The spirit of our times

How many people do you know who claim to be 'spiritual but not religious'? Anecdotally at least, it would seem this category accounts for an increasing proportion among our number, with membership derived from those who formerly belonged to (or at least whose families formerly belonged to) religious denominations.

I recently came across a fascinating piece of research, entitled 'Religion, spirituality and mental health: results from a national study of English households', conducted by Michael King and his colleagues at the University College London Medical School, the aim of which was to examine associations between a spiritual or religious understanding of life and psychiatric symptoms and diagnoses.

Data was analysed from interviews with 7,403 individuals who participated in the third National Psychiatric Morbidity Study in England, and were questioned about their spiritual beliefs, religious affiliations and mental state.

Of the participants, almost half (46%) described themselves as neither spiritual nor religious, 35% described themselves as religious (which meant that they regularly attended a church, synagogue or mosque) and the remaining 19% described themselves as holding spiritual beliefs, but not adhering to any particular religion.

Remarkably, members of this latter group, the 'spiritual but not religious', were 77% more likely than all other participants to be dependent on drugs, 72% more likely to suffer from a phobia and 50% more likely to have generalised anxiety disorder. They were also 40% more likely to be taking psychotropic drugs and at a 37% higher risk of neurotic disorder.

Those in the 'religious' group were similar to those with no religion and no spirituality in terms of prevalence of mental disorders, but those who were religious were less likely to have ever used drugs or to be hazardous drinkers.

What does all this tell us? In the Christian understanding, at least, we are warned of the dangers of being so-called 'lukewarm' in our faith - with just cause it would appear - consider Matthew 12:30 'Whoever is not with me is against me and whoever does not gather with me scatters' or Revelation 3:15-16 'Because you are lukewarm I will spit you out of my mouth'. In other words, fence-sitting is not an option - or rather, it is, but it comes at a price. Mental ill health, if the results of this study are to be believed.

The authors conclude starkly "People who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorder." So sayeth the bible and so sayeth the secular scientists. Where do you sit?

Written by Jacqui Hogan

Don't be fooled by the DSM-V

We can pretty much take it as read - indeed many of us may know first hand - that as we get older our brains start to slow down a little. Losing a name here and there, being a little slower to pick up on a complicated idea - this is known as par for the course. It has ever been thus.

So it is interesting, is it not, that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) the American Psychiatric Association's (APA's) definitive and globally adopted 'bible' which decrees what mental illness is and isn't, has introduced Mild Cognitive Impairment (MCI) as a formal diagnosis.

What this means, of course, in dollars and cents, is that MCI (the acronym serves to legitimise the notion of disorder and obfuscate the natural phenomenon of age-related forgetfulness) can be MEDICATED - that is to say, a drug can now be legitimately prescribed to treat this 'mental condition'.

Which makes the findings of a recent piece of research - the German Study on Aging, Cognition and Dementia in Primary Care Patients - all the more important. What it reveals offers encouragement to those who may be labelled with MCI as part of the fear-mongering, revenue-harvesting agenda.

The researchers analysed three years of follow-up data from 357 primary care patients, aged 75 years or older, with a diagnosis of MCI and found that 42% experienced a remission of symptoms and normal cognitive function at one-and-a-half and three years, 21% experienced a fluctuating course, with their status changing between MCI and normal cognitive function, 15% experienced a stable course with no change in symptoms and 22% experienced a progressive course, moving towards a diagnosis of dementia.

As one might expect, patients were at greater risk of progressing from one course to the next along this spectrum if they had symptoms of depression, impairment in more than one cognitive domain, or were older.

So according to this study, in patients over 75 with normal, age-related 'slowing down' (henceforth to be known as the 'mental disorder', MCI), only a little over one-fifth of individuals actually progress on to dementia - or, to put it in positive terms, almost 80%, four in five, experience an improvement in cognitive symptoms or remain stable. In other words, MOST people. That's good news.

Of course, it remains to be seen how things will pan out once people with such normal cognitive profiles start being labelled MCI and being medicated - will the drugs induce dementia? Only time will tell. My suggestion is, if you notice you're becoming a bit forgetful, don't, whatever you do, tell your doctor - you may wind up on medication.

