Equilibrium read The New Scientist

Kate Ravilious wrote a piece about the idea that ‘homo sapiens rose to dominance over other hominins because of a greater tolerance for psychiatric conditions that produce unorthodox ways of thinking...’ In the editorial accompanying that issue (2837 November 2011) the editor put forward a case for the benefits to modern society of being more accept- ing of mental illness (Gosh, really?). There followed a critique of DSM, and the idea that the ‘bewildering array of conditions’ could be replaced by a similar framework of ‘dimensions’. – scores for traits along continuous scales. ‘That would reinforce the view that these is no clear dividing line between mental health and illness.’

‘Will discarding the concepts of ‘normal’ and ‘mad’ lead humanity to new heights, mirroring the advances that might have stemmed from earlier tolerance of unusual thinking? Perhaps not. But it should definitely promote a clearer and more compassionate view of the misfit minds among us. That must be a good thing.’ This editorial was actually truly revolutionary –and extraordinary coming from a science viewpoint.

Read Kate Ravilious’ article in New Scientist 2837 – usually available in public libraries.

Talk: Gail Hornstein & Bobby Baker

Gail Hornstein (author of Agnes’ Jacket, below) and Bobby Baker (author of Diary Drawings) in conversation at the Whitworth Art Gallery

I would travel over Siberian plains and up to the foothills of Popacatapetl to hear Gail Hornstein talk (below).

Her sensible, rich ways with words combined with a vast well of knowledge and a lifetime of teaching and writing combine to make a fabulous listen.

Here she was talking to Bobby Baker, mistress of all things performance-art- with-food-ish and creator of Diary Drawings: Mental Illness and Me, among other things, which was the subject of an exhibi- tion at the Wellcome Institute Gallery in London in 2009.

This talk was an initiative platformed by CIDRA of the University of Manchester – a cross-disciplinary group throughout the university trying to get arts, technology and science to interweave more ( my interpretation!).

Bobby Baker (now in her 60s) (see below) has been a performance artist for many years, and was hit by a paralyzing anxiety in the late 90s. Her anguish was only partly alleviated by ‘distraction and sleep’. Sizzling talk – Bobby ‘found cake’ in the early 70s and made work (often food related) after her own experience.

When she collapsed psychologically in the late 90s she self referred to a day centre for 3 weeks (which turned into 11 years)..Out of her psychic pain came 711 drawings, which were pruned by Bobby and her daughter for the very successful exhibition at the Wellcome (reviewed in Equilibrium 2009 Autumn along with Agnes’ Jacket – see www. haringey.gov.uk/equilibrium).

photograph: Katherine Rose/Observer

Gail’s story of Agnes jacket (embroidered by Agnes in an asylum in the early 1900s) and many others telling their stories and trying to make sense of non-sense is a gem; it stands alone as a testimony and testament to those with- out mainstream voices.

‘trying to capture the inarticulable’.

So many questions came out of the discussion – if you’re mad are you always mad? ( I would answer a strong no to that – but many are told they are irrecoverable by the profs). Is’outsider art’ a commodification? Why should people be scapegoated? What does a diagnosis do? Where is recovery? How can one find ways to be understood and loved?

Another strand was a fascinating discourse on what is fiction? What are lies? How much of peoples’ stories are crafted and constructed – what is the ‘truth value’? Why are so many people not believed?

The next day I went (masquerading as a post- grad) to a Masterclass at the University of Manchester. After the doling out of a bacon sandwich by Gail to a welcome punter, I was pinned to my chair with awe at the company (inc the revered Griselda Pollock, maitresse d’ of cultural studies), and deep and wondrous ideas flew around the room.

How to speak the unspeakable? Art lead- ing to transformation – how to negotiate the transport station of trauma. The space between. The parts that don’t make it to the representation. Can/Is representation do/ doing justice to the experiences? The inside/ outside, the private, the public.

Gail talked of Agnes’ Jacket as an amulet – the betweenness (verbal and the visual). ‘Disorder self: use art to order the self’.

Lots of meaty phraseology too – transport of the affect and the relief of signification. A little bit of translation needed, but it was clear enough to stick with. Bobby said that the sensual delight of painting meant that as she ‘learnt myself, I learnt my story’.

