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

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

The value of art in expanding our minds

Sculpture by Mary Hecht

You may have noticed there's a lot of emphasis on science thesedays, but a recent study by neurophysicians at the Memory Clinic at St Michael's Hospital in Toronto demonstrates the value, endurance and mysterious role of art in enriching human lives.

The lead author, Dr Luis Fornazzari, reports the case of Mary Hecht, an internationally renowned sculptor who died in April 2013 with vascular dementia, whom he cites as "a remarkable example of how artistic abilities are preserved in spite of degeneration of the brain and a loss in the more mundane, day-to-day memory functions."

Because of her neurological condition, Hecht had lost the ability to conduct a normal conversation, remember words she was asked to recall and even illustrate the time on a clock. But to the astonishment of Dr Fornazzari and his team, she was able to quickly sketch an accurate portrait of of a research student from the Clinic, as well as other people and objects from memory. While drawing, she was able to speak eloquently and without hesitation, in contrast to her prevailing level of functionality.

This shows, at the very least, the unique terrain occupied by art in our brains and Dr Fornazzari concludes that "art should be taught to everyone. It's better than many medications and is as important as mathematics and history."

For those of us who have friends or loved ones with vascular dementia, this work offers hope, in that so often, activities which once gave pleasure, like cooking or gardening or basic activities of daily living, can no longer be undertaken. Could it be that providing them with paper and pencils and painting sets may open the window to freedom and joy, even if for a limited time? It is possible Hecht's extraordinary talent may have been part of the key, but it's certainly worth a try.

No matter how alluring the promises of a life filled with logic and scientific discovery, we dismiss the value of art at our peril. In all its forms, it points to a place where there are no easy answers, touching upon states which we can only feel and barely describe. Our brain is a brain of two halves - let's not succumb to the seductive temptations of a life lived on one side.

Written by Jacqui Hogan

Face-to-face beats Facebook, hands down

You kind of know it in your heart, don't you. Spending too much time communing with your computer can't be good for you. But who would have guessed that, even when the communing involves engaging with a large number of like-minded people (and I've heard it said that the population of Facebook makes it the third largest 'country' in the world), it still isn't good for you. What about all those friends?

A new study supports the notion that Facebook can have a negative impact on the way you feel - researchers from the University of Michigan published in the journal Plos One that "rather than enhancing well-being... Facebook may undermine it."

Using the technique of 'experience sampling', the authors text-messaged 82 young adult participants five times per day for two weeks to examine how Facebook use influenced two components of subjective wellbeing  - how they felt from moment-to-moment and how satisfied they were with their lives.

What they discovered was that the more participants used Facebook on any given day, the worse they felt next time they were text-messaged, and the more they used Facebook over the course of the whole fourteen days, the more their experience of life satisfaction declined.

One explanation put forward by the authors was that loneliness and/or worry might be causing participants to increase Facebook use, which would suggest that Facebook was not the problem at all, and that negative feelings were driving its use. However, even when they accounted for the loneliness and worry variables within the study design, Facebook use continued to predict declines in subjective wellbeing.

These findings deserve consideration in light of the suggestion that Facebook can be considered an addiction, in much the same way that any substance or behaviour can - the Bergen Facebook Addiction Scale (BFAS), developed by Norwegian researchers, testifies to this. As with alcohol, for example, developing a Facebook habit would appear to run counter to improving your psychological wellbeing.

So what are we to make of these findings? As usual, mother knew best, and it's moderation in everything. We'd do well to keep an eye on how much time we're devoting to the use of social media at the expense of participating face-to-face in our real life communities. Probably a good place to end a blog post, don't you think?

Written by Jacqui Hogan

Focus on Ritalin

This week, the annual Care Quality Commission (CQC) Report on Controlled Drugs revealed that the number of prescriptions for Ritalin, the drug commonly used for treating children with Attention Deficit Hyperactivity Disorder (ADHD) has risen by 56% in the last five years. That is to say, in 2007 GPs in England wrote 420,000 prescriptions for Ritalin and in 2012 they wrote 657,000.

You might be forgiven for thinking that Ritalin (chemical name methylphenidate) must be a relatively new kid on the block (pardon the pun) given its recent rise to prominence. But in fact, it was first prescribed as far back as 1957 for the treatment of chronic fatigue, depression, psychosis associated with depression and narcolepsy. By the 1960s, research interest focused on its use in the treatment of hyperkinetic syndrome, which would eventually be labelled ADHD.

Although technically not an amphetamine, Ritalin is a brain stimulant that seems to behave in a similar manner; its mechanism of action is still not understood. Most experts agree that it affects the part of the brain involved with impulse control (the midbrain) and researchers have reported a link between Ritalin and serotonin, a naturally occurring brain neurotransmitter (also the target of antidepressants known as Selective Serotonin Reuptake Inhibitors, SSRIs, of which Prozac is a prime example).

