Thursday, 26 September 2013

Asda, Halloween and who's the mental patient?

Yesterday, Asda was criticised for launching a Halloween costume for online sale, labelled 'Mental patient fancy dress costume'. As you can just make out from the screen shot of the offending item, the model is covered in blood and wields a meat cleaver - charming.

Amidst all the hoo-ha surrounding the offence being done to mental health patients because of this, what I find interesting is that no-one has raised so much as an eyebrow at what seems to me even more disturbing - the alarming spectacle of violence referenced by this, at best tasteless, party costume. I repeat, 'covered in blood' and 'wields a meat cleaver' - can anyone hear that or have we become so numb to such grotesque ideas and images that nothing disturbs our serenity (or should I say denial).

I contend that the increasing incidence of images, items and concepts like these in our everyday lives is a reflection of something we should be far more concerned about - such visions ultimately make mental patients of us all by inuring us to images of the obscene and violent, normalising them and even turning them into a so-called laugh.

Here's an idea - why don't we market Al Shabab outfits and sell them for Halloween in the wake of the recent Kenyan shopping mall atrocity - you know, just for a bit of fun? Given that Halloween is now a popular date in children's diaries, the need to recognise what we're doing is all the more stark. Or perhaps we should wait until the meat cleaving and blood letting starts among our young adults (and we've already seen it on the streets of South London), then introduce education around it into the school curriculum?

On a similar theme, a recent article by James Delingpole on the shocking reality of the content of the new Grand Theft Auto V game, gives a horrifying insight into this brave new world of explicit and gratuitous images of human suffering and violence. Horrifying, that is, to those who are still able to be shocked by the depravity routinely touted as entertainment in these times. I urge you, for the sake of our common humanity, to take a look at James' article.

Written by Jacqui Hogan

Friday, 20 September 2013

Neurocognitive impairment or just bad memories?

Just recently, there have been a few occasions on which I've had cause to wonder whether I'm headed squarely for dementia - being absolutely certain I'd forgotten my keys and then being surprised to find I had remembered them after all (better than the other way round), and the increasingly common disappearance of a word or thought that had, two seconds previously, been top of mind. Know the feeling? I know I'm not the only one, because just last night I was talking to a friend who also confided she's concerned she's on the same slippery slope, citing similar faux pas.

New research from Cornell University doesn't totally allay our fears, but it does move us closer to identifying reliable methods for evaluating whether such lapses are on the 'healthy age-related memory loss' spectrum or the 'Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD)' spectrum. The results hold promise for detecting neurocognitive impairment early and implementing prophylactic strategies.

CJ Brainerd et al. in the paper 'Dual-retrieval models and neurocognitive impairment' showed that declines in reconstructive memory (that is, recalling a word or event by associating it with clues about its meaning, for example recalling that 'carrots' was presented in a word list by first remembering that the list was associated with food shopping) were associated with cognitive impairment of the type described by MCI and AD, but not with healthy ageing. The type of impairment associated with healthy ageing was recollective memory - that is, an increasing inability to recall a word or event precisely.

So, decline in reconstructive, as opposed to recollective, memory is the all-important distinction and, over a period of 1.5 to 6 years, declines in reconstructive memory were a reliable predictor of of future progression to neurocognitive impairment (either MCI or AD). Of great significance is the finding that loss of recollective memory is a better predictive marker of MCI or AD than the best available genetic markers of such diseases.

So, where was I? The bottom line is, that forgetting the odd word or thought (or keys) here and there is a perfectly normal part of ageing. 'Thingummyjigs' and 'What's-his-names' are just fine. And hopefully this research will lead to greater leverage of the predictive value of reconstructive memory and foster earlier and more effective treatment of neurocognitive morbidity.

Written by Jacqui Hogan

Wednesday, 18 September 2013

A crisis of character in the Western world

I have a friend who has recently been 'committed'. In the psychiatric sense. To a mental hospital. Perhaps rather arrogantly, I didn't imagine I would ever be in this position - how could anyone I would befriend ever be locked away for mental illness?

I discovered this just a few days ago. She called from hospital to let me know what had happened. She sounded fine - no, not just fine, but positively chipper. "It's just like being in a hotel" she confided, chirpily. When I asked her what had happened, she said it started with her flooding their block of flats by leaving a bath running, then progressed to the fire brigade attending, followed by the police. For reasons unexplained to me, she resisted the police, who apparently handcuffed her to try to restrain her. Rather than oblige, she continued resisting and wound up banged up at said 'hotel' up the road. It sounded like she was thoroughly enjoying herself, and the prospect of a six-month mandatory stay didn't seem to phase her a bit.