Ideas of infantilizing the distressed came up and the marginalization. More talk of ‘the other’ – Bobby saying she didn’t recognize herself from the diary entries.

Griselda gave a quick guide of attitudes and thoughts towards the distressed from platonic ideas in Ancient Greece to the psychologizing of the 20th century.

I left for lunch with my daughter buzzing with interdisciplinary vibes and desires to find out more, to find answers, to ask more questions and continue to try and change attitudes. Polly

Adam Ant

DIAGNOSED IN THE U.S WITH BIPOLAR DISORDER AFTER A SECOND BREAKDOWN, HE WAS SECTIONED AFTER AN ‘AFFRAY’ IN A PUB IN CAMDEN.

Adam Ant in the Guardian: ‘I was in a very bad state of mind. But you don’t walk into a doctor’s surgery and say I’m nuts – and if you do they just fill you with antide- pressants which just turn you into a Tellytubby. Antidepressants are very good, but it’s a clinical cosh really. Sometimes you have to be knocked out, just to stop; when you’re in that state all you want to do is sleep, and rest your body and your brain. But being on anti- depressants, if you’re not careful you can just be sitting on the couch looking at daytime TV, eating and doing nothing at all. ‘ Which is pretty much what he did for the next four years. ‘ And I didn’t enjoy it at all’.

He talks quite openly about his mental illness, but seems unresolved about medication; he knows he’s not well, but the drugs that stabilize the mind also anaesthetize his creativity, and if that is the price he must pay for sanity, he’s not sure if its worth it. When I ask if he’s taking medication at the moment, he pauses before answering. ’No. But I can if I want to, if I have the warning signs,a nd I know the warning signs, I can go and get them.’

What would be a familiar warning sign? ‘Well, the trouble is, when you look at the list: sexual promiscuity, spending loads of money, flamboyant behaviour – well that describes every rock star I can think of. That comes with my profession. So it’s very difficult to know.’

Thinkpiece - Angela on stress and the varying responses to it

Not every problem is a problem of the mind. I have been a user of mental health services for several years. I found my treatment useful, because there were times when I was very ill and the psychi- atric doctor managed to heal me regardless of what symptoms were presented to her.

However not every problem is a problem of the mind. If you go to the pub and say you feel ‘stressed out ‘ the Barmaid will say what will you like to drink ?

If you go to a travel agent and say you feel ‘stressed out’ they will say where would you like to go on your holiday?

If you went to the health shop and said you feel ‘stressed out‘ they will recommend relaxing aromatherapy products and supple- ments like B vitamins which target the nerv- ous system. If you went to a sports centre and said you were ‘stressed out’ they will offer you differ- ent forms of exercise, because exercise raises the endorphins in the brain which have a feelgood factor.

If you say to your psychiatric doctor that you feel ‘stressed out’ he will say are you taking your tablets properly? A consultant psychiatrist is trained to see a problem as a problem of the mind. For example I had a problem with my eyes. I kept seeing thing move. I told my consultant psychiatrist then she increased my medication. At the time there was a American lady working at the Clarendon Day Centre. She said that she notices that the patients are given medica- tion without a full medical check first. She recommended me to go to the optician. He said it is a condition of the eye not the mind. The Consultant did respect what the optician said.

The bar maid will not send you to the health shop. The sports centre will not send you to the travel agent. So what should the consultant psychiatrist do?

Recovery narratives

Dorset Mental Health Forum are doing great things. Recovery Narratives are stories of recovery. The stories, like the people they belong to, are deeply personal and indi- vidual. These are not simply stories of woe, or stories that support the notion of people with mental illness being victims. Whilst they may contain accounts of hardship, illness, struggles and pain, recovery narratives are also stories of great hope and immense courage, often illustrating the universal search for meaning that is innate in all of us.

Narratives show the process and move- ment towards understanding and accept- ance, as we progress from mental illness to mental wellness, a wellness shaped by the notion of recovery. Recovery can be viewed as a framework of hope, accept- ance and control over our lives, not about being recovered, as in, without symptoms but rather living a full, meaningful and satisfying life even when we’re experiencing symptoms.

Writing a Recovery Narrative isn’t depend- ent on an ability or confidence in writing. Many people use a tape recorder to record their recovery narrative, which can then be typed up. Some people write poems to express their stories. Others use quotes, lyrics or music that best reflect their situation and process. Others express them- selves best through painting, drawing or photography.

