Monthly Archives: November 2012

Dr Richard Gipps ~ Neurotic Theories of Neurosis

This week, the IMH Blog is pleased to introduce blogger Dr Richard Gipps, Charted Clinical Psychologist.  Richard’s blog, Philosophical Perspectives in Clinical Psychology, covers a range of topics including philosophical issues in psychology, psychotherapy and psychopathology, and engaging clients ‘with genuine and fruitful solicitude’.  We encourage you to have a read and check out other posts from his site. 

The post below, entitled ‘Neurotic theories of neurosis‘ was originally posted on 10 November 2012. 

Here’s a hunch: That our theories of neurosis are sometimes rather radically constrained by the ways in which neurosis neurotically invites us to understand it, and by the ways in which we neurotically respond to the invitation.

Here’s a rather simple example to get us going: Geoff says he is ‘falling apart’, struggling to ‘hold himself together’, is worried he is going to ‘lose control’. Ah right, so must we think that the healthy person is one who manages to hold himself together, who is in control of his feelings? But isn’t just this precisely the hubristic idea at the heart of neurotic disorder: that we ought to be managing our feelings, actively holding ourselves together? The idea that this is what mental health amounts to is, it seems to me, clearly absurd – and yet it is all too easy to start thinking this way when we heed the invitation to understand neurosis in a neurotic manner.

What do we have to do with here? In truth it is actually the neurotic person (i.e., admittedly, pretty much all of us some of the time) who tries to keep ‘in control’, who is managing not to ‘fall apart’. For when all really is going well for us we surely aren’t best described as in the business of ‘remaining in control’ or ‘keeping it together’.  That instead is what we do when we are beset by an inner conflict but manage not to show it.

Jonathan Lear

When we are not neurotic we are not beset by an inner conflict; and so, because we are integrated, we have no need for control. When instead I am relaxedly myself then there is no need for me to manage anything inwardly. When all is going well we don’t have to do with, say, ego and id and superego in tension with one another (cf Jonathan Lear on Love and its Place in Nature). We aren’t trying to control unacceptable urges. The patient may come to the doctor because they want help with ‘managing their feelings’; the doctor’s job, however, is to point out the patient’s hidden premise: that feelings need to be managed – to point out that this hidden premise is precisely what is causing the argument not to go through.

Or consider anxious depression. We are often enough encouraged to try to manage our depression, to look after ourselves. In an anxious depression I lose trust that my life will work out as I hope. I become hopeless. My life, one could say, becomes a predicament. But it surely isn’t that, when things are going well for me, it is because I am managing my feelings better, that I am finding reasons to be cheerful, that I am running on hope.

When I am not anxiously depressed I am instead not focused on my own emotional processes, not anxiously thrown back on myself. Instead of thinking ‘how today shall I manage my depression’ I might instead think ‘and how today shall I live, what can I do to live today in the best (most integral, moral, helpful, meaningful) way I know how?’ ‘What responsibilities to others and to myself do I have the opportunity to discharge?’ Depression throws us out of our lives and back in on ourselves. It may seem to be merely inviting us to understand it as a condition – but what is really happening is that we are being invited to understand ourselves as beings who are conditioned. It invokes a passive, causal, language in which the subject is a being now beset by their own feelings, bodies, thoughts, circumstances. The language of agency and genuine subjectivity goes missing. Depression invites us to suppose that what we need to do is to ‘manage our minds’, a challenge which is best left unheeded by anyone who still aspires to genuine subjectivity. (Buber: ‘So long as the heaven of Thou is spread out over me, the winds of causality cower at my heels, and the whirlpool of fate stays its course.’)

Martin Buber

Just as neurosis invites us to understand it neurotically, thereby sucking us in to the neurotic predicament, psychosis invites us to understand it psychotically. We see this in certain theories of ‘made’ thought, feeling and action. …’Ah, what these phenomena (e.g. thought insertion) reveal is that my everyday self-ascriptions of thoughts and feelings actually have a hidden dual character – such that I recognise the thoughts yet must also attribute them to my self.’… But, honestly, can you imagine a more psychotic conception of our allegedly healthy first person aptitudes? Normal thoughts and feelings suddenly become, on this theory, states that obtain in me and which I must recognise for what they are, and recognise as a product of my own psyche. Having a thought suddenly psychotically implicates me in having some kind of inner entity present to my mind. This theory of mind psychotically splits the thinker apart from the thought.

