Tuesday, 11 December 2018

The pain of childbirth and PTSD as a possible after-birth

An interesting news feature dealing with the issue of post-natal post-traumatic stress disorder recently caught my attention.   

I am not at all surprised by its prevalence. 

It is important to understand that PTSD does not have to involve experiences of violence, war or car accidents.  It can occur following any event that a person is overwhelmed by and cannot properly emotionally and cognitively process.  

Of course, an event such as being shot at may give rise to a greater tendency to suffer from PTSD but that doesn’t mean it can’t happen as a result of, for example, a bereavement, a divorce or child birth.

Child birth is, according to a consultant orthopaedic physician I spoke to, “one of the most dangerous processes a woman can put her body through” which should get the attention of everyone involved of how a woman may potentially respond.  

Some 30,000 women are diagnosed with postnatal PTSD each year. Bear in mind these are the women who are diagnosed so this is not a trivial issue.  Psychiatrist Dr Rebecca Moore, a specialist in perinatal mental health, told the BBC in a recent interview that more needs to be done nationwide to improve perinatal care. 

It goes without saying that many women give birth and have no ill effects – some enjoy the experience – but so do some soldiers on tour.  

Those women who do not have positive experiences in childbirth and go on to show symptoms of PTSD need sympathy from loved ones and care and effective treatment from trained professionals to prevent the symptoms and implications going on for years.

As a trauma practitioner, I would place the women who have been unfortunate enough to suffer from PTSD in this way in the same category as those I have treated suffering from relationship break ups.

These clients do not automatically generate the same levels of sympathy from those around them and are more likely to hear friends and family saying: “Come on … what’s wrong with you?” Such a statement is not helpful and shows a lack of understanding of what trauma is.  

As I mentioned before, trauma happens when an individual is emotionally overwhelmed by an experience and then cannot make sense of or integrate the experience into the fabric of whom they are and what this experience has come to mean to them.  

Some symptoms may resemble post-natal depression such as withdrawal behaviours and mood swings but post-natal PTSD may include flashbacks, hyper- vigilance and extreme anxiety about their or their baby’s safety.  Prompt diagnosis is a key to helping these women, as well as seeing a trained trauma specialist subsequently.  

Midwives and obstetricians, who are present at a birth and ought to be more aware of the potential risks to the mother following a difficult birth, should play a key role in flagging potential for PTSD to GPs.

PTSD is one of the most debilitating of mental health conditions.  Post-natal PTSD is perhaps made even more devastating because it comes at a time in a family’s life when happiness should abound.

Written by Bert Stemarthe 

Photo by Hannah Olinger on Unsplash

Friday, 7 December 2018

Infatuation, Romantic Love and the Pursuit of Personal Happiness.