A Recovery Narrative can help us make sense of where we are in our own recovery process. It can help us make sense of our thoughts and feelings and make a situation or a memory clearer in our own minds.

As a peer-led mental health charity we focus on two of the main benefits of Recov- ery Narratives. Firstly, helping to inspire hope and recovery for those who experience mental illness and second, challenging and fighting the stigma associated with having mental illness.

Recovery Narrative Workshops are now being held throughout Dorset. If you would like to learn more about writing a Recovery Narrative or are interested in joining the next workshop in your area, contact Paul Siebenthal (Peer Specialist)

email: paulsiebenthal@dorsetmentalhealth- forum.org.uk or Phone: 01305 257172 Their magazine is called Reflect – it’s an excellent read and can be found at www.dorsetmentalhealthforum.org.uk

With thanks to the Dorset Mental Health Forum

Decisions Decisions

There’s a lot of talk about ‘shared decision making’ in the NHS right now. Many mental health patients say that they do not feel that they are properly listened to or that their expertise is not valued in the consultation, but it’s clear that many health professionals are quite evangelical about working in partnership with service users to determine the best approach to care.

Indeed, it’s a core principle of evidence-based medicine that clinicians should integrate the best research evidence with their own clini- cal expertise and the values and preferences of the patient. It’s impossible to do this prop- erly without some degree of shared decision making.

• Information gathering 

• Training in psychiatry 

• Intuition and experience

• Evidence-based practice 

• Cognitive reasoning 

• Uncontrollable factors 

• Multidisciplinary team influences

Interesting to see no patients on that list Training in shared decision making was highly accepted by patients and changed attitudes toward participation in decision making. There were some hints that it might generate benefi- cial long-term effects.

The Lobotomist - Radio 4 programme

This as expected was shocking. For starters the ‘pioneers’ were thrilled that there was now a ‘cure’. This was psychosurgery. Muniz (left), one of the key mutilators, won..a Nobel Prize.

He equated the structure of the brain to the structure of the psyche (something medical modellers still do today) and thought by cutting fibres he would be cutting obsessions.

In 1935 the claim was that 1/3 ‘greatly improved’, 1/3 ‘improved’ and 1/3 ‘ no worse’. Well...

The most controlling and abusive psychiatrists took it up with gusto – including William Sargant, and Wiley McKissick. The latter almost had a production line going and performed over 3ooo lobotomies. On ‘trou- blesome’ patients.

The operations caused fits, infections, apathy, double incontinence and irrevers- ible damage. ‘I’ve cracked, haven’t I?’ said one lobotomized person afterwards.

A talking head said on the programme:’they were doing the best they could considering what they knew about the world’.......It’offered salvation’. Well, if salvation was apathy and fits and complete loss of personality, I’ll go with the opposite. There was a provoking coda that talked of what we will look back at in 50 years about how we ‘treated’ people in distress. I think a lot of today’s apparent ‘remedies’ (ECT for starters) will be found deeply wanting, and often dangerous.

George Harding Exhibition

An exhibition of portraits which challenge the negative perception of mental health portrayed in popular culture. “These paintings are of self portraits, artists, friends, family and mental health professionals who have guided and helped me through my mental health problems. Together they have given me perspective on a journey through to the other side where there is hope in being able to cope with my illness. The paintings encourage people to look at “us” in a way that is celebratory, unconventional and can teach us something about different ways of being.”

George had a recent exibitionat the Bethlem Gallery South London

Blast from the past - Dr Ellen Holtzman

For the most part, private asylums offered the treatments that were popular at that time. In the late 19th and early 20th centuries, most physicians held a somatic view of mental illness and assumed that a defect in the nervous system lay behind mental health problems. To correct the flawed nervous system, asylum doctors applied various treatments to patients’ bodies, most often hydrotherapy, electrical stimulation and rest.

From 1890 to 1918, however, when the private hospitals were at the height of their popularity, medical thinking about the etiology of mental illness also began to change. A small number of physicians abandoned the somatic view of mental illness and adopted a more psychological understanding of the disease. Among them was Boris Sidis (1867–1923) (see left). Before obtain- ing his medical degree, Sidis had earned a PhD from Harvard University under the tute- lage of William James (1842–1910).