Or consider schizophrenic delusion. Here we have, I would submit, a radical failure of what the analyst’s call ‘symbolism’ – the capacity to find the mot juste to voice, give tractable form to, the feelingful inner life. Instead of the expressive and integrative life of symbol formation the patient offers us a descriptive and explanatory discourse concerning something that is happening to them: this narrative is the crystallisation of the delusion, the patch over the rent in the ego. But then, to make matters worse, the psychologist offers us a theory of delusion as a matter of a subject coming to mistaken explanations about what is going on for them – as if having an explanation here was just fine, it just being the content of the explanation in question which is the problem. (The psychologist, after all, is likely to imagine that we are positioned in the world as sense makers – beings puzzled by their surroundings engaged in their own individual projects of figuring them out. Funny how such an innocent-sounding idea can end up obliterating so much of what is important in being human – such as being someone sensitive to senses and meanings that are already there, sensitive in virtue of their being-in-the-world rather than because of any cognitive endeavours undertaken.)

Or consider PTSD. We are so often invited to think that the problem is as the patient describes: that the problem is that they are having traumatic memories which ‘intrude’ on their consciousness, memories that are not under their control. (Let me be clear: this indeed is a good description for what is experienced: the question concerns what the goodness of the description consists in.) It is as if we are being invited to choose between a conception of memory as happening to us and a conception of it as actively undertaken. But neither of these are normally the case. Rather I, the subject, am of a piece with the flow of my memory which is not (apart from rarely) engaged in in any kind of willed manner. Speaking for myself, I seem to spend a fair bit of my day quite happily in a state of associative daydream; this it seems to me is entirely normal and perfectly healthy. And during this time I quite often recall some of the deeply shocking or upsetting things that have happened to me or to those I love. I do not ‘will’ those memories, since I very rarely, basically never, will any of my memories. The traumas of my life are condensation nuclei around which associative chains cluster; sometimes I must shake myself out of these, but they pass quickly in any case, and this is just normal memory doing its normal thing. A neurotically ill mind, however, may be dissociated from its own memories, unable to bear their affective charge, and the memories will now appear as intrusions, as thrust upon them. It may be these memory intrusions for which they seek help. Now it’s bad enough if I start to construe my memories as ego-alien, to feel them as thrust on me – but now imagine that a cognitive psychologist came along to theorise the whole issue with an mechanised and entified view of memory as a matter of having inner states or processes going on inside us. Or some other mechanistic psychologist (NLP anyone?) suggests that the way forward is in substituting certain ‘cognitions’ for others. Where would be then? (Well: we’d be where we too often find ourselves.)

When we are neurotic it is hard for us to escape, since our every framing thought of the escape route is constructed out of the fabric of the neurotic trap. As if that wasn’t bad enough, it is also all too easy for the clinician to now start to theorise the project of not being neurotic in a neurotic way, to try to help the patient ‘manage their mind’. To use a rather ACT-ish metaphor: the patient asks the clinician to help him find ways to quell or avoid what he takes to be the monster threatening to break down the door of the room in which the patient is hunkered down. Now we clinicians know perfectly well that if the patient were to find the courage to open, rather than push against, this door, the alleged monster would then saunter in and out by himself and in the process shrink down to a much more tolerable size. The patient could also come to see that the monster was nothing but himself. Well, I say we know this perfectly well. But then again, when we theorise, or practice in an overly theory-driven way, it is something which it seems to me is all too easy to forget.

Posted by:
Dr Richard Gipps
Charted Clinical Psychologist
Blog: http://clinicalphilosophy.blogspot.co.uk/

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Dr Simon Clarke ~ Living in Glass-Walled Asylums: The Schizophrenia Commission Report

Last week the Schizophrenia Commission, headed by the mental health charity Rethink, released its report into the current state of care in the UK for people diagnosed with Schizophrenia. It made predictably depressing reading. Amongst other things, employment rates for people diagnosed with schizophrenia are less than 7%. The life expectancy rates are 15-20 years lower than the general population due to physical health-related problems. These health problems are often associated with weight gain, side-effects from powerful anti-psychotic medications. A huge proportion – 87% – of service users report experiences of stigma and discrimination, whilst the cost of schizophrenia to the economy was estimated at around £11.8 billion.