Anyone who’s ever been in love will easily remember the wave of powerful emotion that rushes towards us in the first few months. Countless unrealised needs and fantasies rise to find fulfilment through the heart of the beloved and we imagine everything we long for can be found in them. 
Is it any wonder that when we fall in love, it can be hard to grasp the true nature of our feelings: Is this really love or the riptide of infatuation?
The answer to this question can predict not only our relationship’s outcome, it can also tell us much about the pursuit of personal happiness, both within and beyond the realm of romance. 
So, what is romantic love? How can we differentiate it from infatuation? And what can these experiences reveal about our search for happiness?
  • Romantic Love is the profound recognition of the extraordinary qualities we glimpse in the being of another.
  • Infatuation by contrast is essentially about ourselves. 
Infatuation is centred on the certain desire and unlikely belief that someone can make us ‘whole’ and results in a highly unrealistic expectation of what that person is capable of and how far they can determine our future happiness.
If we’re infatuated with someone, we think of them constantly, so can easily fool ourselves into imagining we wish the fulfilment of their private desires The  reality however, is very different. Because we exaggerate that person’s power to determine our well-being, we will discourage any need in them which would leave us feeling separation, disappointment or lack.
They are the object of our subjective desire and as such their personal needs are entirely subordinate to our own. Any conflict which arises with our need to keep them close cannot be countenanced or even acknowledged.
In order internally to square the circle between professing love and acting out of self-interest, we often persuade ourselves we only have our lover’s best interests at heart when seeking to discourage them from something which doesn’t serve us.
It’s perfectly natural to pursue our own needs and life works best in an atmosphere of mutual reciprocity, but because we imagine our needs can only be met through intimate involvement with another, we essentially play a confidence trick on ourselves by denying our true motivations.
Romantic Love by contrast has at its heart the capacity for an extraordinary level of self-sacrifice.
For the first few months, the difficult, jaded and more cynical aspects of the beloved dissolve in the eyes of the lover and if circumstance demands, the lover is often prepared to forgo their own needs for the good of the beloved.
When both parties possess such feelings simultaneously it’s one of the most magical experiences we can have, but our admiration will inevitably become tempered by the reality of an imperfect world. As familiarity grows, our beloved must be recognised and acknowledged with all their fears and imperfections, as we recognise our own inadequacies.
And here we come to the central paradox: Romantic love and infatuation stand at opposite ends of the emotional spectrum, but as they draw closer and start to mingle their purpose is revealed as the same.
To ensure our survival, we all possess a healthy amount of self-interest, and this includes an awareness that the needs of our partner, children, family and tribe are intrinsically interwoven with our own ability to survive. As such, we are often willing to put their needs before our personal desires and this creates an emotional landscape defined by complexity, nuance and doubt.
The balance we strike between blatant self-interest and the subtler self-preservation of altruism, is essentially mirrored in the balance our psyche unconsciously strives for between romantic love and infatuation. What matters therefore in a romantic encounter is where that balance lies.
If the primary feeling is infatuation, then the emotional outcome will be a difficult one. As the beloved’s character is more fully revealed, our fantasy of perfect happiness is replaced by a growing sense of disappointment. They have failed to meet our expectations, either through wilful disregard or by proving themselves incapable and we become increasingly disillusioned. The more extreme the infatuation, the more likely the person once doted upon now becomes the object of our rage.
Romantic love will also carry its tinge of disappointment. It’s rare we experience this profound emotion without also experiencing the fantasy of complete personal fulfilment. Self-interest in fact is an important component, as it prevents the possibility of too great a self-sacrifice.
In contrast, however, with infatuation, as the difficult aspects of our beloved become apparent, disillusionment is replaced with acceptance. A more mature love for the person develops, one which recognises them as a flawed human being.
In the pursuit of personal happiness, acceptance and empathy trump self-regard; for in seeking to meet the other’s needs in a balanced and compassionate manner, we more fully meet our own.

(An extract from ‘Such is Love: Romantic Games and Why We Play’ by Petra Hassall)

Wednesday, 31 October 2018

Art Therapy – A Creative Approach To Change

Art therapy is a healthcare profession that uses artistic creation as a tool to facilitate the expression and resolution of emotions and emotional or psychological conflicts. Art therapy is practised in individual sessions or in small groups under the guidance of an art therapist. 

Sometimes it is difficult to find the words to describe your emotions or how you are feeling.

Art has the potential to heal. The art-making process and creative therapies can be a reparative and a holistic approach for people to develop new ways of being and relating, while gaining a deeper understanding and appreciation of yourself, and building on self-empowerment.

Art therapy may also be used to support - or as a precursor to - talking therapies, as it may be easier to express yourself visually before verbally. Art therapy combines visual art and psychotherapy in a creative process using the created image as a foundation for self-exploration and understanding. Thoughts and feelings often reach expression in images rather than in words. Through the use of art therapy, feelings and inner conflicts can be projected into visual form. In the creative act, conflict is re-experienced, resolved and integrated.

Art therapy is a profession with more than 70 years of history that fits within the care professions. Art therapy is practised following a strict methodology and under a defined therapeutic framework or setting. This therapeutic framework and the aforementioned methodology are mainly based on the theory of art therapy, analytic group psychotherapy, dynamic psychotherapies and contemporary art theory.

Art therapy is for everyone. It can be used with anyone of any age as long as there is the willingness in the person to start therapy in which they will be encouraged to undertake an artistic process.

The use of art media enables self-exploration and the expression of emotions in a non-verbal way. This non-verbal approach is particularly helpful for people who feel uncomfortable with more traditional “talking” therapies. 

The advantages of art therapy/art psychotherapy are that clients can be encouraged to:  

  • express feelings a client may find difficult to verbalise
  • explore their imagination and creativity
  • develop healthy coping skills and focus
  • improve self-esteem and confidence
  • identify and clarify issues and concerns
  • increase communication skills
  • share in a safe nurturing environment
  • identify blocks to emotional expression and personal growth

The psychological value of art therapy explores how past relationships and experiences affect an individual’s current circumstances. In order for this to be facilitated, a trusting relationship is built between therapist and client, and “art making” provides a form of expression so that personal development or growth can occur in a safe and supportive environment.