A recent new Canadian study among thousands of children http://www.nber.org/papers/w19105 should give us pause for thought when it comes to the subject of Ritalin prescriptions. It showed that Ritalin and other such stimulants have no long-term benefits and, if anything, children on these drugs experienced worse outcomes than children not taking them. To quote the authors:

"We find evidence of increases in emotional problems among girls and reductions in educational attainment among boys. Our results are silent on the effects on optimal use of medication for ADHD, but suggest that expanding medication can have negative consequences given the average way these drugs are used in the community."

Why this, one wonders? One thought is that while Ritalin may work to quiet children down, it may also give the appearance that their behavioural problems have been solved. The difficulty is, that if the underlying cause of an ADHD diagnosis remains unaddressed, it won't necessarily go away and when the drug is discontinued, symptoms will inevitably re-emerge. Children who have been 'damped down' in this way are also (arguably) less likely to get any additional academic help they may need, which may have been an unconscious reason for the original disruptive behaviour.

It is recommended that Ritalin should always be prescribed alongside non-medical psychological treatments such as counselling, though in practice this doesn't always happen. This removes a significant check from the treatment equation. Psychoactive medication combined with failure to treat underlying causes rarely ever prospers the patient.

None of this is to say that Ritalin is not an effective treatment for a small, but significant, number of children with ADHD, whose lives without the drug would probably be all the poorer. But clinicians are rightly becoming disturbed by the rapidly rising number of children who are now receiving treatment as a matter of course - an incredible 11% of all school children in the USA (nearly 20% of high school-aged boys). From these latest CQC figures, it appears that a similar trend is emerging in the UK.

Given the large demographic, particularly in the USA, are children being medicated for the 'disorder' of being a child, one has to ask. What are your thoughts? We'd love to hear them.

Written by Jacqui Hogan

I thirst for you - cognitive performance, that is!

A recent study by Caroline Edmonds and her colleagues from the University of East London and the University of Westminster has shown that when people are thirsty, they tend to respond more slowly in performing tasks. Interestingly, extended response times were not associated with actual physical dehydration, but more with the experience of being thirsty.

In the experiment, participants abstained from fluid overnight on two separate occasions. The following day, on the first occasion, they were given 500ml of fluid to drink before performing a specified task and on the second they were given no fluid to drink before performing the same task. Their reaction times were measured and only those who were subjectively thirsty demonstrated compromised reaction times - the level of physical hydration itself was not the issue!

What can we take from this novel finding? Well, we at number 96 plan to make sure, from this moment on, that our water cooler is always topped up - specially during the warmer weather. We figure, at least for ourselves, we need all the support we can get when it comes to maintaining optimal cognitive performance!

So if you're wandering down Harley Street and feel in need of a cooling draught, please do press the buzzer - we'll welcome you to our waiting room (water cooler to the right of the fireplace, pictured above) with open arms.

Written by Jacqui Hogan

Merry Christmas from all at 96 Harley Psychotherapy

Christmas is upon us and, amidst all the welcome chaos of Christmas decorating and last-minute appointments, we're trying to make the time - sometimes successfully, sometimes not - to take inventory of the year that has been, in order to process the old and make preparation for welcoming in the new.

We've seen lots of new and exciting developments here at number 96 during 2012, with new therapists Sheron Green, Claire White, Roisin Golding and Renee Thurston expanding and enriching our therapeutic offering with their skills in trauma, hypnotherapy, acupuncture, NLP and child psychotherapy. Along with our many long-standing therapists, it's fair to say there isn't a psychological ailment we can't address on these premises, with sensitivity, experience and a vast amount of specialist knowledge.

As many of our clients will know, 96 Harley Street, as well as being a world class psychotherapeutic hub, is home to a a broad range of other medical specialities, among them dermatology, gastroenterology, gynaecology, physiotherapy and psychiatry. During 2012, we have also welcomed Rheumatologist Professor Hasan Tahir and Men's Health Physicians Malcolm Carruthers and Kam Mann, all distinguished experts in their fields.

This growth is consistent with our vision to create a multidisciplinary centre of healthcare excellence, in which healthcare professionals of every discipline will benefit from the cross-fertilisation of ideas that can only come from working under the one (magnificent!) roof. Many of our clients have reported they appreciate the convenience of having all their specialists gathered together, and we hope to build on the number and range of practitioners operating from the house in 2013.

Another development this year has been our decision to apply for registration with the Care Quality Commission (CQC), to provide reassurance for our clients  that our services are accredited to the highest possible standard. This is expected to benefit our therapists as well, who, having met our exacting recruitment criteria, will enjoy full accreditation with the CQC under our auspices.

We're delighted to report the continued flourishing of our website, which, with the help of our SEO and  marketing experts continues to hold its own in the search engine rankings. We have noted an increase in the number of enquiries fielded through the site, just as we had planned. The website provides a powerful canvas for all of our therapists to use in promoting their services to the public at large, and we strongly encourage everyone to take advantage of this. One of our aspirations for 2013 is to persuade more of our therapists to make use of the website for promoting their workshops and other activities.

All that remains, then, is to wish you all a merry Christmas and a happy and prosperous new year. We look forward to seeing you, all shiny and renewed, in 2013.

Written by Jacqui Hogan