Perhaps even more depressing was report’s findings into the current state of mental healthcare in the UK for people diagnosed with schizophrenia. Mainstream psychiatric care was described as “a broken and demoralised system that does not deliver the quality of treatment that is needed”, in which service users “feel shuttled from one team to another as if on a factory production line”. Inpatient wards are often “frightening places where the overwhelmed nurses are unable to provide basic care and support” and in some cases “so anti-therapeutic that when people relapse and are in need of a period of care and respite, they are unwilling to be admitted voluntarily”. Too often, “medication is prioritised at the expense of the psychological interventions and social rehabilitation” and genuine service innovations like Early Intervention is Psychosis (EIP) teams are “vulnerable to service cuts”. The net result of all this is that psychiatric care “adds greatly to their distress and worsens the outcomes for what can already be a devastating illness”.

As someone who has experienced psychosis, been sectioned, diagnosed with schizophrenia, spent time in an alternative therapeutic community, qualified as a clinical psychologist and worked for two years in an EIP service in London, I can relate to much of this. I found my inpatient stays traumatic and demoralizing. As a result of medication I put on four stone of weight in 6 months. I used cannabis to cope, which of course led to more long-term problems. Thankfully I was helped by an alternative therapeutic community; the love and kindness showed by people in the community helped repair some of the damage from my experience as a psychiatric service user. Supportive but challenging relationships were key, as in fact they always are (Pilgrim et al., 2009).

So before we become self-satisfied with smug complacency about having better attitudes towards severe mental illness than wider society, perhaps we should get our own, crisis, house in order. Attitudes amongst mental health staff can still reflect negative, and inaccurate, expectations of people diagnosed with schizophrenia; in one study for example (Nordt et al., 2006), psychiatrists’ attitudes were more negative than the general population. Health professionals with past or present experience of mental health difficulties are often less likely to disclose their problems to colleagues than people outside the health service (Hinshaw, 2008).

When I was working at a large, well-known mental health research institution a senior colleague once told me, “you only got the job because of your psychiatric history, not because you are a good researcher”. When, whilst working at another NHS Trust, a confused visitor looking for an A & E department was told by a receptionist, “No, no love you’ve got it wrong; this is not a real hospital, this is a hospital for mental people”. The receptionist helpfully added a circular motion beside his head to illustrate what he meant by ‘mental’, just in case the flummoxed visitor (and, presumably, the patients and carers waiting in reception) didn’t understand.

Those in glass houses…

Posted by:
Dr Simon Clarke
Clinical Research Psychologist
Nottinghamshire Healthcare NHS Trust

References:
The Schizophrenia Commission Report (2012): http://www.schizophreniacommission.org.uk/the-report/.

Hinshaw, S.P. (2008) Breaking the Silence: Mental Health Professionals Disclose Their Personal and Family Experiences of Mental Illness. New York: Oxford University Press.

Nordt, C., Rossler, W. & Lauber, C. (2006) Attitudes of Mental Health Professionals Toward People With Schizophrenia and Major Depression. Schizophrenia Bulletin 32(4): 709–714.

Pilgrim, D., Rogers, A. and Bentall, R. (2009) The Centrality of Personal Relationships in the Creation and Amelioration Mental Health Problems: the current interdisciplinary case. Health: an interdisciplinary journal for the social study of health, illness and medicine 13(2): pp.235-254.

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Debbie Butler ~ Work, mental health, and general health

Ever had a re-occurring health problem making time off work an ever increasing problem? Add on top of that a mental health difficulty, and what do you get? In my case very anxious and an enormous feeling of guilt: ‘If I don’t go to work they will think I am pulling a fast one’.

My physical health has been poor these last four years with numerous leg operations. For those of you who have known me for a while you will have grown close to my moon boot, crutches, and plaster. I have seen research showing that those individuals with mental health problems and are employed have a better attendance than those without mental illness. Within my circle of friends I have seen that a lot and am very proud of those that keep themselves in work under self-pressure to keep going. Work is difficult for us all at times, we all have things happening outside of work which can impact on our attendance, but if you add mental health problems to the equation then stress can be exacerbated.

