Archive for the ‘Misc.’ Category

Mood induction procedures

Thursday, April 25th, 2013

As a teenager I spent hours in my room listening to arch-miserabilist pop band the Smiths.  I felt they really understood my teenage angst, and my love for them withstands even David Cameron’s unrepentant fandom and Morrissey’s regular and unsavory announcements.

We spend a lot of time and money trying to feel good, but there is also a pleasure in the melancholy that listening to every Smiths’ song played back to back can engender.  Alongside teenagers, researchers use various experimental methods for inducing mood states.  These are often used in studies which aim to investigate the correlation between mood and neurological function.

Self referential statements

One of the first mood induction procedures was the Velten Mood Induction Procedure.  Subjects read aloud self-referent statements, which progress from the relatively neutral to those associated with either a negative or positive mood.

Example of questions – this site suggests that the Velten mood induction procedure should be used as a form of “guided meditation”.

Music

Music can arouse deep emotions in the listener.  The majority of studies use classical music, but a wide variety of musical pieces is used to experimentally induce mood states.  This paper lists music used in forty-one music mood induction procedure studies.  The authors find that most musical pieces are used in one study only, but find twelve studies that use Delibes Coppélia to induce happy or elated moods.  No mention of the Smiths.

It’s probably best to ban your teenage children from listening to Stravinski’s Firebird suite.  Played at 80 dB, as one study used this to provoke anger.

Movie clips

Habitual cinema-blubbers will not be surprised that requesting participants to watch movie clips is a common way to manipulate moods experimentally.

In a 2008 study positive mood was induced by participants watching a 10 minute excerpt from a British comedy series (the actual series itself is not identified alas – Monty Python?). Neutral mood induction involved an excerpt from a nature documentary, and negative mood was brought about by an excerpt from a film about dying from cancer.

According the many authors film and music based mood induction is the most effective.

Critical feedback.

Another technique is to use verbal feedback. This 2008 study asked participants to complete a series of anagrams and then report their answers through an intercom system. To induce a negative mood state they received insults in return.

After the 4th anagram, the experimenter said: “Look, I can barely hear you. I need you to speak louder please.” After the 8th anagram, the experimenter said in a louder and more frustrated voice: “Hey, I still need you to speak louder.” After the 12th anagram, the experimenter said in a very frustrated voice: “Look, this is the third time I’ve had to say this! Can’t you follow directions? Speak louder!

Forming mental images/autobiographical recall.

This approach can use emotionally charged sentences, with subjects asked to try and experience the affective state they would feel if the situation were real.

“Imagine that you just won the lottery and you will have all the money you could ever want” (paper)

(These lottery winners are in the lucky situation of not having to use their imagination).

In a similar approach participants were instructed to write a short essay about an event they experienced that provoked specific feelings such as anger or sadness.

Combining methods and effectiveness

The most effective mood induction procedures may combine two procedures in the belief that multiple interactions contribute additively to mood.   One type of induction occupies the foreground attention, whilst the other forms the background atmosphere.  So, for example the Velten mood induction procedure has been combined with music mood induction.

The effectiveness of mood induction procedures is questioned by some authors, who dispute whether they can produce moods of sufficient intensity.  Another debate concerns whether the results of experiments using mood induction result from the expectations that the protocol induces in participants, rather than because of the induced mood per se (demand characteristics).

Sponsored by Inexika, creator of iMoodJournal – mood tracking application for iPhone and Android

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Occupy LSX report

Monday, November 21st, 2011

This was originally published on BMJ Blogs

 

Established on 15 October outside St Paul’s and watched over by a statue of Queen Victoria, the Occupy London Stock Exchange (LSX) camp continues its controversial settlement in central London. 

Paul, a doctor whose day job is as a sexual health specialist in South London, shows me around.  For a movement with no apparent leadership, lurking somewhere must nevertheless be an effective organising team. The camp is clean and alongside the accommodation are larger tents with information, welfare, first-aid, and “university” roles. 

Paul tells me of the chaotic establishment of the camp: “The police were stopping us from going into Paternoster Square,” he says. Corralled, the protestors’ current spot was chosen by default.  “There were a lot of police,” he continues. “When I woke up in the morning, I was really surprised we were still here.” The police eventually withdrew the following morning. 

We drop into the university tent where Professor Ted Honderich, UCL professor emeritus of the philosophy of mind and logic, is hosting a discussion; an erudite debate is underway concerning the nature of capitalism. Immediately outside the disparate aims of the Occupy movement are clear from the posters that now adorn the pillars facing M&S on the north side of the camp. “More to life than money,” reads one, whilst others variously call for defence of public services, Julian Assange’s release, as well as more niche concerns. 

Defending the NHS is a motivating factor for some protestors for whom the recent takeover of Hinchingbrooke hospital by Circle augurs future unacceptable developments. David stays in the camp, doing his job remotely via a laptop from the nearby Starbucks.  He’s also first aid trained and works shifts in the camp’s first aid tent. “I’m here to put pressure on the government to look seriously at the Robin Hood (aka Tobin) tax,” he says. “I’m concerned about the cuts in public services and especially the NHS.” He sees the Tobin tax as avoiding cuts that would otherwise be inevitable.

A large sign outside the mediation tent reads “No drugs” and suggests concern that some camp visitors might mistake Occupy LSX for the Glastonbury Festival. “There’s a problem about having a thing like this in the centre of a city,” explains Paul. “It attracts people who are homeless or have addiction problems.”