Sidis’s psychological training distinguished him from other asylum doctors. He argued that consciousness itself, rather than the nervous system, was the “data” of psychology. Sidis also believed in the subconscious. In his treatment, Sidis hypnotized patients to gain access to memories buried in their subconscious. After he roused patients from the hypnotic trance, Sidis described their memories to them. Patients’ awareness of their hidden memories, according to Sidis, eliminated all of their symptoms.

In 1910, Sidis opened a private asylum, the Sidis Psychotherapeutic Institute, on the Portsmouth, N.H., estate of a wealthy New Englander. Hoping for referrals from psychologically minded colleagues, he announced the opening of his hospital in thePsychological Bulletin and advertised it in the Journal of Abnormal Psychology, which he had founded. The ad noted that he would treat patients by “applying his

special psychopathological and clinical methods of examination, observation and treatment.”

Sidis touted the luxury of the asylum’s accommodations and setting, even more than the availability of psychotherapy. “Beautiful grounds, private parks, rare trees, greenhouses, sun parlors, palatial rooms, luxuriously furnished private baths, private farm products,” wrote Sidis in his brochure describing the institute. Moreo- ver, he offered his patients the somatic treatments of hydrotherapy and electrical stimulation, as did his less psychologically minded colleagues. The emphasis on luxury combined with the availability of the popu- lar somatic treatments, even in an institu- tion created by an “advanced” thinker like Sidis, suggests that wealthy patients expected a traditional, medical approach to treatment.

Book reviews

American Madness:

The Rise And Fall Of Dementia Praecox

By Richard Noll. Harvard University Press 2012

Meaty and academic, though fascinating, book about the appearance and disappearance of Dementia Praecox. In 1895 there was not a single case in America, by 1912 there were thou- sands of people with the diagnosis locked up in asylums, hospitals and jails. By 1927 it was fading away.

‘Noll shows the co-dependency between a disease and the scientific status of the profession that treats it. The ghost of demen- tia praecox haunts today’s debates about the latest generation of psychiatric disorders’.

The Locked Ward:

Memoirs Of A Psychiatric Orderly

By Dennis O’Donnell. Jonathan Cape 12.99

Dennis O’Donnell was an orderly for seven years in the Intensive Psychiatric Care Unit of a large hospital from 2000. AS well as encountering ‘fear, violence and despair’ he also encountered a lot of care and compassion.

He goes into detail about life behind the doors of ‘ the most feared and stigmatized environments in healthcare’. He looks at all the major mental disorders and how triggers such as religion, sex, wealth and drugs bear influence, and look at treatment and the role of the families involved. ‘What emerges is a document of humanity and humour, a remarkable memoir that sheds light on a world that still remains largely unknown. Review in next issue

Philosophy tackles the big issues...

Philosophy tackles the big issues: who we are, what the world is like, and how we ought to treat one another. If you’ve ever wondered about the answers to these questions, you’re already doing philosophy! A new group run by philosophers will help you think through these questions yourself in a friendly, accessible environment.

The Stuart Low Trust, an Islington-based mental health charity, has for several years included philosophy talks in their programme of weekly Friday Evening Events. These free events provide an inclusive welcome for around 200 people each month and offer a variety of presentations and workshops, including self-esteem, health and wellbeing, music and comedy gigs and talks from such well- known psychologists as Dorothy Rowe, plus a healthy bite to eat and the opportunity to socialise.

The Stuart Low Trust was so struck by their Friday group’s interest in philosophy that they have conjured up a crew of philoso- phers prepared to come to London to run two hour sessions in philosophy every Sunday evening.

The sessions, which take place at a venue in Archway, N19, kick off with a main speaker introducing the topic under discussion. It may be based on a particular philosopher (like Plato), or on a general idea, like the nature of a person. After a brief general talk, everyone splits up into small groups of five or six people to discuss a question. Examples include: “What is goodness?”; “Are animals moral?”; “Am I my body, or my mind (or both)?”; “What is happiness?” The groups reform as one and discuss the ideas they came up with. They are led by a questioning and probing main speaker, who takes the ideas a step or two further, until the tea break, when everyone gets a chance to relax and, of course, discuss philosophy. The second hour brings a second question and a final discussion, when the speaker may aim to wrap up an idea only to find that the participants have a lot more questions to ask!

