Archive for the ‘Uncategorized’ 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

Photo credit

Institute of Psychoanalysis event

Wednesday, May 9th, 2012

Oedipus Through the Life Cycle: Childhood

Location: The Institute of Psychoanalysis, 112a Shirland Road, off Elgin Avenue, London, W9 2EQ (tube: Maida Vale or Warrick Avenue)

Saturday, 19 May 2013

Time: 9.30am – 1.00pm

Tickets: £45 (trainees £40, students £35)

Web Site: http://www.beyondthecouch.org.uk/

The story of Oedipus can be used to explore significant aspects of emotional development from many perspectives. The myth was the foundation for Freud’s theory of the Oedipus complex, mainly unconscious feelings of wanting to posses the parent of the opposite sex. Melanie Klein, through her understanding of object relations, opened the door to the exploration of the oscillations of positive and negative unconscious fantasies. Further theoretical contributions, in spite of their differences, acknowledge its importance

This fundamental stage in a child’s development will be discussed by speakers from different theoretical perspectives. Beata Shumacher will consider the Oedipal development of the daughter of a single mother, while Viviane Green will talk about a reconstruction of childhood as seen through the eyes of an adult male with persisting omnipotent wishes. The event will be chaired by Jenny Stoker.

Beate SchumacherHow Can You Remember the Name of the Father? On the oedipal development of a single mother’s daughter.
A case history following the analytic treatment of a 6-year-old girl brought up by a single mother, making use of Lacan’s concept of ‘the name of the father’ to conceptualise her difficulties.

Viviane Green: Oedipus: Cirumvention, Conflic and Compromised Development
Reconstruction of childhood as seen through the eyes of an adult male with persisting omnipotent wishes.

Chair: Jenny Stoker

To book:  http://www.beyondthecouch.org.uk/, or contact Ann Glynn, ann.glynn@iopa.org.uk or 020 7563 5017

Beate Shumacher is a BPAS Child, Adolescent and Adult Psychoanalyst in private practice. In the NHS, she was a Consultant Adult Psychotherapist on the Cassel Hospital’s Family Unit from 1995 – 2011. Currently, she works for the Brent Adult and Family Psychotherapy Service and for West London Mental Health Trust’s Forensic Psychotherapy Unit., She also teaches at the Institute of Psychoanalysis and ran an infant observation course at the Karl Abraham Institute in Berlin from 2009 to 2011.

Viviane Green is a  Child and Adolescent Psychotherapist (ACP) and Adult Psychotherapist (BPC). She works in private practice and is  Programme Director of  the MSc in Child and Adolescent Counselling and Psychotherapy, Birkbeck College. She was formerly Head of Clinical Training at the Anna Freud Centre and has developed a number of child and adolescent training programmes in Europe and Brazil.

Jenny Stoker is a child and adult psychoanalyst. She has a private practice and is on the staff of the Anna Freud Centre.  She is the author of You and your Toddler, one of a series of books aimed at helping parents to understand their child’s development.

“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

Xmas manifesto

Monday, December 21st, 2009

19709

It’s easy to assume that things are as they’ve always been.  This of course is not the case and recently I discovered that the rate of economic growth during the UK’s industrial revolution, one of my native land’s most significant upheavals, rarely exceeded 1%.  Nowadays, for a country’s economy to be admired, economic growth needs to be at least double this number, which is to say that a growth rate of what was once a time of enormous upheaval has now become commonplace and mediocre.

This has a significant upside.  From a state where it would take two generations or more for what was once simply imagination to become reality we are now in situation where what is unthinkable in our early lives is realized well before the reaper calls.  I remember with fondness when I was young and my father brought a laser home from his work and we invited all the children in the neighbourhood around to see it in action.  Some were so excited that they made repeat visits; readers can try to imagine the depth of their indifference should a similar offer be made today.  I am less enamored with my recollection with my first experience of accessing the internet as where others saw opportunity I saw a page that crashed immediately and instinctively knew that it would come to nothing.