One part of her story which raised a red flag for me, was when she described how she had behaved in response to the flooding incident. She said that (rather than going downstairs and checking to see what damage had been done) she chose to hide in her kitchen. The fire brigade thereby ended up having to break down her door to get in.

This small cameo speaks volumes to me and gives a clue as to what might really be going on for my friend - is she really bipolar, as she tells me she's now been diagnosed (like most of the population now, it seems) or are we witnessing a crisis of character - the unwillingness to take responsibility for one's behaviour.

According to experts only a handful of clinical conditions can potentially render a person not fully responsible for their behaviour. For example, people with delusional psychosis can commit heinous acts because their brains are not functioning properly. In such cases, an individual can lack the capacity to judge right from wrong.

But my friend is not in this position. She has never been diagnosed with delusional psychosis or any other condition that exonerates her from responsibility for her actions. But what I do notice, looking back, is that she has actively denied taking responsibility at crucial points in her life.

For example, when she was diagnosed with a serious physical condition which was subsequently retracted by her doctor as her health improved, she asked if he would keep the revised diagnosis a secret, to which he (remarkably) agreed. This entitled her to the full slew of sickness benefits and relieved her of the burden of ever having to take responsibility for her work life again. (The flats I mentioned are council of course, so any responsibility for rectifying the considerable damage caused by the flooding falls to the council).

When I delicately raised this matter with her some years later, she had totally forgotten that particular game-changing conversation with her GP, and I do recall thinking at the time - she has genuinely purged her mind of that truth. I wondered, at the time, what happens to the minds of people who choose to live in a state of denial. Perhaps now I am witnessing the answer.

A recent article by Dr George Simon PhD entitled 'Mental disorders and accountability: is everyone a victim?' speaks to the increasing shift in Western culture towards a 'he couldn't help it - he has a mental disorder' attitude, when in fact he does have a choice about whether or not to engage in responsible social behaviour. He refers to this as a crisis of character in the people of our Western nations:

"Not only has the character crisis being witnessed by the industrialised world over the past several decades reached epidemic proportions, but we have become so desensitised to it (or are in such enormous denial about it) and have grown so accustomed to claims that various mental disorders are really to blame for willful misconduct, that the very notion of personal responsibility for behaviour is in jeopardy of becoming extinct."

I agree with him that 'character is has always been key to responsible social functioning' and we are now entering a brave new world where virtues of character are the exception rather than the norm.

As to my friend, in many ways, being committed may be her preferred next step along the pathway to total relinquishment of any responsibility for her life whatsoever - reversion to a perennial childhood. Perhaps, to her, being committed is not such a high price for total relief from the adult challenge of character formation.

Written by Jacqui Hogan

Thursday, 5 September 2013

A good kind of crossing boundaries

Those of you who are therapists and/or patients of therapists will likely be aware that, in the normal course of things, it's not a great idea to cross boundaries - as in, slap someone without permission (violating a physical boundary) or engage in emotional blackmail (violating an emotional boundary). But this month, the Mental Health Foundation is launching a new paper, front cover pictured above, entitled Crossing Boundaries: Improving integrated care for people with mental health problems which, it has to be hoped, represents a good kind of crossing boundaries.

The report sets out the findings of an inquiry which ran between April 2012 and June 2013, whose aim was to identify good practice, generate discussion and draw up key messages on integrated healthcare for people with mental health problems.

One of the key findings of the report is that the quality of the leaders involved in delivering mental healthcare services is vital - it is particularly important they understand that an integrated approach is needed. To achieve effective patient outcomes requires the co-operation of many professional disciplines and focus on major social influences such as education, unemployment, housing and poverty. Support based simply on medical diagnosis of mental illness is insufficient in and of itself - medical support is obviously critical, but adverse social factors for example, may mitigate against any positive effect.

This 'crossing of boundaries', the report finds, needs to be underpinned by a number of structural and organisational improvements, among the most important being integrated IT systems within and across different care and social organisations, the ability to pool funds from different funding streams into a single budget and shared protocol and partnership agreements.

But most important of all, the report cites, is the involvement of 'staff who understand the holistic nature of health care and have no professional defensiveness about working closely with colleagues in other disciplines...'. Hmmm. One has to wonder - would a little psychotherapy be in order?

Written by Jacqui Hogan