Written by Eden O. Shoro  2018

Art Psychotherapist MA, HCPC, BAAT

Photo by Alice Achterhof on Unsplash

Wednesday, 10 October 2018

Cannabis - Is It Wacky To Legalise It?

Psychiatrists are to reconsider their opposition to the legalisation of cannabis. The Royal College of Psychiatrists has decided on the move following the government’s decision to allow the use of cannabis for medicine purposes and on prescription.

Up until now, the college has opposed its legalisation and the College’s advice has been at the forefront of government decision making. Other medical bodies, however, are calling for reform and the RCP has decided to look at the matter again.

Dr Adrian James, Royal College of Psychiatrists’ registrar, told The Times the panel would start with an open mind. However, he said he was still concerned about the risks of psychosis.

Dr Robin Lawrence, founder and consultant psychiatrist at 96 Harley Street, believes the College is right to have concerns.

“Before, the government makes a decision about legalising cannabis, there are several pitfalls that need to be addressed. 

“First, it’s important to understand first of all that the cannabis plant contains more than one active ingredient: THC and CBD. 

“The cannabis smoked by students in the 1970s contained a high proportion of CBD, a relaxant that actually expresses anti-psychotic properties.  

“THC, on the other hand, causes hallucinations and leads to a short-lived psychosis in many, a few of whom may go on to suffer schizophrenia for the rest of their lives.

 “Skunk, which is what is now available on the streets of the UK has a very high proportion of THC – the ingredient connected with psychosis. 

“What is worse, is it is now very difficult to buy the earlier form of cannabis because the growers – by selective breeding – have actually changed the nature of the wild plant so that it contains higher quantities of THC.

“The THC gives the cannabis a much greater ‘kick’, making it much more dangerous from the psychotic perspective.”

Dr Lawrence believes legalisation, as long as it’s licensed in the same way as alcohol so that the strength of the cannabis can be measured, could improve safety concerns.

Even so, he suggests, it is highly likely that there would be a black market for the “strong stuff”, whatever legislation is passed.

The psychiatrist has another concern about permitting teenagers or young adults to take the drug.

Dr Lawrence says: “There is a risk is the long-term use of cannabis, usually from a young age, which can result in the user (normally a male) spending hours and days in his room smoking rather than going for a job interview or taking on any responsibility. This can mutate into an entirely wasted life. 

“The importance here, is that the adolescent brain should never be exposed to cannabis unless there is a pressing medical need (as in some cases of epilepsy where cannabis oil is the only available treatment). 

“I do not believe cannabis should be legalised for anyone whose character has yet to form.

“Currently that legal cut off is 18, but many would regard character as still developing right up until the age of 29.”

Written by Lulu Sinclair 

Photo by Roberto Valdivia on Unsplash

Monday, 1 October 2018

The Power of Hypnotherapy

To keep this blog simple, I need to explain how our minds work.  Our minds drive our behaviour.

You may have heard of the conscious, subconscious and the unconscious minds.

Your conscious mind is reading this article right now.  It is capable of handling between five and seven bits of information at any one time.  If you think of your mind as being like an iceberg, the conscious is the piece you can see.  It is also the part of your mind that is least responsible for your behaviour.

The subconscious is the part of your mind that is beneath your awareness but is, right now, aware of the feeling in the little toe on your right foot.  Now that I have mentioned it, the subconscious will bring that sensation to your consciousness so you can attend to it. The subconscious can handle, depending on whom you read, between two and 11 million bits of information at any one time!  The subconscious will inform the conscious mind on how to behave and respond to a given situation based on information stored in the unconscious.

The unconscious is where all of our experiences are stored.  According to neurologist Sigmund Freud, the founder of psychoanalysis, the unconscious holds those experiences that our conscious mind finds so difficult to deal with. Most importantly, I believe, the unconscious also stores the meanings we attach to those experiences.  And it is the meaning we attach to our experiences that determine how they will subsequently affect our behaviour.

The subconscious and the unconscious account for 90% or more of our behaviour. Or, put another way, you have not been in charge of you for 90% of your day so far! 