In contrast to this instance, where we see the DSM labelling normal as abnormal, we also see the reverse happening - the abnormal being labelled as normal. So, for example, in this latest edition of the DSM, we also see paedophilia being declassified as a disorder and newly described as 'sexual interest' (you can read our post about this here). And, as I hope you'll agree, the day paedophilia is legitimised as a bona fide predilection, as has happened now with the APA, is a dark day indeed.

Have you noticed this trend? What are your thoughts on the DSM-V? Is it serving to help doctors in treating patients with mental difficulties or not? Is there, perhaps, a different agenda? Whose is it and what is it? We need answers to these questions.

Written by Jacqui Hogan

Mental health, global style

It can't have escaped anyone's notice that we are now living in a global world, driven by international directives, legislation and so-called 'thought leadership'. It does make me wonder, where exactly HQ is and, more importantly, who's the boss.

Mental health has now come under global scrutiny, with a new report published jointly by Mind and the McPin Foundation, which gathers together the collective experiences of mental health charities (NGOs) from around the world. Nineteen charities from Australia to Uganda have contributed to the report, entitled Driving Change, which highlights some great progress being made, especially in countries where astonishing practices, such as stoning, are still meted out to the mentally ill.

Interestingly, notwithstanding the vast differences between the countries - economically, socially and geographically - there were common concerns noted by the participating representatives. These can be summarised as:

• Stigmatisation of the mentally ill, which often prevents individuals from seeking help
• Lack of mental health funding, which translates to a shortfall in referral services and facilities
• Lack of NGO funding, which hinders their ability to support the mentally ill
• A shortage of trained mental health workers

In many countries, the report noted, mental health NGOs are effectively run by committed volunteers with personal experience of mental ill health, who are motivated to protect fellow sufferers from the difficulties with accessing help they have encountered. For these people, contact with the global community through collaboration on this project has been invaluable, enabling them to share ideas and diminish isolation.

Have you gained insight into the treatment of mental illness by experience in another country and/or collaboration with colleagues from other parts of the world? Are local factors more important than blanket observations made by organisations whose interests lie beyond individuals with mental illness? Either way, what is the answer to the mental health epidemic that is surely sweeping our nation and our world? Let us know what you think about this report, Driving Change - does it, in fact, move the conversation on?

Written by Jacqui Hogan

The truth about workplace stress in Britain

Do you ever feel like your email inbox is your worst enemy?

Thesedays, it's almost the norm for organisations and individuals to engage the services of productivity consultants and enrol on courses that go by names like 'Getting your inbox back into shape'. How interesting that the technology that was supposed to simplify and streamline our lives is now showing its darker side, as all promises of free ease and comfort in life inevitably do.

A new survey by recruiters StepStone and Total Jobs shows that Britain is leading the way on the work stress stakes with 24% of British respondents (out of a total sample of over 2,500 which included employees from France, Germany, Spain and Switzerland) admitting they suffer from workplace stress.

Consistent with this trend was the number of British participants who said that they did not suffer from any stress at work - which was three times lower than the European average (13% for the Brits, 42% for our European neighbours).

It should come as no surprise, then, that the most recent figures from the Office of National Statistics in this area, reveal that absence from work as related to stress, anxiety and depression was up by almost 30% in 2013, compared with 2010.

This has to translate into more visits to counsellors, psychotherapists and skilled helpers or, if it doesn't, arguably it should. At the very least, we might expect it to become an increasing focus within counselling sessions, as technology assumes dominance where once simple men ruled the roost. Such a cultural shift also has implications for workplace security (or should I say insecurity) - you only have to look at initiatives like self-serve supermarket check-outs or the plans to replace London Underground station workers with machines to tap into the prevailing zeitgeist of jobs being under threat.

Like all psychological conditions for which people seek help, it's impossible to pin workplace stress down to any one cause, but for my money, one of the obvious potential culprits must be boundary failure - that is, a breakdown in the individual's ability or willingness to say 'no' to unreasonable work demands. This will, of course, be especially acute in an insecure work environment, further complicating the picture.

What it all boils down to, in my opinion, is the need to develop and cultivate that highly elusive and long-lost virtue in these resolutely secular times - that is, the virtue of faith. Because faith allows us to say 'no' when it's absolutely justified and be able to shoulder the consequences. And faith has us know that we are much, much more than our jobs and, in the end, all shall be well.