I would be interested in hearing from anyone who may have done research in this area or is contemplating doing so. I do know there is still a lot of stigma around employing people like me. I have the Personality Disorder label and do find some days hard but that shouldn’t stop me going to work. We all have bad days. I don’t give up easily and would advocate work as a real and useful distraction. I remember my first coping strategy when I realised I needed to evade violent and intrusive thoughts was to put the kettle on.  I do it as second nature now, as well as coming to work. I have a great bunch of friends and colleagues in the Institute of Mental Health and look forward to coming to work each day. Instead of sitting on the sofa as I did for ten years doing nothing. Over the last few months I have felt like going back to that sofa but you know I would miss the life I have now with all my friends and colleagues and to be honest I can now go on holidays; for example, I love to go cruising.

Don’t forget, if you need a forum to take research ideas to, let me know at the MHRN and we will get some service users and carers together to help you.

I look forward to seeing you when I get back from my operation.

Posted by:
Debbie Butler
Patient and Public Involvement Officer
NIHR Mental Health Research Network
East Midlands Hub

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Jenelle Clarke ~ Change in Action at the TCTC Annual Conference

Cumberland Lodge (Windsor Great Park)

The Consortium for Therapeutic Communities (TCTC) hosted its first annual conference last month, 22-24 October 2012.  Held at the beautiful and scenic Cumberland Lodge within Windsor Park, it was an opportunity for those interested and/or working in therapeutic communities (TCs) to come together.  The conference itself has been running for several years, organised by the 40-year old Association of Therapeutic Communities (ATC).  Significantly, this was the first year that the newly formed TCTC, which took over from the ATC earlier this year, hosted the event.   This year’s conference theme was ‘Delivering Integrity’.*

I am relatively new to the TC world and this was my first time attending the conference.   This was like no other conference I had attended.  It was not just that each day started and ended with a community meeting (60+ individuals sitting in a circle, talking and reflecting as a group on the days’ events), the Greek dancing, the multiple cheerful toasts at dinner, or that at times the conference resembled a type of family reunion; it was more the atmosphere and purpose of this conference that set it apart.

On the first day, members of the TCTC (formerly members of the ATC and Charter House Group) had the opportunity to vote for the first TCTC board of directors.  This was no small thing – it was not only saying goodbye to 40 years of the ATC, it was asking the question, what do we want next?  Conference delegates had the task of discussing the future direction of TCs, what type of organisations/communities TCs should include (or perhaps more importantly, exclude), what the ‘mission’ should be, building a solid research evidence base, lobbying and advocating for community approaches within mental health / education / social care, and how the TCTC should go about all of this.  There was much discussion and debate; however despite the variety of voices in the room, it was clear that the current direction of TCs has to change to become more proactive, rather than reactive, to changes in government policy and funding.  For some, this sparked feelings of loss at having to let go of the old.  For others, especially those of us who are new to the TC world, it felt rather exciting and optimistic.

Having ushered in TCTC and started the conversation as to the future of TCs, Day 2 of the conference moved on to explore ‘Promoting Integrity’.   To that end, presentations included a keynote address from Professor Colwyn Trevarthen titled ‘The Social Brain: The Healing Power of Emotions’; a talk by Mark Johnson, ‘Reclaiming Integrity after a Destructive Childhood’; and Leonie Cowen, ‘Integrity in Commissioning: Ensuring Needs are Met’.

Drawing Room – where 3 stories of personal change were given (Day 3)

Day 3 of the Conference, which specifically looked at ‘Demonstrating Integrity’, included a presentation from the TCTC Research and Development Group, research paper presentations, life stories of personal change, and a presentation and video on the MAL-HER-JUST-ED project (for more info about this project, please see the Performance and Workshops section on the Therapeutic Living with Other People’s Children website).

At the final community meeting of the conference, the feeling in the room still held one of excitement and of hope for the future of TCs.  Whether that can be translated and then sustained in terms of real life policy and funding challenges remains to be seen.  However I am an optimist, and as an American my faith in the optimist approach was restored in last week’s US presidential elections.

President Obama

Just like Obama managed to pull off a re-election win during trying times in American (and world) history, I would like to believe that TCs too will find a way through the funding cuts, the individualist and at times isolationist approach to mental health and social care.  But, as with Obama, there is real work to be done as the challenges and oppositions we face will be with us for some time.  And will likely get worse.  So the question remains, despite all of this, what will 40 more years of TCs bring?