For example, if you suffer from social anxiety, your conscious mind may accept an invitation to a dinner party. However, the discomfort and trepidation you feel when you’re getting ready to go or when you’re sitting at the dinner table thinking you have nothing useful to say and really should leave, is coming from your subconscious based on information gleaned from past experiences. This past experience information is stored in your unconscious and you are probably not even aware of it.

And, because of this, it is the unconscious with which hypnotherapy concerns itself.

Why Hypnosis?

Unfortunately, most people’s perception of hypnosis comes from stage and screen. This leaves many people believing that hypnosis is a strange parallel universe to which they have never been.  Nothing could be further from the truth.

In hypnosis, we induce a trance state in our clients.  The important thing to remember is that trance is an everyday phenomenon.  Take your commute to or from work – how much of it can you remember?

Or, say you don’t like spiders and “find yourself” running away from a giant spider without even realising it.  You are in trance – acting unconsciously –because, as I said above, the unconscious is in charge 90% of the time and instructs the conscious part of the mind on how to respond.

The premise of hypnotherapy and any other therapy that believes the unconscious is responsible for most of our behaviour is that, in order to effect change, we need to change what the subconscious mind feeds into the conscious mind. To do this, we need to understand and change what the unconscious mind believes about the experiences and beliefs stored within.

The easiest way to access the unconscious is through relaxation.

When relaxed, the client can access memories, feelings and experiences that are normally beneath their awareness.  A skilled hypnotherapist will then understand how these experiences are shaping behaviour and can use hypnotic language to change the meaning of those experiences.

Hypnotic language is not from another universe either.  It is simple every day language, normal words but put together to help a client change their behaviour.

I always say to my clients that I cannot change the past but I can help them to change the meaning of their past which then changes the nature and framing of the information divined from the unconscious by the subconscious.  This “reframing” of previous experiences, in turn, changes the information the conscious mind is presented with when faced with triggers that had previously produced unwanted behaviour.

The Buddha described the mind as being like a man riding an elephant.  Although he wouldn’t have used these terms, nowadays we could say the man is the conscious mind and the elephant represents the subconscious and unconscious. 

So, returning to the Buddha analogy and in simplest terms, hypnotherapy is relaxing the client sufficiently so that the rider is persuaded to get off the elephant and go and have a cup of tea so that we can talk to the elephant.

In order to understand the rider better, I believe it is vitally important to understand exactly what the elephant believes.  When did it acquire a particular belief that a particular response is appropriate to social situations, for example, and what was happening at the time?

Then by getting to know the client – and their elephant – I can tailor the hypnotic language towards their particular elephant so that beliefs, meaning, responses and behaviours change. I do this by understanding what the problem means to them, what this past experience means to them, the context of their issue, the language the client uses to describe the issue and other important information.

Theoretically, anyone can hypnotise someone else because, at its base, it is simply relaxation.

What takes skill and experience is the understanding of the complexity of the behaviour of each individual, to find out what is underpinning it and what to say to the client and their elephant that will help bring about change.

Written by Bert Stemarthe

Photo by Yeshi Kangrang on Unsplash

Wednesday, 12 September 2018

Intermittent Fasting – Good for Body AND soul?

Have you ever heard somebody say: “S/he’s feeling depressed. Give him a chicken leg?” Probably not, neither have I. On the other hand, I have often heard people say: “S/he’s feeling in need of comfort, perhaps a piece of cake might help. Or a bar of chocolate.”

Chicken, of course, is a protein and does not affect moods. Cakes comes into the food category called carbohydrates – also containing potatoes, pasta, bread, etc – which is known to offer comfort to those in distress. 

The way carbohydrates work is that they raise serotonin levels in the brain thereby increasing a person’s sense of wellbeing. Chocolate is similarly comforting. It is high in tryptophan which gets turned into serotonin in the brain. That and its sugar rush will more than double its attraction to the comfort eater, even if the rush may be short lived.

Some people with long-term or high levels of depression or anxiety may be treated with SSRIs (Selective serotonin reuptake inhibitor to give them their full name), giving them a level of balance through chemicals that they might not otherwise achieve. But what if a particular diet may be found to help? 

According to an article in psychiatry journal Medscape, Intermittent Fasting is gaining in interest within the medical profession. According to the article, the practice of “voluntarily abstaining from food and non-water beverages” for a limited period of time is known to benefit a range of illnesses from cardiovascular disease and cancer to diabetes and weakening cognitive skills and it seems to have its appeal with some followers who say it helps their moods and mental abilities too. 

