Hallucinating children

CC Licensed Photo by Flickr user Tali Le Bamba. Click for source.I’ve got an article in The Observer about childhood hallucinations which are much more common than we previously imagined.

You tend to get one of two reactions when you discuss children hallucination: that’s obvious – children live in a fantasy world, or that’s horrendous – there must be something very wrong with them.

The answer is that neither response is particularly accurate. Children’s fantasies are not the same as hallucinations but neither are they normally a sign of something ‘going wrong’ – although certain forms of hallucinations can suggest a more serious problem.

Hallucinations often reflect a bizarre, blurry version of our realities and because play is an everyday reality for children, the content can seem similar. Both can contain quirky characters, strange scenarios and inspire curious behaviour. One child described how he saw a wolf in the house, another that he had “Yahoos” living inside him that ate all his medicine. On the surface, these could just as easily be a child’s whimsy, but genuine hallucinations have a very different flavour. “In play and make-believe, children are imagining,” says Elena Garralda, a professor of child and adolescent psychiatry at Imperial College London. “They do not have the actual perceptual experience of seeing and hearing.” Another key difference, notes Garralda, is that “hallucinations feel imposed and children cannot exercise a direct control over them”.

There’s more on these fascinating experiences in the full article linked below.

Link to ‘Childhood hallucinations are surprisingly common – but why?’

A less hysterical reaction

CC Licensed photo by Flickr user Les Black. Click for source.There’s a fascinating article in The Guardian about one of the least understood aspects of human nature: experiences like blindness, paralysis and seizures that seem to mimic gross damage to the nervous system but aren’t explained by it. People can experience profound blindness, for example, but have no detectable damage to their visual system.

These difficulties have various names: conversion disorder, hysteria, dissociative disorder, medically unexplained symptoms, functional neurological symptoms, somatoform disorder, or are denoted by adding the word ‘functional’ or ‘psychogenic’ to the disability.

The original concept, usually falsely attributed to Freud but actually first suggested by French psychologist Pierre Janet, was that emotional disturbance was being expressed as a physical problem, potentially as a form of psychological defence mechanism.

This is the origin of one of the modern names – ‘conversion disorder’ – but it’s not clear that ’emotion being converted into a physical symptom’ is a good explanation. We do know, however, that these experiences are more likely in people with a history of trauma, stress or emotional difficulties.

Crucially, people affected by these conditions feel no voluntary control over their symptoms – they’re not faking – but if you understand the nervous system you can often see how the symptoms aren’t consistent with the disabilities they appear to mimic.

For example, in the article, the neurologist tests a patient’s blindness like so:

He took from his bag a small rotating drum painted in black and white stripes. He held it in front of Yvonne and spun it quickly. Her eyes flickered from side to side in response to it, involuntarily drawn to the spinning stripes.

If the patient was blind due to damage to the eye, retina or optic nerve, visual material wouldn’t cause an involuntary eye tracking response, because the visual information would never make it to the brain.

So strikingly, the visual information is clearly being perceived at one level but is not accessible to the conscious mind – and it is this dramatic dissociation between the conscious and unconscious which is at the core of the problem, and is so poorly understood.

Unfortunately, these problems have also been traditionally stigmatised within medicine with people affected by them sometimes treated as fakers or time-wasters.

Similarly, to patients, the problems often feel as if “something has gone wrong with their bodies” meaning it can be difficult to hear that the origin may be psychological – partly of course, due to the common misconception that ‘psychological’ means ‘under your control’.

So this is why The Guardian article is so interesting because it is a little discussed area that needs a wider understanding both clinically and scientifically.

It describes several people with exactly these difficulties and how they are experienced.

Apparently, it’s taken from a new book by the same neurologist which is entirely about ‘functional neurological symptoms’ which could be equally as interesting.

Link to ‘You think I’m mad?’ – the truth about psychosomatic illness.

A brief and unlikely scenario

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.

Vice on 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.

She’s giving me hallucinations

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.

How is the brain relevant in mental disorder?

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.

Trauma is more complex than we think

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.