As a consequence, a welfare tent was established with the involvement of two consultant psychiatrists. Paul says this required some consideration. “There was part of me that said we are not about caring for people, we’re here for a political purpose,” he says. The welfare tent’s presence is not entirely altruistic to my mind. The camp’s continued existence remains precarious, and a responsible, civic-minded community is harder to demonise and evict.  Asides medical involvement in the welfare tent, a medical team also wrote a report on site safety, hygiene, and sanitation. 

In Starbucks I meet Simon, a part time nurse also involved with the first aid tent. A target at past protests, Starbucks is in fact warmly regarded by all I meet at Occupy LSX. As well as Occupy’s de facto common room, early on the café allowed the protestors use their toilet before alternative portable ones were sourced.

“We do have two facets to the organisation. There’s the progressive widespread attempt to verbalise certain issues and get them fed into the media, and then there’s the occupation and the collaboration of people living together and trying to maintain a site,” says Simon. By chance at an Arab Spring protest earlier in the year, Simon had been impressed by the protestor’s medical facilities and sought to bring similar facilities to Occupy LSX.  

These from scratch facilities may be laudable, but what is the actual message of the camp? “It’s pro-activism here” says Simon. “There are very few groups that are excluded. I’ve yet to meet anyone down here who thinks that we shouldn’t make our corporations pay more tax or that services should be cut over sourcing additional sources of income.”

What I hear the loudest from the protestors is that Occupy LSX is about creating a space for people to articulate arguments about the government’s economic policy and its consequences:  unemployment, increasingly expensive education, and the privatisation of the NHS.  The vague sense of unease many of us feel is here, amplified and expressed. 

The criticisms are obvious.  The camp has no manifesto and articulates no alternative. In focussing on bankers it victimises a small part of society, when the true causes of the current crisis are less straightforward. Contrary to their claims, the activists have no mandate to represent the “99%.”

But I’m inclined to be generous. Expecting protestors to have a fully developed alternative before they raise their voices represents an unrealistically high expectation. But whatever I think, they have no inclination to pack up their tents yet. At the time of writing a third camp is forming in an abandoned UBS building in the City. 

Paternoster Square remains closed indefinitely. When I stood by the security barrier peering in, armed only with an iPhone, a security guard approaches menacingly. Curiously, here’s a press release from Mitsubishi Estate – Paternoster Square’s owners – describing the square as a “public space.”

Some names and identifying details in this post are changed by request.

Metaphors in medicine

Tuesday, August 23rd, 2011

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Illness as metaphor on Amazon.com

Metaphors are widely used by both healthcare professionals and lay people when talking about matters of health. Despite this their role is largely unrecognised. This is a shame, I feel, as they can have a powerful effect on the practice of medicine and the experience of illness. 

A metaphor is a way of understanding and experiencing one kind of thing in terms of another. Many complex concepts are understood in this way and they are integral to the way we understand things. 

The essayist Susan Sontag was one of the first to identify the widespread use of metaphor in relation to certain diseases. She wrote Illness as Metaphor whilst being treated for breast cancer and visited the topic again in 1988 with AIDS and its metaphors

Sontag argued that metaphors attach themselves to certain diseases and these metaphors exert influence on patient and public attitudes. With both HIV and cancer Sontag argued that metaphors introduced an unhelpful emotional dimension when a more detached scientific approach was required. 

Two main sorts of metaphors have been suggested. “Biomilitary” metaphors represent disease and the body’s response to it in terms of “attack” and “defence.”  By contrast with “bioinformationist” metaphors the body, in both health and disease, is seen as a communication system with “receptors,” “transmitters” etc. 

Particular diseases attract metaphorical description more readily than others. Biomilitary metaphors are pervasive in discussions of cancer. By contrast heart disease is discussed almost exclusively in terms of the mechanical metaphor of plumbing.

Arguably metaphors don’t merely describe similarities; they create them. As well as illuminating they can also conceal. It can be hard to think of cancer in a way that is not biomilitary, but wars honour battles which can make the transition to hospice care problematic. Mechanical metaphors for heart disease are also limited as they hold no place for lifestyle modification. I don’t agree with Sontag that metaphor should be eliminated from the discussion of medical illness. In fact I don’t actually believe that it would be possible to talk about disease without them. But they have a hidden power that should be understood. 

If you choose a metaphor, choose it wisely.

Also published on BMJ blogs

Whither the riots? A theory digest

Thursday, August 18th, 2011

 

Also published on BMJ blogs

Last week’s riots took place across different nights in multiple cities and involved no one ethnic group.  The reasons behind them are complex and a unifying theory is likely to be evasive. 

Many of the explanations for the riots have been made to fit around already established political agendas.  The left has focused on deprivation and an excessively greedy society, while the right has blamed police numbers and a lack of discipline and boundaries.

With such widespread disturbance, it’s more than likely that any explanation will have some merit.  The explanations favoured by our political elite will have very real consequences.  

Criminal?
According to some on the right the riots were largely criminal acts of opportunistic looting and vandalism. This cannot be discounted, not least as there are reports of the looting being highly organised. However it does not have sufficient explanatory power to be the complete story behind the disturbances. 

Political?
The night of the riots involved widespread looting of consumer goods, with institutions of the state left largely untouched. On this basis, they could be described as “apolitical.” However simply because the riots were not purposeful does not immediately disqualify them from being political. 
Alongside their ostensibly consumerist goals, the riots challenged the police for control of the streets, flouting law and social convention. This is arguably a political act. 

