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Posts tagged ‘Mental Health’

A New Vision for Mental Health


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I want to help promote a new website, whose promotional flyer says:

Be part of the solution …

Have you ever wondered what mental healthcare would look like if, knowing what we know today, it could be redesigned from scratch?

A New Vision for Mental Health is an innovative website that seeks to answer this question by taking a critical, informed and constructive look at the current mental health system.

It explores ideas, insights and suggestions – from a wide range of individuals and organisations – that might, in time, lay the foundations for a new and quite different approach to mental healthcare.

As well as exploring new ideas and approaches, A New Vision for Mental Health will create opportunities for service users, mental health professionals, trainees and students to engage actively in discussions, debates and events. And, over time, it is hoped that these contributions will comprise a growing resource bank, an expanding knowledge base, and a coherent framework for mental healthcare.

Just some of the subjects covered in A New Vision for Mental Health:

  • 20 myths about counselling and psychotherapy
  • Psychiatry beyond the current paradigm
  • Urban design and its effect on mental health
  • Celebrating neurodiversity
  • “Mad Studies”
  • The drugs don’t work!
  • The emotional heart of service provision.

To find out more – and to get involved – please visit www.newvisionformentalhealth.com. Access is completely free and open to everyone.”

Psychiatry: a failed profession?


Psychiatry.jpg

 

Psychiatry: its origins, how it became threatened and its response:

Psychiatrists are doctors of medicine who have undergone additional, specialist training.

The path towards establishing psychiatry as a mainstream profession effectively began with Sigmund Freud, a medical doctor who famously developed psychoanalysis as a means to help some of his patients. This ‘talking treatment’ approach included the exploration of dream-symbolism and the unconscious self, a focus on repressed (unconscious) sexual desires (e.g. the ‘Oedipus complex’) and the use of free association … where the patient talks freely, without censorship or inhibition, about whatever ideas or memories occur to them. Within this approach, anxiety and depression (for example) were seen not as symptoms of disease, but instead as emotional distress arising from internal psychological conflicts.

The psychiatrists who followed in Freud’s footsteps keenly adopted psychoanalytic theory, partly because it hugely expanded their potential ‘customer base’ beyond the asylums, opening the way for the treatment of patients in private practice.

As the 20th century wore on, however, the effectiveness of psychoanalysis was scrutinised and increasingly criticised … to the point where psychiatry as a reputable profession came under serious threat, partly because of problems over diagnostic ‘fuzziness’, and also because of the rise of counselling[1] as a rival form of talking treatment offered by practitioners who didn’t need to have medical doctorates.

In an effort to protect their guild interests – and to safeguard the very survival of psychiatry – the profession switched direction. It enthusiastically adopted a ‘disease model’ for mental ill-health, a model that fitted well with the medical background of the doctors involved. And with this new model, the treatment of patients became increasingly centred on prescription drugs.

So began the development of an institutionally-corrupt financial relationship with the pharmaceutical industry. And so also began psychiatry’s journey down a deeply unscientific path.

Psychiatry as pseudo-science:

The American psychiatric ‘bible’ is the Diagnostic and Statistical Manual (DSM) of Mental Disorders (equivalent diagnostic manuals exist in Europe and elsewhere). The first DSM edition, published in 1952, contained 106 categories of supposed mental disorder, including homosexuality as a “sociopathic personality disturbance.”

Fast forward sixty odd years: the recently published 5th edition (DSM-5) now lists well over 600 categories of supposed mental disorder … a nearly six-fold increase compared to the 1st edition. This is, of course, excellent news for the business and commercial interests of both the psychiatric profession and the pharmaceutical companies.

Thus, egged on by vested commercial and guild interests, almost every type and incidence of emotional, personal and ‘mental’ problem or distress has been turned into a ‘disorder’ or ‘illness’ or ‘syndrome’ or similar type of stigma – to be treated (of course) mostly by means of prescribed drugs.

In what way has this process been driven by pseudo-science? In what way is the bio-physical ‘disease model’ adopted by psychiatry so profoundly flawed? The main answer is simple: after all this time, after decades of research, there is still a complete absence of any biological markers for – and biogenetic causes of – ‘mental’ ill-health.[2]

Take, for example, some of the more severe forms of ‘mental’ ill-health. Dr. Lucy Johnstone (a psychologist) has written:

“We have known for a long time that terms such as ‘schizophrenia’ are scientifically meaningless. They are not actually ‘diagnoses’ in a medical sense, since they are not based on patterns of bodily symptoms or signs. Instead, the criteria consist of a ragbag of social judgements about people’s thoughts, feelings and behaviour.  The people who are so labelled may well have difficulties and be in urgent need of help, but this is not the way to help them.”[3]

Or, for further instance, take so-called Attention Deficit Hyperactivity Disorder (ADHD). As one of the more enlightened psychiatrists, Dr. Sami Timimi, has written:

“ADHD is … ideally placed as a convenient diagnostic ‘dumping ground’ allowing all of us (parents, teachers, doctors, politicians) to avoid the messy business of understanding human relationships and institutions and their difficulties.’[4]

Or as John Shlien, Professor of Education & Counselling Psychology at Harvard University, has written:

“Diagnosis is not good, not even neutral, but bad. Let’s be straightforward and flat out about it, it is not only that its predictions are flawed, faulty and detrimental to the relationship and the client’s self-determination; it is simply a form of evil. It labels and subjugates people in a ways that are difficult to contradict or escape.”

The good news, however, is that the crisis of psychiatry has now reached the point where even the authors of diagnostic manuals are starting to finally admit that psychiatric diagnoses are not supported by evidence.

So where to now?