Many of us connect intermittent fasting with the 5:2 diet where you eat what you like for five days and severely restrict intake (to about 600 calories a day) for the other two. However, there are variations. 

One 30-something fan of intermittent fasting, who has also experienced depression, uses the 16:8 method, meaning he eats between an eight-hour period and fasts the rest of the day.

He explains: “When I did intermittent fasting using the 5:2 method, I effectively had one meal only rather than spreading it over a day. I preferred to eat in the evening so found that, by 4pm, I was hungry and having concentration issues. And I didn’t do it over the weekends.

“I now have tea or water up to 12 noon and then eat reasonably up until 8pm. That means my concentration remains good and my work doesn’t suffer.”

He says another benefit is that, because he exercises in the morning, he’s burning stored fat, rather than the calories he’d have accrued with a breakfast meal.

Mood-wise, he says he feels much better. “Eating has always made me feel sluggish and that has affected my mood. I do have the occasional slip up – if I’ve a bit of a hangover, for instance! – but most of the time it’s fine. It’s become a way of life and I feel much happier now than I did before I was on it.” 

Psychiatrist and founder of 96 Harley Street, Dr Robin Lawrence believes there is a case for this way of eating. He says: “I have been using intermittent fasting for years; I am sure it elevates the mood and sharpens my thinking. 

“This is anecdotal – there have been very few studies so this is not evidence-based advice – but some of my patients have reported a similar effect. 

“It’s certainly worth a try if you are a bit ‘stuck’ despite antidepressants.”

Written by Lulu Sinclair

Photo by Izzy Boscawen on Unsplash

Thursday, 6 September 2018

The Surprising Pleasure of Ageing

Who would have thought that one of the benefits of getting older is actually enjoying life more? Why is it we get happier as we age? We live in a society apparently programmed to appreciate youth, we use the term: “The optimism of youth” and, in youth, the future seems to stretch out eternally, with nothing but possibilities and hopes on the horizon. 

Looking at it that way, it would seem people should get sadder as they get older. 

And yet, according to a recent survey by the Georgia Institute of Technology, involving 20 young adults in their early 20s and a similar number of adults in their 60s and 70s, quite the reverse is happening. 

The study, which put volunteers into an MRI scanner and used eye-tracking experiments to monitor reactions to a series of pictures, found the brains of young millennials tended towards “hyper-vigilance”. That meant the young people were always on the lookout for threats and things going wrong and were permanently on high alert.

In contrast, the older people, while recognising the danger, seemed to be able to manage and control the “high-alert” function of their brain. 

What happens, says head researcher Brittany Corbett, is that, instead of the brain in an older person being overwhelmed by whatever threat it perceives, it can block out a fearful reaction that would set down a bad memory “template” and create instead a “positivity effect”. 

It seems that while older adults may indeed perceive a threat, they are able to assess its importance – or not – and put it to one side. In other words, they worry less about what may happen. 

Ms Corbett told The Times newspaper: “As we age, we try to have better overall wellbeing and protect our emotional health. Older adults who focus more on negativity avoidance seemingly live happier lives, have better health and longevity."

Ms Corbett suggested the results made sense from an evolutionary perspective. 
“As one's perceived time left in life grows shorter future-orientated goals such as information seeking grow less important.
“Instead present-orientated goals such as living a happy life and having a good well-being are prioritised.” 
Dr Robin Lawrence, founder and consultant psychiatrist at 96 Harley Street, offers his view. 

“I am not sure if we can say that this is a consequence of growing older or a difference between the generations. 

“If the former, it is to be welcomed and supports the anecdotal impression that resilience increases with age.  There is also evidence that personality disorders (particularly Borderline Personality Disorder) get better with age and that fits with the former theory. 

“If it is a generational thing - the older generation have always had a greater capacity to ward off unhappiness - then the future looks bleak and must result in a continued increase in demands for psychiatric and psychological services.”

In our current turbulent times, it could be argued there are good, practical reasons for young people to be feeling deeply concerned about the stress they have to manage. Worries about student debt, career paths, mortgage or rental affordability and relationships are real and  immediate concerns.  

One way to help train young brains to identify and contain what must be an instinctive survival fear might be to encourage the here-and-now benefits of the ancient art of mindfulness. 

Written by Lulu Sinclair