Naomi Klein writes of the riots as a “nighttime robbery” following the “daylight robbery” of recent massive banking bailouts and subsequent austerity programme.  “When you rob people of what little they have, in order to protect the interests of those who have more than anyone deserves, you should expect resistance—whether organised protests or spontaneous looting.”

Driven by consumerism?
The looting during the riots was mostly of consumer goods, leading them to be described as “aspirational.”  This explanation for the riots centres on what we value in society and the ability of some people to afford this. 

In a consumerist society, like that in the UK, the idea of social identity through consumerism is promoted. Yet economic hardship has left many people unable to afford consumer goods. 

This article argues that “Far from disregarding the values of society … the young people who were involved in property theft were enacting the very values that are communicated to them every day through advertisements and public culture.”

Failure of the criminal justice system? Poor relations with police?

It was striking how many of the rioters didn’t cover their faces. Why did they think that they wouldn’t go to prison? 

There may be genuine tensions between some communities and the police, and this has been the trigger to previous serious UK rioting.  In October 2010 for instance it was reported that black people are 26 times more likely than whites to face stop and search.

A breakdown in society?
This is an argument favoured by the left. Its proponents feel that a large section our society has no stake in it and that the riots were an understandable response to the brutality of the poverty they experience. 

Put another way, society relies on collaborative behaviour.  The majority of us are pro-social, at least in part, as we are convinced that it is in our best interests. If people feel themselves to be disenfranchised, by a society that offers little educational or employment opportunities, this does not apply. In the absence of mainstream ways of gaining self worth, some look inwards and create their own self esteem through their involvement in gangs, with violent consequences. 

The Prime Minister David Cameron has also talked about societal breakdown, and blamed in part the bad example set by our elites. 

This paper links budget cuts to social unrest.

Parenting/lack of respect?

This is a related argument to that of the “broken society.”

Some of the rioters were minors, suggesting both inadequate supervision and a failure to introduce pro-social values. A judge was critical of a family who did not turn up to the court appearance of their 14 year old daughter. 

Are the riots symptomatic of breakdown elsewhere?  Some people have written that, due to the intervention of the state, parents are no longer able to adequately discipline their children. As a result children are growing up with a dangerous sense of entitlement and lack of responsibility. 
In times of economic downturn some family units can become fragmented. The father of the 14 year old mentioned above said that he was unable to attend court as he has two jobs. 

The power of the crowd?
Other explanations floated for the riots have touched on crowd psychology. This might seem to explain the relative normality of some of participants. 

One psychologist was quoted as likening the riots to those seen in jails where “there is no higher purpose, you just have a high volume of people with a history of impulsive behaviour, having a giant adventure.”

Deindividuation, where social norms are compromised when people are in groups, has also been mooted. “That violence is an epidemic is not a metaphor; it is a scientific fact,” writes Gary Sultkin who likens violence to that of disease spread. Some sociologists write here that crowds are irrational (but then offer to explain them).

Professor Stephen Reitcher, professor of social psychology and expert on crowd psychology is unimpressed

Architecture?
Anna Minton writes in her book Ground Control about how current trends in city planning have led to a transformation of public space. Designed with the objectives of profit and safety paramount, physical environments in the city are being created which “reflects the stark division of the city creating homogenous enclaves which undermine trust between people.” 

The gentrification of large parts of previously disadvantaged areas has led to different communities – between whom communication is almost non-existent – living in close proximity as discussed in this London Review of Books blog.

“Historically” writes architectural historian Wouter Vanstiphout, “there is a correlation between large-scale urban projects and upsurges in urban violence.” But, “it is much too soon to say anything,” he says, “about the relationship between the gentrification of Brixton, or the coming of the Olympics to London, and the current explosion of violent alienation”

A unified theory?
The number of people involved in the riots is in the thousands, in cities of several million.  As of 17 August the Met had charged 1005 people and made 1773 arrests.  Therefore we should be wary of making generalisations about communities based on a relatively small number of their members.  All of the above explanations hold some truth, and the discourse is about which we afford the greatest weight. 

At a structural level The UK’s “knowledge economy” benefits some people but excludes many others. Many people are able to accumulate the skills and qualifications necessary to thrive.  However for reasons of upbringing and opportunities, others are unable to benefit. Social mobility remains poor.

Inner cities are particularly disadvantaged. In some communities single parent families are common, and role models are lacking. Family life is difficult if family members are obliged to take multiple low paid jobs. There are few activities available for young people and unemployment is high. 

In addition, the example set by UK elites has been poor and low income groups have disproportionately suffered from austerity cuts.  The money spent on the Olympics has had little effect on surrounding areas.  Expensive consumer goods are available for sale to the affluent middle class for whom city living is now fashionable and more affordable in previously run down areas.

Did something have to give?

BMJ: Riots on the streets.  A public health perspective would help if politicians would listen

 

Guest post: The Art of Psychiatry

Tuesday, December 21st, 2010

It all started with a bomb scare… Outside the conference venue (The Cumberland Hotel, Marble Arch)

 

I was a lead organiser for this year’s Annual London Psychiatry Trainee Conference.  Dr Penny Brown who was one of the team has written this report.  You can download two of the conference’s sessions from here – Darian Leader’s afternoon keynote speech is well worth a listen

This report initially featured in the London Division December newsletter.  