Change in modern life is nowhere more prominent than that brought by information technology.  So significant are the transformations visited that it often feels as if we’re involved in a project no less important than that of redefining what it is to be human.  I exaggerate, and (at the risk of looking foolish a second time) some technologies – twitter for instance – are over-hyped but someone cryogenically frozen in 1995 and thawed in 2009 would need to be equipped with a mobile phone and a broadband connection or would swiftly find themselves unable to use the maps application on their iPhone to guide themselves to any Xmas parties.

But the benefits of new technologies should also be viewed in the context of what is lost.  The demise of some things, say camera film, troubles none but aficionados, the rigid or sentimental of outlook, but other changes are more significant.  There is concern that, with an email arriving every three minutes, the modern workforce is permanently distracted and their days fragmented.  Universal mobile phone usage means that silence, always a precious commodity, is all but extinct and with this a chance for reflection and self awareness.  The Blackberry’s email technology, universal Wi-Fi coverage means that the boundary between work and recreation is blurred as never before.   Our population feels if it is constantly behind, but yet never deserving of a rest.

This situation is I suspect only going to get worse, or better depending on your point of view.  Whilst this technology is undoubtedly transformational, a skill we have yet to learn is when to switch it off.  But with many of us getting four days off at Xmas, this holiday season would be a good time to start.  Power down your television, mobile phone, mp3 player, laptop computer find a comfortable chair, preferably in the sunlight and nowhere near your recently purchased ebook of “1001 Places to visit before you die”. Close your eyes.  Then when you open them again send me an email, twitter or text and let me know how you got on.

Links:

Distracted: The erosion of attention and the coming dark age – Maggie Jackson

Information overload: Switch off  your mobile, iPod, and emails – technology is turning our brains to mush Daily Mail July 2008
Can I have your attention please? Guardian CiF January 2008
Stress of modern life cuts attention spans to five minutes – Telegraph November 2008

Psychiatry in the news – 7 April 2009

Tuesday, April 7th, 2009

Guardian reports that Legalisation of drugs could save UK £14bn, says study but it’s hard to imagine that this will do anything to change Jacqui Smith’s position.  Transform discuss further

The Today Programme reported today that care home children whose behaviour during the 1970s/80s was controlled using large doses  of medication have subsequently given birth to children with birth defects.   The drugs in question included Haloperidol, Droleptan and Depixol.  The BBC have Professor Jeffrey Aronson, professor of clinical pharmacology at Oxford University who says that high doses of such drugs can cause genetic damage.  Presumably he’s suggesting that the drugs cause damage to unfertilized eggs – rather than being teratogenic.  These drugs can currently be given to women of child bearing age.  It’s obviously concerning that large doses of sedatives should be given to anyone without a mental health disorder (or even with…) but if they’re right (nb: it doesn’t sound like a very rigerous report and there could be other causes for what they’re suggesting has happened) this would have wide ranging implications.

14 April 2009 Update: I emailed Aronson but as yet no reply.  A very well known academic clinical pharmacologist where I work said to me that he’d never heard of antipsychotics causing oocyte damage. 

Not strictly on psychiatry, but on the subject of this Government’s ongoing project to give us all anxiety disorders, check out the latest Metropolitan Police anti-terrorist tube advert.  New Campaign to urge Londoners to report suspicious activity 

Reds under the bed all over again - reminds me of a Viz cartoon I once read where Jack Black knew that the new bearded people who’d moved into his sleepy, Daily Mail reading village were terrorists because they read the Guardian.

14 April 2009 Update: this annoyed me so much I wrote a full post about it.

Psychiatry book club: proposal

Thursday, January 15th, 2009

As I sat my exam on Tuesday, I’ve got a lot more time for this blog, and I would like to try an experiment in reader participation. Every month or so I’ll nominate a book which a few of us can read and then comment upon. A bit like a book club, but without the red wine or sexual tension.

Nothing too difficult, and obviously I’m very open to suggestions.

This month I thought that we could start with The Bell Jar by Sylvia Plath. I read this about ten years ago and loved it beyond reason; this was before I became a psychiatrist so I’m interested to know what I think of it now. In brief, it’s an autobiographical novel of a young woman who, about when about to break into the world of writing, has a mental breakdown. The real story is well known and Plath committed suicide a month after its publication.