“Doing philosophy here makes me happy” one participant said, “even though I am not in a comfort zone. Pushing the boundaries is what makes it exciting.” Everyone is learn- ing how to reflect on their own thoughts and enjoy the differences in opinions. As one person put it: “These discussions are good for both the head and the heart!”

What is the effect of philosophy for people with mental health issues? Just what it is for us all: an exciting opportunity to think freely, reflecting on the deepest questions we can ask about the human condition.

For more information have a look at the Stuart Low Trust webpage: www.slt.org.uk.

Mental Health in South Asian Communities

By definition the South Asian community is a group of countries i.e. India, Sri Lanka, Pakistan, Bangla- desh, Bhutan, Afghanistan Nepal, Maldives and Nikaba islands. Each country as well as sharing common borders they also share culture, social and historical similarities. This also accounts for people with mental problems.

In the sub-continent mental problems are seen as taboo, in other words mental problems are not spoken of. In the subcontinent, when a person has mental problems such as schizophrenia, depression or any other type, they are basically frowned upon or pushed under the carpet.

When people from the subcontinent like my family come to this country they bring their culture and history with them. This would also include social and religious stigmas like mental problems. For instance sometimes it is said that a person has mental problems because they have done something bad in their past life. So people with this condition tend to hide it. So what happens is that when they start have these attacks, or any other situations that occur, the families tend to have to deal with the situation by themselves and without any help from the outside.

If you look at non-Indian or Western culture, you will notice that they are more open and are able to deal with it the rest of the community. This is partly because they are in their home country. And when South Asians come to this country they feel that they are on a different planet and find it difficult to integrate into a western culture, or what is commonly known as culture shock. So what happens is that some people tend to create their own group of people that have the same cultural believes as they have from their countries. Hence they become a closed community with their traditional values and stigma. Rarely people who came to this coun- try during the 60’s and 70’s find it difficult to express their feelings. This is because they were mostly brought up with South Asian values, which in a way can be good, i.e. gives you your own unique identity and beliefs.

The children of immigrants, i.e. who were born around the 70’s and 80’s, that have grown up here find themselves in a “catch 22”. On one end you have the Asian culture i.e. tradition, religion, customs, music, films. And on the other end Western values that they might have experience such as relationships, making out etc. This might lead to people isolating them self from what is really happen- ing to them. This may include serious matters like extreme views, abuse, and the unable to deal with various behaviours within their family. All this builds up and what I call “an over flow” of emotions could lead to mental breakdowns, depressions, anxiety attacks, creating a barrier between themselves and “the rest of the world”, and many more. 

In some cases if this is not taken care of could lead to drug abuse, hate crimes, violence. And lead to mental health problems as I have mentioned.

If we want to deal with this as a society we may want to find ways of befriending people from various groups. What I mean is having people who work for various organisations but are from those cultural groups to deal with those issues. One factor could be to go to people and their family and explain the mental health problems. Another factor could be to teach the family and the people involved the way to cope with any events or “mental problems”. One last factor could be to “destigmatise” any mental problems. I am not sure but there might not be any type of befriending schemes for the Asian community.

On a lighter note, most young Asians who are very young second generation and third generations are finding it a bit easier to deal with mental problems. This is probably because they find fellow “brit-asian” or Asians from the subcontinent that have grown up here to go to for advice and support them. This article is just my opinion and not anyone elses.

Dev Chatterjea

Haringey Foodbank

The Food Bank movement is run by a the claimant is directed to the nearest Job Christian organisation, The Trussell Trust and hands out three day supplies of food to people with no other recourse. There are 163 throughout Britain and they supply tinned and non-perishable foods donated largely by church congregations.

Will they get much use at the Clarendon? Hopefully not. The first port of call for anyone currently on benefits will be to the Social Fund, which can be handled on the tele- phone. Crisis Loans are interest free and you do not have to be on Income Support to apply.

A Crisis Loan is an urgent payment that can be made to anyone who does not have enough money to meet their immediate needs. The loan should be paid when it is the only way of preventing a serious risk to the health or safety of you or a member of your family.