(*NB: Rex Haigh also wrote a blog post about the TCTC Conference: TCTC: born 22/10/12, Windsor, England.  As a regular conference attendee for many years, he provides a much more in-depth perspective about all these changes and talks more fully about the presentations and speakers.  I highly recommend it!)

Posted by:
Jenelle Clarke
ESRC PhD Student (Sociology)
E: lqxjmcl@nottingham.ac.uk


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Dr Hugh Middleton ~ Mental health care: working together to reach full potential

Dr Hugh Middleton (Consultant Psychiatrist Nottinghamshire Healthcare NHS Trust and the University of Nottingham’s School of Sociology and Social Policy) writes on how research is identifying success stories and offering new strategies for collaboration:

To précis, mental health professionals need to work together if they are to fulfil their potential and deliver the best possible patient care, a new report has revealed (ref. below).

Hospital soap operas, everyday experience and what we hear about the “state of the NHS” all draw attention to strife between those who “do” health care and those who manage them, so it is good to see publication of some fresh research that tries to rise above this. October 10th saw publication of the final report from a three-year investigation of multi-disciplinary team working in mental health. Numerous investigators were involved, including Dr Hugh Middleton and other participating organisations (e.g. Nottinghamshire Healthcare NHS Trust).

Healthcare professionals must work together as effective teams if they are to provide the best possible patient care. This is important for mental health services where quality includes consistency and a reassuring sense of being known and understood. Providing these and at the same time working in shifts, so that the service is available beyond office hours, is difficult without great team processes.

Previous research shows that many multi-professional teams fail to perform to their full potential, as they are not clear about their objectives, disagree about goals, their leadership and how to work together; or they find themselves trying unsuccessfully to meet the conflicting demands of senior managers from different disciplines. The Healthcare Commission has discovered that as many as half of all NHS staff may work in dysfunctional teams, which can jeopardise patient care and undermine staff well-being.

The overall aim of this research was to explore such issues in more focused detail amongst teams providing NHS mental health services. A variety of settings were investigated. Service users, their families and friends, a range of mental health practitioners and service managers were all consulted in the course of developing a novel measure of community mental health team effectiveness. Some 1500 practitioners from 120 teams took part in a survey which estimated how effective such teams were, and reported upon what it was like to work in them.

There were strong associations between team effectiveness, measured on a scale which reflects service users’ views of good and bad practice, and the quality of team working. This was assessed using the Aston Team Performance Inventory, a well-established measure of team working. Particular success in providing good quality mental healthcare was found amongst teams that had a clear sense of purpose, welcomed participation in creative problem solving and were well led in a style that encouraged reflective practice.

Alongside this survey the investigators also observed a number of team meetings and interviewed 114 service staff, 31 service users and 13 users’ informal carers. This qualitative research enabled enquiry into the interactions that lie behind numbers derived from the survey. In terms of what matters to service users it revealed disparities between what they find important, such as relationship, flexibility, availability, consistency and understanding, and requirements of the organisational settings from which care is provided.

Of service users, in the words of one community mental health team manager:

“… they don’t really want to see the paperwork and they don’t really want to see the risk assessment, don’t really want to see the care plan, sometimes they’ll talk to us about the care plan but they don’t want copies of it … a care plan doesn’t mean anything to them in that sort of sense but I think we do keep trying to engage with them … “

In relation to creativity, in the words of a support worker:

“So there may be some patients who would really, really benefit from you say taking them for a day at the seaside, because that was what they remembered their parents doing for them when they were little and that would mean so much for them to do that. We obviously can’t do that, and time is probably our most valuable resource really”

These are readily dismissed as intuitive and predictable findings. Perhaps unsurprisingly they relate good clinical mental health outcomes to team creativity, task focus, participation, supportive leadership and interest in true relationship. On the other hand they are also timely and novel. They identify clear relationships between organisational determinants of the practitioner’s context and well-being, and the outcome of their clinical activities. It will require further studies to establish whether such interactions are also present in healthcare settings that are possibly less dependent upon practitioners carrying out “emotional work”, but an element of that is present in all health care settings. What this research demonstrates is that the success with which “emotional work” is conducted, in part reflects the practitioner’s emotional well-being and that is in the hands of those who manage and commission health care. There are connections between the management of health services and the service user’s experience which are not simply reflections of business efficiency, but provide the creative commissioner or manager with more sophisticated opportunities to influence real outcomes.