 

On an overcast autumnal day in central London, three hundred and fifty psychiatry trainees defied tube strikes and bomb scares to attend the third Annual London Psychiatry Trainee Conference. Joined by a host of names from literature, art, stage and screen, the trainees enjoyed a wide variety of entertaining and thought-provoking sessions on ‘The Art of Psychiatry’.

The conference has become an annual fixture since 2008 and Dr Stephen Ginn, East London ST4 in General Adult Psychiatry, took on the challenge of organising the 2010 meeting. He chose to focus the theme on psychiatry and the arts, explaining his motivation as follows:

‘Many psychiatrists, including trainees, have a strong interest in the creative arts and this informs their practice.  Both psychiatrists and creative artists are concerned with exploring human behaviour and motivation, and come to the subject of the mental disorder from different viewpoints and with different narratives. For instance the language creative artists and psychiatrists use to record or express psychopathology is totally different but equally valid. I have a strong belief that we have much to learn from one another and my motivation for making this year’s London trainee conference about the shared elements between psychiatry and the arts was to explore this space and to give trainees an opportunity to examine their practice from alternative viewpoints.’

Stephen and his organising committee planned a day of lectures and workshops, and in addition to inviting artists and psychiatrists from a number of disciplines, trainees were also encouraged to present their own work. The committee were overwhelmed with proposals of trainee presentations on wide-ranging topics, from studies of ‘Outsider Art’ to psychodynamic interpretations of the baptism scene from ‘There Will be Blood‘.

On the day of the conference, the Cumberland Hotel, with a lobby filled with contemporary art, set the scene for what was to come. On display at the entrance to the conference area was an exhibition of ‘Portraits: Patients and Psychiatrists‘. This award-winning collaboration between artist Gemma Anderson and forensic psychiatrist Dr Tim McInerny is a series of portraits of psychiatrists and their patients, exploring how patients experience mental illness and how this is formulated and treated by the doctor.

“Connor” by Gemma Anderson from ‘Portraits: Patients and Psychiatrists’

After an introduction from Dr Michael Maier, Head of the London Deanery School of Psychiatry, Professor Dinesh Bhugra gave the first keynote lecture on ‘Using films for teaching and cultural competence’. With examples from Hollywood to Bollywood, he demonstrated how film can teach psychiatrists about mental state examination (such as Jack Nicholson’s portrayal of OCD in As Good as it Gets) and psychotherapeutic concepts (counter-transference in Analyze This), as well as cultural sensitivities and prejudice.



Professor Dinesh Bhugra giving the first keynote lecture ‘Using films for teaching and cultural competence’

The enjoyment and good-humour of the delegates was evident even when the following session was delayed due to a combination of bomb scares and stranded pianos, but after an extended coffee break we were treated to a performance of ‘Losing It’, a two-woman show tracing the emotional breakdown of Ruby Wax, through monologue and music, with songs performed by jazz singer Judith Owen whom Wax met while a psychiatric inpatient. Wax’s depictions of her own struggle with bipolar disorder, as well as group therapy in the addictions-riddled world of the Priory, were both amusing and sensitive, and her work in breaking the stigma of mental illness can only be welcomed.

Ruby Wax and Judith Owen perform “Losing It”

The conference was then divided into ten parallel sessions. A team of dramatists and directors discussed theatre and television depictions of psychiatry, and artists explored the role of art in expressing and understanding mental illness. In a workshop on psychiatry and graphic novels, Darryl Cunningham and Philippa Perry gave examples of how graphic novels can provide an accessible but educational medium for discussing mental health issues and battling its associated stigma. Poet Dr Sarah Wardle read from her own work and discussed the benefits to doctors of reading poetry. Author Will Self drew a substantial crowd, despite competing with the delayed lunch, and gave a thought-provoking reading of his latest novel ‘Walking to Hollywood‘, which included surreal stories that raised questions about our daily assumptions. The roles of psychiatry in film and literature were explored, and in discussing psychiatry and music Dr Andrew Johns gave a fascinating talk which included a psychopathy checklist on Wagner’s Siegfried.

Three sessions were led by trainees who discussed their own studies of creative arts and psychiatry as well as experiences working abroad, and opportunities for creativity in teaching psychiatry were demonstrated by the Extreme Psychiatry team.

Will Self discusses Psychiatry and Literature

The afternoon keynote lecture was given by psychoanalyst and author Darian Leader. He spoke about the psychodynamic treatment of psychotic patients using the example of German judge Daniel Schreber, whose memoirs of his own mental illness were later interpreted by Jacques Lacan. Leader went on to join Nell Lyshon, the first female playwright at Shakespeare’s Globe with ‘Bedlam’, Sarah Wardle, Gemma Anderson and Dr Tim McInerny to take part in the final plenary session discussing ‘What can creative artists and psychiatrists teach each other’. Lyshon was accompanied by three poets from Vita Nova, a theatre company providing writing workshops to recovering addicts, who read self-penned poems about their own experiences of mental illness to a captivated audience.


Delegates and members of the plenary panel Dr Tim McInerny, Gemma Anderson, Nell Lyshon and poets from Vita Nova enjoying “Losing It” ealier in the day

The conference ended with a poster prize presentation, won by Dr Paul Wallang (ST6 Forensic Psychiatry, East London) whose poster on “Wittgenstein’s Legacy and Narrative Networks” was perfectly in keeping with the theme. All in all the day was a huge success enjoyed by delegates and speakers alike, as was clearly evident later on in the hotel bar!