You can apply for a Crisis Loan if you have had a crisis such as a fire or a burglary for example or if you have lost your money or are waiting for a benefit to be assessed – you will need to show you do not have enough money for you and your family’s immediate living expenses or for an essential item such as a cooker or fridge for example.

They will award a Crisis Loan for subsistence at a rate of about £40 per week which has to be repaid through benefits in cases of dire emergency. Once a loan has been agreed

Centre (such as Granta House) where a Giro (remember those?) will be issued to be cashed at a post office.

Only in the event of this application being turned down will it be necessary to access the Food Bank vouchers.

Alternatively someone with an addiction problem might be better off taking food rather than cash.

The latest available figures reveal that, in 2008-09 in England and Wales, almost 2.4 million people applied for crisis loans. Only 1.7 million received an initial award, meaning almost 700,000 were left waiting for a loan or had their applications turned down.

Many of the people involved are often working or a turned down for multiple or inappropriate applications. Oxfam has esti- mated that 6 per cent of Britons now go hungry some of time and that 13 million live in poverty.

What should you do if you are destitute?

Mark Francis is the signatory for the Vouchers at the Clarendon Centre. He will try to get you a Crisis Loan & if this fails- or you have an addiction problem that might make this the better option- then a voucher will be given to take to the local Food Bank. Like a Crisis Loan, you may only have 3 in any twelve month period.

Mind in Haringey

Mind in Haringey is a small charity support- ing local people affected by mental ill health, their families, friends and carers in the London Borough of Haringey. We started up in 1974 in a small church hall offering hot meals to those that needed it and have developed to become a thriving mental health charity which aims to improve the quality of life of those affected by mental ill health by offering relevant services. These include daily well-being activities such as discussion, arts, gardening, complementary therapies; two full-time advocates provid- ing information on subjects from benefits to legal rights so that clients are able to make informed decisions; one-to-one counselling; and a Younger Minds project helping multi- ple disadvantaged 16-25 year olds who find life difficult to cope with.

We consult our service users and work with other organisations to meet the needs of Haringey residents affected by mental ill health, using feedback to continuously improve our activities and services. We have a small staff team supported by our trustees and volunteers many of whom have their own experiences of mental ill health.

We work in collaboration with partnership organisations in tackling stigma and discrimi- nation and have a popular community café at our premises on a Friday which is open to the public and helps to break down barriers with the local community.

Mind in Haringey is a safe and welcoming environment, offering activities which give people a reason to get out of bed in the morning and help to combat the loneliness and isolation that goes alongside mental ill health. We give people the information, tools and support they need to follow the road to recovery.

Despite being hit by funding cuts of £750,000 in the last 3 years and having to restructure the entire organisation, we are now well on our way to recovery and are able to offer counselling services once again, support for young people and a wider choice of well-being activities. Unfortunately a further £67,000 of core funding from Haringey Council is likely to stop in June 2012 and we need your help to keep us going.

Please visit our website to find out how: www.mindinharingey.org.uk

Play: The Fantasist

A phenomenal play about a woman’s mental illness. The acting was outstanding. There were only three roles , the ill woman, her friend, and a nurse but the interpretation of each was excellently executed. Very clever use of puppets which each had their own character and were very real. The puppeteers were visible, but cleverly were invisible and there was often two people operating one puppet character showing incredible coordination. There was danc- ing furniture but the whole mood of the play was very dark. The madness seemed never ending. I went away from the play feeling unsettled although the show ended on an optomisitic note.

Tizzy McKenzie

Poor Angela

My GP referred me to the London Chest Hospital in Bethnal Green. Yes the same hospital the footballer called Muamba who collapsed recently. She referred me because she thought that because I had to keep taking naps during the day and I was slow at work she thought I was not sleeping prop- erly at night.

I was given a sleep machine to use for one night Unfortunately the machine was faulty and gave out the wrong result as oxygen being dangerously low So I was kept in the hospital for m2 days. I was given oxygen on the first day through out the night. Blood was taken from the artery through the wrist, which is very painful and I had to keep still. The oxygen level was too high. Then on the second night I slept with no equipment. The blood was taken which showed a normal oxygen level. So it meant that I stayed in the hospital for 2 days for nothing.

However when I mentioned about being too slow the doctor recom- mended cognitive behavioural therapy (CBT) Where there’s a will there’s a way.

Angela