It occurs to me that people might think that I’m doing this to encourage people to buy books through this site. Of course you can, but worldcat lets you know which libraries have a copy of the book near to you.

Miscellaneous

Thursday, July 24th, 2008

 

BBC From our own correspondent ‘A shoulder to cry on in Baghdad’ – Psychiatrists in Baghdad 31 May 2008

(From our own correspondent homepage)

‘How Britons get high – drug users tell their stories’  Observer 20 July 2008

 

‘The Perfect Penis’ and body dysmorphic disorder

Tuesday, June 10th, 2008

 

I got home from the pub the other night and was casually scanning through the TV channels, when I happened across the second half of a curiously compelling documentary.  ‘The Perfect Penis‘ was about an American psychology student who was paying $4000 to have his penis lengthened.  This is not my area of expertise, but apparently this involves cutting a ligament located in the pubis.  A lot of the penis is actually in the body and cutting this lets a bit more of it protrude. 

The next bit sounds worse: to complete the job, the gentleman must then hang a weight off his member for no less than eight hours a day for several weeks after the op.  As well as sounding painful and unbelievably tedious, the results appear barely worth the trouble, with Wikipedia quoting an increase in penis length of 2-3cm and netdoctor stating that the only study available suggested that average increase in length was 0.5cm.  

The chap who was having it done actually seemed pretty normal, although my suspicions of obsessive/narcissistic personality traits were raised by his buff physique.  I didn’t catch all the programme so I didn’t see if he had a psychiatric evaluation.  I suspect not, as it might have spoilt things and there was a bit where he was talking to this psychology supervisor, who said sensible things which were completely ignored.  We got to have a look at the ‘inadequate’ equipment towards the end of the show and it looked perfectly fine to me.  We were also told at the end of the show that the penis surgeon had recently bought a new house in which to keep his four rollers;  I couldn’t help thinking our poor boy had been done. 

Leaving no grotesque stone unturned, the documentary makers included an interview with ‘Mister Mark’.  Mark is a gentleman who has injected enough silicon in his testicles and penis to make his scrotum 1ft in circumference.  He was appeared pleased as punch about this, and even has a website called ‘extremecock.org’ dedicated to his enlarged genitals (full admission: in the spirit of ‘frontier psychiatry’ I did visit this website, but I really wouldn’t recommend it to anyone of an even slightly queasy disposition).  

If I was trying to drum up business for myself, I’d be concerned if the psychology student was suffering from body dysmorphic disorder; Mister Mark is a subject for another day.  At the end of the show it was revealed that he was unwell and that he may be suffering from a silicon embolis.

Body dysmorphic disorder (Also known as dymorphophobia) was first described by Morselli in 1886:

‘A subjective description of ugliness and physical defect which the patient feels is noticable to others, although the appearance is within normal limits.  The dysmorphophobic patient is really miserable in the middle of his daily routines, everywhere and at any time, he is caught by the doubt of deformity’

Typically the patient is convinced that some part of his/her body is too large, too small or misshapen.  This is usually a part of the face, but can be any body part.  To other people the appearance is normal or there may be some slight abnormality.  The patient may be constantly preoccupied and tormented by his/her mistaken belief;  he/she may blame all his other difficulties on it.  For instance they may think that if only their nose were a better shape then they might have a better life or job. 

There may be time consuming behaviours.  I once had a patient who was constantly late for work as he used to spend hours examining his nose in the mirror. There is substantial overlap with other psychiatric disorders, especially depression and social phobia.  At its extreme the BDD may be very disabling and may leave the patient housebound and unemployed.  In the absence of corrective operations, people have been known to take matters into their own hands, for instance using a clothes iron to remove wrinkles on their face.

The prevalence is 1% in the community. The treatment is often difficult and  surgery is usually contraindicated.  Patients usually will have unrealistic expectations and once the operation is complete their concern may transfer to another part of the body. 

Dr David Veale’s site has a BDD reference page which is worth a look.