The Independent have been running a series called ‘If I were Prime Minister’ where they’ve asked a diverse range of people what they would do if they were PM. I written a brief piece for them where I talk about why we need to make hospital care for people with psychosis much less distressing.
It’s worth saying that I’d make a rubbish Prime Minister (“Exchange rate, yep, are there any snacks in here?”) but before I’d get the Queen to let me off the hook, I’d certainly make transition to psychiatric hospital care a much more positive experience,
Being treated in hospital under section is one of the most serious psychiatric interventions but you may be surprised to hear that it is one of the most poorly researched. We have so little evidence about what works and how to help people in a way that is safest for both their physical and their mental health. So if I were prime minister, I would ensure that the transition to inpatient care, for the most seriously unwell, was also a priority for research, funding and improvement.
It’s not fashionable to talk about gentleness in healthcare but it is exactly what is needed for people in crisis. Through neglect and under-funding, we have created a system that makes the time, consistency and environment needed for gentleness almost impossible to achieve – both for the staff who want to provide it and for the people who need it most. We are using our sanctuaries as warehouses and they need reclaiming.
Link to piece on crisis care in mental health.
Somewhat unexpectedly, Vice magazine has just launched a series of articles, videos and interviews on mental health, and it’s really very good.
The VICE Guide to Mental Health covers the science of mental illness, what it’s like being sectioned, recovering from suicide or being severely anxious, and the social issues in getting mental health care, to name just a few of the many articles.
It also covers sex and drugs (it is Vice magazine after all) but even those are pretty good.
The series has been done in collaboration with the mighty mental health charity Mind and is well worth your time.
Link to The VICE Guide to Mental Health.
Last year I did a talk in London on auditory hallucinations, The Beach Boys and the psychology and neuroscience of hallucinated voices, and I’ve just discovered the audio is available online.
It was part of the Pint of Science festival where they got scientists to talk about their area of research in the pub, which is exactly what I did.
The audio is hosted on SoundCloud which gives you an online stream but there’s no mp3 download facility. However, if you type the page URL into the AnythingToMP3 service it’ll present you with you an mp3 to download.
It was a fun talk, so do enjoy listening.
UPDATE: The nice folks at Pint of Science have made the mp3 downloadable directly from the SoundCloud page so no second website trickery needed.
Link to audio of Vaughan’s talk on hallucinated voices.
The Psychologist has a fascinating article on how neuroscience fits in to our understanding of mental illness and what practical benefit brain science has – in lieu of the fact that it currently doesn’t really help us a great deal in the clinic.
It is full of useful ways of thinking about how neuroscience fits into our view of mental distress.
The following is a really crucial section, that talks about the difference between proximal (closer) and distal (more distant) causes.
In essence, rather than talking about causes we’re probably better off talking about causal pathways – chains of events that can lead to a problem – which can include common elements but different people can arrive at the same difficulty in different ways.
A useful notion is to consider different types of causes of symptoms lying on a spectrum, the extremes of which I will term ‘proximal’ and ‘distal’. Proximal causes are directly related to the mechanisms driving symptoms, and are useful targets for treatment; they are often identified through basic science research. For example, lung cancer is (proximally) caused by malfunction in the machinery that regulates cell division. Traditional lung cancer treatments tackle this cause by removing the malfunctioning cells (surgery) or killing them (standard chemotherapy and radiotherapy)…
By contrast, distal causes are indirectly related to the mechanisms driving symptoms, and are useful targets for prevention; they are often identified through epidemiology research. Again, take the example of lung cancer, which is (distally) caused by cigarette smoking in the majority of cases, though it must be caused by other factors in people who have never smoked. These could be genetic (lung cancer is heritable), other types of environmental trigger (e.g. radon gas exposure) or some interaction between the two. Given the overwhelming evidence that lung cancer is (distally) caused by smoking, efforts at prevention rightly focus on reducing its incidence. However, after a tumour has developed an oncologist must focus on the proximal cause when proposing a course of treatment…
The majority of studies of depression have focused on distal causes (which psychologists might consider ‘underlying’). These include: heritability and genetics; hormonal and immune factors; upbringing and early life experience; and personality. More proximal causes include: various forms of stress, particularly social; high-level psychological constructs derived from cognitive theories (e.g. dysfunctional negative schemata); low-level constructs such as negative information processing biases (also important in anxiety); and disrupted transmission in neurotransmitter systems such as serotonin.
It’s not a light read, but it is well worth diving into it for a more in-depth treatment of the brain and mental illness.
Link to Psychologist article neuroscience and mental health.
I’ve got an article in The Observer about how the official definition of trauma keeps changing and how the concept is discussed as if it were entirely intuitive and clear-cut, when it’s actually much more complex.
I’ve become fascinated by how the concept of ‘trauma’ is used in public debate about mental health and the tension that arises between the clinical and rhetorical meanings of trauma.
One unresolved issue, which tests mental health professionals to this day, is whether ‘traumatic’ should be defined in terms of events or reactions.
Some of the confusion arises when we talk about “being traumatised”. Let’s take a typically horrifying experience – being caught in a war zone as a civilian. This is often described as a traumatic experience, but we know that most people who experience the horrors of war won’t develop post-traumatic stress disorder or PTSD – the diagnosis designed to capture the modern meaning of trauma. Despite the fact that these sorts of awful experiences increase the chances of acquiring a range of mental health problems – depression is actually a more common outcome than PTSD – it is still the case that most people won’t develop them. Have you experienced trauma if you have no recognisable “scar in the psyche”? This is where the concept starts to become fuzzy.
We have the official diagnosis of posttraumatic stress disorder or PTSD but actually lots of mental health problems can appear after awful events, and yet there is no ‘posttraumatic depression’ or ‘posttraumatic social phobia’ diagnoses.
To be clear, it’s not that trauma doesn’t exist but that it’s less fully developed as a concept than people think and, as a result, often over-simplified during debates.
Full article at the link below.
Link to Observer article on the shifting sands of trauma.
Articles on people’s experience of the altered states of madness often fall into similar types: tragedy, revelation or redemption. Very few do what a wonderful article in Pacific Standard manage: give an account of how a young couple learn to live with psychosis.
It’s an interesting piece because it’s not an account of how someone finds the answer to loving someone who has episodes of psychosis, it’s how a couple find an answer.
It discusses psychiatry, antipsychotics and R.D. Laing but not in terms of what we should or could think of psychosis and society, but what one couple takes from them – finding value where it helps.
Touching, genuine, unpretentious and uncensored.
It is romantic in the truest sense.
Link to ‘My Lovely Wife in the Psych Ward’.
PBS has an article on ‘How economic theory can help stop sexual assault’ which despite its unappealing title is actually a genuinely thought-provoking piece on how game theory and social norms marketing could help prosecute and prevent sexual violence.
Both approaches look at how people’s behaviour is shaped by their perception of other people’s beliefs and behaviour.
People are less likely to report rape when they think they’re going to have to do it alone and people are more likely to intervene to prevent violence if they believe other people will also intervene.
The article discusses two existing interventions to tackle sexual violence based on game theory and social norms marketing and the article is also a great guide to the theories themselves.
Link to PBS article on approaches to preventing sexual assault.