Written by Dr Penelope Brown, ACF in Forensic Psychiatry, South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry

With thanks to the London Deanery and the 2010 London Psychiatry Trainee Conference Organising Committee:
Dr Stephen Ginn (ST4 General Adult Psychiatry, East London)- conference lead
Dr Jane Jones (ST4 CAMHS, Tavistock Clinic)
Dr Penelope Brown (ACF Forensic Psychiatry, SLAM)
Dr Myooran Canagartnam (Fellow in Medical Education and ST6 CAMHS, Tavistock Clinic)
Dr Olimpia Pop (ST6 General Adult Psychiatry, South West London and St Georges)
Dr Issy Millard (CT2 SLAM)

Photographs by Dr Wojtek Wojcik (ACF in General Adult Psychiatry, SLAM)

MJA Review January 2011: Should the law on assisted dying be changed?

Wednesday, December 15th, 2010

This is a report I wrote for the Medical Journalist’s Association January 2011 newsletter.  In the above picture taken at the debate I’m the devilishly good looking chap in the front row.

The MJA discussed this contentious issue on November 25 at the Medical Society of London. Four speakers, ‘widely respected for their integrity but divided by their beliefs’, in the words of John Illman, who organised and chaired the meeting, spoke for and against modification of the law on assisted dying. Stephen Ginn reports.

Support for a change in the law came first from GP and MJA member Dr Ann McPherson. She is behind a new group called Healthcare Professionals for Change, set up to challenge the medical establishment’s stance against assisted dying for terminally ill people, and to lobby for a change in the law. Ann’s support of assisted dying is not academic; she herself is suffering from a terminal illness, a situation that, she said, made her ‘really start thinking about death’, and led her to publish an article in the BMJ explaining her views.

Ann told us that, during her working life, she had cared for many terminally ill patients, seeing many die in a way she would not wish for herself. In her view, doctors were ultimately unable to provide humane help for the terminally ill because of their inability to offer assisted dying. She wanted to see assisted dying incorporated into the palliative process. She said that she was only calling for a change in the law for specific cases: for the terminally ill who had clearly stated their wishes when of sound mind.

Baroness Ilora Finlay, professor of palliative care at Cardiff University, opposed this proposal, based on her faith in palliative care and pragmatic concerns about how assisted death decisions would be reached. For her there was a paradox inherent in the debate: increased discussion of assisted dying came at a time when palliative care was improving. She had practical doubts as to the accuracy of a terminal prognosis, the degree of internal and external coercion put upon patients, and the reliability with which patients in distress were able to make clear end-of-life decisions.
She related the case history of a patient who, with what was thought to be only days to live, had requested an assisted death in 1991, but was still alive today. She spoke of ‘societal considerations’, concluding that licensing assisted dying was not only about personal autonomy: ‘To talk about it simply as a choice is to trivialise the enormous decision we take if we change the law.’

Baroness Mary Warnock, who spoke third, is a respected moral philosopher who has expressed strong, sometimes controversial, views in favour of assisted death. She said many people wish for a good death, and some stockpiled the necessary pills, but this was ineffective because most deaths took place in hospital where medication was controlled. She was critical of doctors’ resistance to change. ‘It is simply derogatory to suggest the medical profession has the right to override the longthought- out wishes of the dying,’ she said. In her judgement, if someone wished to die, this moral decision should be taken seriously and no one else should be able to gainsay it.

She thought that the possibility some people might seek assisted death because they wished to unburden their relatives was in fact an honourable motive, to be admired. ‘Why shouldn’t I shorten my life for the sake of my children?’ she asked. Nor did she accept that a change in the law would threaten disabled people, if they made their wishes clear. ‘No one is suggesting doctors make the decision to end a life,’ she said.

Professor Mayur Lakhani, chair of the National Council for Palliative  Care, was the last to speak. In his estimation, ‘the case for a change in the law has not been made’. He reminded us that in the past 10 years little over 100 UK subjects had sought an assisted death at Dignitas, while during the same time period six million had died elsewhere. Although he felt it was important for doctors to facilitate end-of-life care, this did not imply assisting dying. In contrast to the two speakers who spoke in favour, Professor Lakhani thought it was ‘undignified to hasten death’.

The debate was opened to the floor and the audience posed questions and shared personal experiences. Someone asked about withholding medication, and Dr McPherson clarified the difference between giving medication to assist death (illegal) and withdrawing medical treatment (permitted) that resulted in death. There was general agreement that healthcare professionals found themselves as unprepared as lay people for the death of a loved one. Although there was no concluding vote, my impression was that most present were in favour of a change in the law. Debate continued over dinner, some saying that their opinion had been changed by the arguments they had heard.

“This house believes that psychiatry has been unfairly treated in the media” Royal Society of Medicine Debate

Thursday, November 11th, 2010

I gave this speech at the Royal Society of medicine at an event called Psychiatry as a career: Everything you wanted to know but were afraid to ask.  It loses something without having the opposing view available but I hope will be of some interest.  There’s a list of links I used for research which may be of use. 

***

I wish to propose the motion “This house believes psychiatry has been unfairly treated in the media”

By the end of what I have to say, you will have no difficulty in agreeing with me that this is indeed the case.

First allow me to define what I wish to examine:

  • Psychiatry’ has no exact meaning but encompasses psychiatric disorders, their treatments and those who provide them.  I include psychiatric patients also; not least as many people – including doctors – are unaccustomed to separating the disorder and the patient.  
  • The media is collection of means for mass communication.  Here the newspapers, television, radio and cinema continue to be the most influential.  
  • Fairness’ is very much in the news, and to be fair is to be just and to be aware of the right way to value things.  