Reference:  West M, Alimo-Metcalfe B, Dawson J, El Ansari W, Glasby J, Hardy G, et al. Effectiveness of Multi-Professional Team Working (MPTW) in Mental Health Care. Final report. NIHR Service Delivery and Organisation programme; 2012.

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Dr Rex Haigh ~ The World Psychiatric Association International Congress 2012 Conference

Whilst attending the World Psychiatric Association International Congress 2012 Conference (held 17-21 October), Rex Haigh, an NHS consultant psychiatrist, wrote a blog post for every day of the conference.   With a packed conference schedule of activities from 6:30am to 11pm, Rex reported on the variety of presentations, themes and discussions that emerged over the five days.   To highlight the conference, we have selected one post to reblog in full, covering the presentation from Rex’s team and a variety of poster and speaker presentations from Day 2: More than 17 (just).

We would highly recommend checking out the rest of his posts as it appears to be an excellent conference with thought provoking themes arising.  To access all of the conference daily posts, please see the following on Rex’s blog:

The Yerkes-Dodson Test (Day 1)

(Day 2 is posted below)

Ulysses or Lithium? (Day 3)

Wheeling, Dealing and Scheming (Day 4)

The Kindergarten of Democracy (Day 5)

 

Featured Post by Dr Rex Haigh: More than 17 (just) 

Arriving for breakfast at 0632, I was surprised (and very pleased) to see I was
the last one there. We ate rather silently and nervously, and got the metro to
arrive in our presentation room just after 7am. We put up our display posters
either side of the stage, and leaflets on all the seats; we adjusted Yousuf’s
powerpoints a few more times,and finally handed it over to the technicians.
Then we waited…

Although there were only 3 attendees there on the dot of 0800 (our official starting time), somebody did say that lots more were outside the congress centre, just arriving – so we waited a few minutes before starting.

Soon there were 17 and by the end we had about 30, though there was some coming and going. The talks went pretty well exactly to time and to plan, and are available on the LLE website www.livinglearningexperience.com.  Afterwards, we breathed a sigh of relief and had the freedom to enjoy the rest of the congress.

Nearly 17 by now

C B Nemeroff (USA) gave the first plenary lecture – on Neurobiology of Child Abuse and Neglect – and gave a dazzling exposition of the genetic, neuroimaging and pharmacological bases of adult consequences of childhood trauma and abuse, and how the people with histories of maltreatment had different brains. Although he seemed to deliberately avoid the PD label, it was almost a return to the days of ‘endogenous v reactive’ depression – except over a life course, rather than weeks or months. Quite reassuring to those of us who fear being eclipsed by the biomedical juggernaut driven by the economics of the pharmaceutical industry.

Then to the posters – hundred of them from all over the world; interestingly all of those from latin countries bearing a prominent ‘no conflict of interest’ declaration, none of which would have suggested any such suspicions. Is this an international version of the UK ‘health and safety’ culture, used to destroy trust and spread persecutory anxiety? And next to the poster, a display of restraint cages through the years, and straitjackets exhibited like a fashion display. Was this deliberate irony?

Bed shortage?

C&R?

PICU?

Straitjacket couture?

Next to a heart-warmingly reassuring session by Czech psychiatrists and therapists from The International Centre for Integrated Psychotherapy (Knobloch). Heart-warming because it was human-scale and clinical, reassuring because it is a TC by any other name. Although they only briefly referred to TCs, I asked if they recognised the British TC tradition, with Maxwell Jones and all, as their work seemed so familiar: and indeed they did. Somehow, we should be making friends with groups like this.

Towards the end of the afternoon, were workshops. The title of ‘Innovation in Psychotherapy Education’ was catchy enough to attract me, but for some reason, my heckles were soon raised once there. It was a sharply commercial presentation of an elegant and well constructed Moodle website for training in basic psychotherapy – not unlike KUF in its design, but lacking the radical ‘relational’ edge that I think is essential in any therapeutic engagement. A sales pitch, I suppose, when I was looking for realttitude change, I suppose – tackling ‘us & them-ness’ – ever seeking that dear old ‘quality of relationship’ again.  After an initial altercation which Yousuf and I had with the presenter – about the viability of hard evidence-based rules for all psychotherapies – I meekly shut up and watched nigh on a dozen video clips of very self-assured therapists teaching how to do CBT…

The final session was much more cheering, though. Professor R S Murthy was being presented with a special prize. The purpose, structure and committee for this prize was explained at great length before the ceremonial exchange of gifts and flowers and the lecture could begin. Professor Murthy is recently retired Dean of the NIMHANS – ‘the Maudsley of the Subcontinent’ in Bangalore – and I explained to him before the talk about our link with ASV and the intention to do an LLE there in the next year or two. Maybe we should do a second one for NIMANHS residents! But he was great – talking our language like few others did here.