The reform of ‘mental’ healthcare is a vast subject and contains many needed elements (not least, under the heading of ‘prevention’, a priority focus on children and young people – see here, for example, ‘Bad Education’). But we can identify at least three of the main strands without further ado.

  1. Recognise that ‘mental’ healthcare is largely misnamed. The real focus should be emotional healthcare … because emotions (e.g. depression, anxiety, fear, guilt etc.) are the core experiences of most so-called ‘mental’ health problems.
  2. Abandon the disease/medical model and replace it with a contextual approach in which problems do not exist in isolation, but arise from, and are connected to, each person’s unique self, life story and life circumstances. Instead of asking people ‘what is wrong with you?’, we should instead ask ‘what has happened to you?
  3. Hugely reduce the emphasis on drug-treatments (treatments which stem largely from the misconceived disease/medical model) … and hugely increase the provision of counselling services.

The upshot of these is that psychiatry, as a profession, becomes largely redundant … at least in anything even remotely resembling its current form.

Of course the majority of psychiatrists – and the drug companies whose profits thus become threatened – will loudly protest. But when it comes to emotional healthcare, the truth is that the majority of doctors do not know best.

[1]     A profession effectively begun by Carl Rogers in the 1940s.

[2]     As used here at least, the term ‘mental ill-health’ does not include conditions – such as dementia – that are caused by bio-physical factors and involve a loss of brain function (e.g. memory).

[3]     Dr. Lucy Johnstone, www.madinamerica.com 2013.

[4]     Dr. Sami Timimi, Making and Breaking Children’s Lives, PCCS Books.

Bad Education


education

 

The key problems:

Three-quarters of people who have mental health problems in working life first experienced symptoms in childhood or adolescence.

For children and young people, there’s not just exam pressure and insecurities around body image, but also the risks of social media … not to mention the bullying and harassment that occurs outside of a social media context. Research from a respected mental health charity (Mind) suggests that one in five young adults in the UK will end up crying in any given week because of stress and anxiety.

It’s therefore no surprise that when the UK Youth Parliament recently voted to choose their priorities for the year ahead, nearly one million young people chose ‘curriculum for life’ and ‘compulsory mental health education’ as two of their three most important aims.

Of course the best way to prevent the escalation of mental health problems into acute and/or chronic conditions is to identify and work with these problems early, and to teach children and young people the emotional and psychological skills and knowledge that can greatly help them to maintain their well-being.

Yet currently, one in four people will suffer a mental health problem at some time in any given year (with anxiety and depression being the most common), not least the more than 53,000 people in Britain – the highest number ever recorded – who were detained last year under the Mental Health Act.[1]

Moreover, the majority of bio-physical illnesses are caused by obesity[2], smoking and excessive drinking: lifestyle problems which (together with other addictions) stem primarily from underlying psychological factors. This is why attempts to tackle them with advertising campaigns or taxation (or a combination of both) have met with only limited success.

But the inter-related problems in focus here don’t just centre on mental or physical ill-health. In England and Wales, 30.0% of women and 16.3% of men have experienced domestic abuse since the age of 16: around 4.9 million female victims and 2.7 million male victims?[3] And a recent study found that 11.3% of young adults in England aged 18-24 had experienced sexual abuse during childhood. Yet more, for the year ending March 2015 the latest estimates from the Crime Survey for England and Wales show there were 1.3 million violent incidents – including homicide, violence with injury, and violence without injury – in England and Wales.

The questions:

In the face of all this – the sheer scale of mental ill-health, lifestyle-induced physical illness, domestic and sexual abuse, the violence in society – we are entitled to ask:

  1. How is it that so many children exit from our school system, after 10 years or more of full-time education, so lacking in the social, emotional and psychological skills and knowledge that would greatly help them (and those around them) throughout their life?
  2. How is it that so many children exit from our school system, again after 10 years or more of full-time education, to become the teenagers and adults who commit such violence, or live such unhealthy lifestyles, or engage in domestic and sexual abuse?

The answers:

Clearly the vast majority of children receive a bad education – one that singularly fails to teach them what they really need most of all to know and be able to do. Instead, the school curriculum (the key issue here) largely centres on things – reading, writing and basic arithmetic apart – that most pupils don’t need to know and will never ever use.

Children in our schools learn far too little about the understandings, skills and areas of knowledge that would prevent many of them – even despite the difficult family and domestic backgrounds which some must endure – from becoming mentally ill or turning into anti-social and/or violent characters. And they spend far too much time in school learning about things that little benefit society (and themselves) when weighed against the huge societal and personal burdens that result from mental ill-health, physical ill-health (that which is caused by psychological factors), and abusive and violent behaviour.

The cosine of wasted time, the algebra of trivial information. Months spent on calculus, scant time given to schooling empathic imagination. Years ransomed to teaching foreign languages, yet many can barely grunt in the dialect of relationships. A decade or more given over to studying facts and information about the outer world, with barely a glance at the inner worlds that will affect them, their lives and the people around them so much more.

When was the last time you, the reader, ever really needed or used a knowledge of chemistry or physics or geometry?

In contrast, when was the last time you felt depressed or anxious or isolated?

And when you’ve answered these questions, here’s another one. Did you – did any of us – really get a good education?

 

[1] “Britain’s Mental Health Crisis”, BBC Panorama, October 26th 2015.

[2] According to Prof Nick Finer, from University College London’s Institute of Cardiovascular Science, obesity is now “the most pressing health issue for the nation”. He says that “estimates of the economic costs of obesity suggest they will bankrupt the National Health Service.”

[3] 2012-13 Crime Survey for England and Wales, Chapter 4 – Intimate Personal Violence and Partner Abuse, Office for National Statistics.

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