The vehicles for mass communication in this country regularly treat people who work in or are treated by psychiatry as if they have no need for any consideration, as if they have no value.  

This is unfair

Unlike psychiatry, the media is a business, and is subject to very different pressures.  

As a result it is uniquely ill suited to report the richness of the fascinating human stories with which psychiatrists daily deal.

In essence the people who work within the media are primarily interested in one thing: selling the content they produce.  

This could be newspapers or DVDs, TV advertising or cinema tickets.  

Their output is driven by the overriding need to gain and sustain attention.  Their central question is ‘Is this engaging to busy people?”

All other things including truth, and fairness, are subsidiary to this.  

This is a shame, but it is the world in which we live

Under this imperative the media show no contrition in using crude stereotypes of the psychiatrically unwell and those that treat them that are unchallenging to lay people.  

These stereotypes are appealing as they confirm peoples’ view of the world and their place in it.  Whilst in sometimes engaging, comforting and even entertaining, they often misrepresent and stigmatize.  

The Hitchcock film ‘Psycho’ illustrates one of the most repeated and harmful stereotypes.

Maybe you should cover your ears if you don’t already know the ending.

Hitchcock knew how to unsettle his audience.  Although cinematically a masterpiece, Psycho has no shame drawing on and thus perpetuating popular stereotypes and fears.  

The knife wielding maniac

The violent and unpredictable madman.

The film’s anti-hero Norman Bates is a murderous ‘psycho’ whose mother resides in his psyche.  

This is a rather unlikely diagnosis in my opinion.  

Tensions between these alternative personalities drive him towards his crimes.  

Following in Hitchcock’s footsteps, films that feature psychiatrically-disturbed serial killers are now so numerous that they merit their own sub-genre.  

Another example is Halloween – one of the first ‘slasher’ movies- where on Halloween an escaped psychiatric patient stalks and kills teenagers.  He is pursued, with mixed results, by his heroic psychiatrist played by Donald Pleasance.  This film’s popularity was such that it spawned seven sequels and a recent remake.

This stereotype of the dangerousness and unpredictability is also seen in printed media as one of its most consistent features of reports about patients with psychiatric disorders.

Journalists like stories about violence and mental health as they are inherently newsworthy and tap into our fears and anxieties.  

Many newspaper articles leave the unquestioned impression that there is a link between all people with mental health problems and crime or violence.

The Health Education Authority’s ‘Making Headlines’ report found that negative coverage of acts of violence by people with mental health problems outnumbers more balanced reporting by 3:1, with stories about harm and crime accounting for the biggest quantity of all mental health pieces in broadsheets and tabloids.  

Here are three recent headlines from the Daily Mail.  Note that these headlines compound their insult by combining this corrosive stereotype with pejorative language

28 October 2010: Schizophrenic mother who stabbed three-year-old daughter and doused body in acid to stay in secure hospital

11th October 2010: Why was a drug-abusing schizophrenic left free to kill my son? And why will no one take the blame?

5th October 2010: Schizophrenic man hooked on cannabis stabbed stranger 81 times… after NHS said he ‘posed no danger’

There is an increased risk of someone with psychosis being involved in an act of violence, but such headlines leave all people with mental health problems under a cloud of suspicion.

Such treatment would not be tolerated if it were applied to other vulnerable groups.

I put it to you this is unfair.  Psychiatry is treated unfairly in the media

So psychiatric patients get a raw deal.  But it goes wider than that.  The Psychiatric Bulletin has reported that psychiatry in general gets a bad press when compared to medicine.  

Balanced discussion of psychiatry’s controversies is of course to be welcomed but what has emerged in the media is rarely sober and considered. 

This is unfair

Our treatments are often under fire:

Our antidepressants are addictive.

We reach too quickly for a prescribing pad.

The  draft of the new fifth edition of the Diagnostic and Statistical Manual of Mental disorders was met by a hailstorm of criticism about how psychiatrists wishing to medicalize ‘normality’.  

Psychiatrists are not well represented by the media either.  

Who do you think is the best know psychiatrist in popular culture?

I’d say Hannibal Lecter.  Off the back of this grimly compelling character The Silence of the Lambs has sold over 10m copies in book form and the Oscar winning film grossed $300m.

Who is Hannibal Lecter?

Not a learned clinician or venerated academic, but a murderous serial killer with a curious lack of insight into his own condition and a penchant for torture and cannibalism.  

Dr Lecter is hardly a good role model for aspiring psychiatrists.  

Another TV psychiatrist is Fraiser Crane from the long running American TV show.  He is uptight and pompous and has great troubles sustaining romantic relationships.  

That doesn’t sound like anyone I know

This is an improvement on Dr Lecter, but not exactly complementary figureheads for a profession soberly striving to treat humankind’s most difficult of diseases.

Worst of all is Dr Silberman, who in Terminator 2 is responsible for incarcerating Sarah Connor who we know – but Dr Silberman cannot see – is trying to save the world.  

I put it to you that it is truly unfair to accuse psychiatrists of trying to stop planetary salvation.
 

It’s a shame that the media has proved so unbalanced in its portrayal of our work.  Not least because we are all interested in the same thing: attempting to explain human behaviour and motivations.  

The media do not cope well the subtleties of meaning that psychiatry regards as commonplace and instead dehumanisation, inaccuracy and sensationalism are their stock-in-trade.  