Here’s the points from two of my favourite slides of his. This one gave seven criticisms of the current ways of psychiatric thinking and practice:

1.       Medicalisation of suffering
2.       Vague diagnosis
3.       Mainly pharmacological interventions
4.       Doubtful outcomes
5.       Insensitivity to local customs and practices
6.       Loss of personal context
7.       Psychiatric imperialism

And this one gave three points for the ‘paradigm change’ that’s needed for world mental health to improve:
  • Recognition of the central role of people and families
  • Information and interventions for them
  • Professional development to share this
Back for a celebratory meal of stroganoff with dumplings and Czech beer at a cosy little restaurant just near the hotel. But rock on Professor Murthy – you’re my main man!
Posted by:
Dr Rex Haigh
http://greenshrink.blogspot.co.uk/

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Helen Smith ~ Changing the approach to self-harm in young people

In 2006, The Mental Health Foundation reported that 1 in 12 young people self-harm. This year, YoungMinds, a mental health and emotional wellbeing charity dedicated to children and young people, have been working in conjunction with Cello PLC’s ‘Talking Taboos’ campaign to conduct extensive research into self-harm in young people. The published report entitled, ‘Talking Self-Harm’, detailed that inpatient admissions over the last year alone have risen by 10% in under young people under the age of 25. It is likely however, that numerous young people coping with self-harm remain undetected for a number of reasons addressed below, and therefore these statistics are likely to underestimate those affected.

‘Talking Self-Harm’ details that two thirds of teachers, parents and young people who took part in the research feel more uncomfortable talking about self-harm than other issues such as eating disorders, drug use, smoking, bullying and binge drinking. They would additionally be concerned that they would say the wrong thing if a young person who self-harmed turned to them. Whilst young people reportedly feel most comfortable approaching the internet for help regarding self-harm, this may be detrimental as the information available online is variable and can present dismissive attitudes rather than supportive attitudes. 50% of young people included in the research acknowledge that they should in fact be approaching parents and GPs for help instead of the internet, however only 10% said they would feel comfortable doing this.

Regarding groups in a position to offer help to a young person affected by self-harm, parents typically reported that they would perceive self-harm in a young person as failure as a parent, and a third of parents would not seek help with a health care professional.  Almost half of the GPs reported that they did not really understand young people who self-harm, whilst a third were concerned about what language to use when consulting with a young person about self-harm. Teachers reported feeling ‘helpless’ on the issue and the majority expressed that they would like clear practical advice and materials to help young people address self-harm. All groups reportedly have trouble empathising with young people who self-harm.

These points highlight serious weaknesses in the social support network and the professional help that should be available to young people who self-harm and furthermore exposes the need for us all to talk more about this sensitive topic so that we can more readily support those who need it. It is not surprising that nearly 4 out of 5 young people who completed the research said they don’t know where to turn to for advice about self-harm. It is apparent that although most people acknowledge the seriousness of self-harm, too many feel they are not in a position to offer appropriate help and support. The report calls for increased awareness and handling of self-harm in young people if we are to break down the barriers and stigma that currently prevent people from seeking and receiving the help and support they need.

Posted by:
Helen Smith
PhD Student (Division of Psychiatry)
Institute of Mental Health

Resources

The Mental Health Foundation ‘Truth Hurts’ report is freely available at:
http://www.mentalhealth.org.uk/content/assets/PDF/publications/truth_hurts.pdf?view=Standard

The YoungMinds and Cello PLC’s Talking Taboos ‘Talking Self-Harm’ report is freely available at:
http://www.cellogroup.com/pdfs/talking_self_harm.pdf

A BBC interview with a woman coping with self-harm is available at:
http://www.bbc.co.uk/news/health-20039008

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