overly zealous arguments in favour of using too much medication. They may be too general.

Just as not all cases of psychosis seem likely to be chemical, so not all cases need necessarily be purely stress related. Whether the argument is in favour of medication or against it there is a real problem with polarisation and over-generalisation in mental health care. The disadvantage of these ‘black or white’ arguments is that they assume that everyone is the same and that everyone needs the same sort of intervention.

This sort of one-sidedness can feel easy and comfortable for those doing the arguing but there’s a price to be paid for superficial reasoning. The price is poor treatment because of flawed assumptions that compare chalk and cheese and assume that they are the same thing.

And that price is not generally paid by the individuals doing the arguing. It’s paid by the mental health service-user whose options for recovery are limited not by lack of knowledge but by stubborn refusal on both sides of the argument to look beyond their own, pet theories.

If I seem a little hard-nosed about this it’s for good reason. I was trained in the traditional way where medication and unquestioning acceptance of the biological hypothesis were everything. I was at the extreme ‘medical’ end of the continuum.

Then I was lucky enough to be selected by the NHS for further training at the Post Graduate level. I spent two years part time being exposed to the other side of the argument and, like many of my peers, became just as rabid in my defence of social and psychological perspectives instead. I was for a while the typical antipsychiatrist (or more accurately ‘antipsychiatric nurse’). And that felt good.

Today I’ve moved on a little from either of those two positions. Now I am able to see past the partisan posturing of either side and I try to walk the middle line. It seems to me that balance is everything. Isn’t that usually the case in the real world?

I no longer see much of a place for extremism in mental health care – especially when those who pay the price are not the ones making the arguments.

Please don’t misunderstand me though. I am far from an apologist for the biomedical status quo. I believe that medicine may well have something very positive to offer in relation to symptom management but in most cases that’s about all. I think that true recovery is generally achievable in other ways. But that’s for a later video.

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Stoicism for mental health 1: Introduction

Stoic philosophy isn’t the dry, humourless approach to life that many think it is. ‘Stoic joy’ comes from the ability to manage and control our emotions, the ability to choose our feelings without being blown this way or that by the winds of fortune.

Much of modern mental health practice comes from the wisdom of the ancient Stoics. Some of our most successful modern therapies are derived almost exactly from the Stoics whose philosophy leads inevitably toward happiness, contentment, self control and yes, joy.

This video series introduces the basic elements of Stoicism to a modern audience. It’s the antidote to the instant gratification, consumer culture that is the root of so much misery today.

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Expectation

Care workers need to learn from past experiences.
The best predictor of future behaviour is past behaviour.
But the people we work with can change too.
The whole point of much of our work is to help them to change.
How can we balance past behaviours and future potential?
How do we promote change without becoming naive and vulnerable?

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Wisdom from Weyland’s Smithy

What’s important in your life? What are you involved in that’s more important then you are yourself?

Thousands of years ago our neolithic ancestors came together to create collective tombs and monuments that were far more important than any of the individuals who helped to construct them.

Here at Weyland’s Smithy we see the remains of one such structure. The now exposed chambered tomb, once covered by a mound of earth, stands testimony to the human need to achieve something bigger than ourselves.

In the modern consumer-driven world we’re encouraged to believe the lie that happiness comes from what we own, what we can afford to buy, how much money we have in the bank and how our stuff compares to the acquired stuff of our neighbours. But that’s not the path to mental health – it’s the path to mental disorder, to neurosis, self-loathing and petty jealousy.

True happiness comes not from what we have but from what we do. When we commit to something bigger than ourselves we leave a lasting impression on our world. We touch others in unexpected ways and our own mental health benefits as a result.

As I was filming I came across a fellow lover of all things Neolithic called Gary. He too understands the importance of monuments like the Smithy and the pull that they can have across the ages. He explains his reasons for visiting sites like this in his own words at the end of the video.

What’s important in your life?

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Labelling, recovery and therapeutic optimism

 Back in 1963, researcher David L. Rosenhan masterminded an elaborate hoax. It was a scam designed to study the effects of labelling upon clinical practice and to determine whether psychiatric diagnosis is based upon professional skill or simple expectation and prejudice. It was a bold experiment with profound implications for clinical practice even now almost half a century later.

The idea was simple enough. Rosenhan persuaded a group of confederates to approach state hospitals in America and request a consultation. Each told the psychiatrist who assessed them that they had begun to hear a voice which said “Empty”, “Hollow” or “Thud”. That was enough to secure them a bed in the local psychiatric hospital. But that wasn’t all, bad though that low threshold for admission might be, in itself.

Once admitted on to the ward Rosenhan’s confederates ceased any pretence of voice-hearing. They behaved perfectly normally and showed no symptoms of mental disorder at all. At this point we might expect the staff running the ward to smell a rat but that’s not what happened. Whilst the fellow patients could tell very quickly that their fellow patients weren’t actually ill, the staff apparently could not.

Even perfectly ordinary activities such as writing was seen as pathological. Pacing up and down through boredom in this secure, low-stimulus environment was interpreted as a sign of illness. It seems that once the label of ‘mentally ill patient’ was applied everything the confederate did was interpreted by those lights.

The staff saw precisely what they expected to see.

This mirrors an earlier study by Rosenhan and his colleague, Jacobson who examined teachers’ attitudes to students who had arbitrarily been tagged either as ‘bright’ or ‘not bright’ by the researchers. The school, known as ‘Oak school’ to protect the identities of all concerned, also lived up to expectations of labelling theory. Not only did teachers interact with children in accordance with the labels they had been assigned, but the children also began to live up or down to the expectations of the teachers – even though their actual test scores had been ignored when they were randomly assigned ‘bright’ or ‘not bright’ status. Each child took on the behaviours and traits of the label, regardless of their actual abilities and achievements.

This is why it is so important that we understand labelling in our work with people who have mental disorders. Whatever we believe and expect is likely to come true.

If you want the people you work with to recover you need to start believing that they can, and you need to act upon that belief. Remember that recovery is built upon lots of little steps in the right direction and we can encourage that simply and effectively by doing relatively simple things, things like offering praise, acknowledgement, recognition and practical help, repeatedly and well.

That’s hardly rocket science, is it?

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