Their portrayal of psychiatry is demonstrably unfair.  

Please join with me in supporting this motion.

Thank you.

***

Resources

Health Education Authority Making Headines: Mental Health and the National Press

The Psychiatric Bulletin (2000) Newspaper coverage of psychiatric and physical illness

The Guardian 22 July 2010 Hollywood’s mental block

Advances in Psychiatric Treatment Psychiatry and the media

The Psychiatric Bulletin Terminator 2: Judgement Day

Politics of Health Group The media: agents of social exclusion for people with mental illness?

The Psychiatric Bulletin The stigma of mental illness: how you can use the media to reduce it

Exchanges at the Frontier: Gwen Adshead

Thursday, October 28th, 2010

I can’t go but there’s an interesting event coming up which readers of this blog may be interested in attending.

‘Exchanges at the Frontier’ returns to Wellcome Collection this autumn with a second series in partnership with the BBC World Service, hosting some of the biggest names in world science. Join A C Grayling, Professor of Philosophy at Birkbeck, University of London, to test them on the social impact of their discoveries and explore the frontiers of scientific knowledge.

Gwen Adshead is a consultant forensic psychotherapist at Broadmoor Hospital, a high-security psychiatric hospital in Berkshire. Here she oversees some of society’s most problematic personalities, attempting to understand psychotic behaviour and find ways of treating it. She also has a degree in ethics and an interest in the relationship between doctors and their patients. Join her in conversation with A C Grayling to explore what medicine can do for people with personality disorders, and whether hospital is the right place to hold them.

There’s also a tour of Broadmoor Hospital.  Link for details

Gwen Adshead was on Desert Island Discs recently - well worth a listen

If you go please leave a comment to let me know what I missed.

Update 25 November 2010

Here’s the programme

Letter to The Guardian (unpublished)

Sunday, September 26th, 2010

I sent this letter to the Guardian last week, but alas not chosen for publication.  I was trying to advance the idea that prejudice does not flow simply in one direction.  I haven ‘t looked at it for two weeks, and I don’t think I’d make the last sentence so categorical if I was to submit it again.  Comments welcome as always. 

 

Dear Sir,

Re: : ‘Oxbridge’s class divide raises food for thought’

Given the high prevalence of an Oxbridge education amongst prominent people in our society, few would argue that striving for a situation where access to these institutions is available to students from a broad variety of backgrounds is not desirable.  Your article ‘Oxbridge’s class divide raises food for thought’ examines the difficulties faced by students from lower income families who seek to study in these universities.

Although the start of a university experience is anxiety producing for most, starting out at an Oxbridge college may be more difficult for some than for others.  For example many students from fee paying schools are awarded places alongside a large proportion of their existing social circle, whereas on day one a new student from an average comprehensive might well know no one.

Yet ‘fitting in’ is a skill that is worth mastering at an early opportunity.  It’s a shame then that rather than focus on positive Oxbridge experiences of those from deprived background your article choose to feature students who were as prejudicial towards more privileged students as they expect those students are towards them.  Although their parents do probably listen to Radio 4 (and read the Guardian), I find it difficult to believe that the ‘white posh boys’ described by one student in the article, were really ‘disgusted’ when the television was tuned to MTV.

In reality whilst there will always be people who refuse to see beyond the narrow confines of class the majority of Oxbridge students are friendly and welcoming.  For all but the deliberately anti-social, marginalisation based on background is available only for those that seek it.  

Yours etc.

Guest post: Psychiatry – an Industry of Death

Friday, September 3rd, 2010

When I heard one of my acquaintances was heading to Los Angles, I sent him to spy on the Psychiatry – an Industry of Death Museum in Los Angeles.  Here is his report:

Visit to Psychiatry – an industry of death

It’s official; Psychiatrists are all murderers, rapists, extortionists, fraudsters and the scum of the Earth – so say the Citizens Commission on Human Rights.

I am not a Psychiatrist and have no medical training.  My interest in the Museum came about as a result of a very close relative having had the following treatments (not necessarily in this order) for depression about fifty years ago: insulin induced coma, LSD treatment, ECT with and without aesthetic, and a frontal lobotomy procedure (not transorbital).  Fortunately today my relative is alive, well and active and has no depression apart from that caused by England’s performance in the recent World Cup!

The Museum is situated along Sunset Boulevard but not in the best area of this long road.  It’s actually a rather run down white painted single story building which could be mistaken for a shop.  Next door is parking lot and there was a discarded sofa on the sidewalk opposite. 

Inside, the entrance was smart with a large curved reception desk with low level glass.  I was warmly greeted by an English lady who asked me to sign the visitor register and state my profession.  Along side the register book was a sign stating that they had the right to refuse entry – I decided not to ask if this would apply to psychiatrists!

I was invited to enter through the door to the left, which turned out to be a padded cell with bench seats, to watch an introductory video.  My greeter then mentioned, by way of casual conversation, that twenty million children are prescribed mind altering drugs each year and then asked if I knew how ECT came about.  Actually, following a very informative visit to an abattoir, I did know this.  In 1938 Dr. Ugo Cerletti became interested that pigs were prepared for slaughter by being electrically shocked through the temples. This rendered them unconscious but did not kill them, and they could survive the shock if allowed to recover. Since this was the days before ethics committees, he was then able to try this out on his patients. 

This introductory films were called “Psychiatry’s Destructive Agenda” and “Psychiatry’s Path of Destruction”.  Each was hard hitting and very compelling watching with a fast talking commentator who had a voice was just right for the CCHR’s apocalyptic message. 

Following the padded cell, the museum tour consisted of 14 different areas each with an on-demand video.  Here they are together with their CCHR summary:

1 – An Industry of Death
Governments, insurance companies and private individuals pay billions of dollars each year to psychiatrists in pursuit of cures that psychiatrists admit do not exist.  Psychiatry’s “therapies” have caused millions of deaths.

2 – Origins of Psychiatry
From its beginnings in the 1700s, using the practices of confining, restraining and isolating people with mental problems in institutions, psychiatrists have cashed in on human misery.

3 – Man Redefined
Redefining man as an animal without a soul, psychologists and psychiatrists thought man could be manipulated as easily as a dog could be trained to salivate at the sound of a bell.

4 – Psychiatry: The Men Behind the Holocaust
The Nazis killed millions.  Their justification was psychiatry and psychology’s theory of eugenics – that certain people were inferior and should be exterminated and their kind bred out of the race.  These architects of the Holocaust were never brought to justice.

5 – Psychiatry: Creating Racism
From apartheid in South Africa to the Ku Klux Klan and experiments on minorities in the United States, the most brutal racists were inspired by eugenics which justified injustice, inhumanity and denial of human dignity to millions.

6 – Soviet Psychiatry
Men fight and die for the right to speak and act freely.  Psychiatry conspired with those in power in Communist Russia to strip the rights of political dissidents and to define their “search for justice” as a mental disorder to justify their imprisonment.

7 – Brain Damage:  Psychiatry’s Miracle Cure
If an ice pick were accidently shoved behinds someone’s eyeballs, or they were jolted by 120 or 240 volts, leaving them convulsing and barely breathing, they would be rushed to hospital.  To a psychiatrist, these acts are “treatment”.

8 – Drugging for Profit
Psychiatric drugs are not designed to cure, but to suppress symptoms’ and physically damage the person taking them.  Claims of safety and efficacy are made with each new “miracle pill”; its dangers only later exposed.  Psychiatric drugs kill.

9 – Psychiatric Coercion and Restraint
Today, psychiatrists’ use of physical and chemical restraints in mental institutions is a very lucrative procedure.  Admitting that death is often inevitable from such procedures, psychiatrists literally get away with murder.

10 – Psychiatric Criminality
Working in a “profession” made up of people who commit rape, extortion and fraud, many psychiatrists have received prison sentences and civil fines.  Minimally, ten percent of psychiatrists sexually assault their patients, with one out of 20 victims a minor.

11 – Inventing Mental Illness
Psychiatrists charge huge sums of money to insurance companies, governments and anyone else who will pay to “treat” made-up mental disorders.

12 – Kids in Psychiatry’s Cross Hairs
Millions of children are given psychiatric labels for normal childhood behaviour and prescribed psychiatric drugs that drive them to commit violent acts and suicide.

13 – Psychiatry: Hidden Influence
Psychiatry has pushed its agenda of control, power and domination onto an unsuspecting society for over 60 years, infesting the fields of law enforcement, education, medicine, politics and many others.

14 – CCHR: Restoring Human Rights and Dignity to Mental Health
Psychiatrists act above the law – locking people up with no trial, stripping them of their human rights while enforcing unwanted treatments.  The Citizens Commission on Human Rights has exposed, fought and won against psychiatry’s violations for over 36 years.

I need hardly write that these videos were less than complementary about psychiatrists.  They are available from CCHR for about $16 or free from the CCHR site if you register (why would you do this?).  You can also view the complete series online. 

Each area had artefacts and photo images related to the video theme.  There were loads of photographs as well as examples of whips, torture boxes, and ECT equipment.  Drugs samples were displayed next to reports of their gross sales.  I now know that Marilyn Monroe had seen a psychiatrist the day before she died.  But was that relevant to her death? – we will never know.

I spent three hours at the museum and watched all the videos and exhibits.  During my afternoon visit I was aware of one other visitor who didn’t seem to activate any video panels.  I imagine that the visit would be less interesting if several people were activating adjacent videos simultaneously due to the noise generated.

When I left the exhibition area I was asked for my thoughts.  I complimented the quality of the exhibits and video.  I then explained that I was disappointed that CCHR had decided to present the information without any attempt at a balance view.  It might be true that Psychiatrists in the United States have the ability to milk medical insurance via the DSM and disbursements but this must also be true of other areas of their medical system (I recently was charged $400 for a week’s course of antibiotic pills which in the United Kingdom are available for £0.28 each).  Other countries have different reimbursement systems.  Was it not obfuscation to point out that using X-rays it was not possible to see any evidence in the brain of a so called mental condition but a broken bone shows up clearly?  And to describe a person with Bipolar Disorder as having normal ups-and-downs is surely a misrepresentation?

During my three hour stay I was bombarded with negatives statements and images about psychiatrists.  It would seem reasonable to suppose that at least a percentage of the profession provide a valuable service to patients, allowing them to live useful lives but no such information was presented which I found off-putting in the extreme.

I was also concerned about the use of video chips, such as those from the 2006 American Psychiatric Association Convention, where interviewees stated that they had not been able to cure any of their patients.  I have a suspicion that these remarks were taken out of context.

Finally, as the CCHR has a close relationship with the Church of Scientology, I was surprised that there was no obvious mention of this organisation during my visit.