Written by Jacqui Hogan

Why do we self-harm?

Self-harm, like so many physical manifestations of the growing psychological distress in our world, is on the increase, according to a new survey among young people conducted by four self-harm support groups, and referred to yesterday on Radio 4's The World at One. Figures from the NHS in England show that 11% more young people were admitted to hospital having harmed themselves during 2012 than during 2011, the piece revealed.

The report covered an interview with a girl called Chloe, who was 14 when she began cutting herself, and is now in successful counselling treatment.

Chloe described her former routine dispassionately - she would go to school, come home, go to her room and then cut herself, and remain in isolation from her family for the rest of the evening. She put down the cause of her behaviour to bullying and unhappiness at school and was able to make a clear association between needing to express the pain she felt on the inside by hurting herself on the outside. 'If you can hurt me on the inside, why can't I hurt myself on the outside?' she said to herself at these times.

This distorted notion of 'you're hurting me, so I'll punish you by hurting me too' will not be unfamiliar to therapists who will likely spot the projection involved in this maladaptive way of thinking and behaving. While the victimisation from class mates is obviously real, the attempt is actually to punish the parents - who, after all, will be most punished by living with self-harm in their midst?

Notwithstanding this well-known but little understood psychodynamic principle, according to the survey, bullying is the number one reason given by young people for starting to self-harm, along with a sense of feeling alone in the world. This latter point is significant - why would a child feel alone in the world if the family is operating in the way it's supposed to?

Rachel Welch from selfharm.co.uk, one of the groups responsible for the survey also points to the role of smart phones and tablets in providing 'inescapable' victimisation - with 24/7 connectivity, you're only ever a beep away from the next spiteful remark, she says.

Surely, that's true, but what ever happened to formation of fortitude. something I seem to recall having to cultivate in response to my own long distant and catty adolescence. Learning to understand that a spiteful comment says more about the persecutor than the victim was part of my formation - unless we come to understand this, we will forever remain victims of a naturally dysfunctional world.

Let's hope Chloe's counsellor is delving deep and helping her identify exactly what was driving her need to punish her parents in this tragic and misguided way - rather than simply vilifying the bullies, who are themselves victims of irresponsible parental nurture.

Written by Jacqui Hogan

A Cambridge research first in teenage male depression

It probably comes as no surprise, just from looking within our own circles of acquaintance, that depression and anxiety among our young is on the increase.

According to the Centers for Disease Control in the States, 81% of deaths from suicide between the ages of 10 and 24 occur in males - that might be America, but like any good, virulent strain of flu we, in the UK, seem to catch whatever they do. Research from The Nuffield Foundation confirms this trend and cites changes in employment patterns and family life over the last several decades as possible contributing causes.

Recent findings by Professor Ian Goodyer and his team in the Department of Psychiatry at the University of Cambridge suggest that predicting the likelihood of clinical depression among teenage boys, at least, may become a reality in the near future.

The protocol entailed collecting saliva from hundreds of teenage boys and girls who were concurrently asked to self-report any symptoms of depression. The saliva samples were then measured for cortisol, a hormone released by the adrenals in response to stress. The cohort was then divided into four groups based on cortisol levels and depressive symptoms, and followed up for between 12 and 36 months.

Girls who started out with high cortisol levels and depressive symptoms were found to be four times more likely to develop clinical depression than those starting out with no symptoms and low cortisol levels (an interesting enough finding). Boys with elevated cortisol and depressive symptoms, however, were found to be fourteen times more likely to progress on to developing clinical depression than those with low cortisol titres and no symptoms.

Two obvious implications arise:
1. It would appear that gender difference does have a role to play in the evolution of clinical depression
2. Cortisol may be a reliable biomarker, which could be used to identify those at risk of developing clinical depression, especially among teenage boys

The work also raises the question of how cortisol might be contributing to the development and maintenance of depression and whether it may even be considered as a target for treatment.

This is useful research and let's hope it leads to early identification and prevention of depression in vulnerable young men. But let's not forget, for one minute, the need to address the social, environmental and many other complex factors in the aetiology of depression.

Written by Jacqui Hogan

One sure-fire cure for depression

The current debate in The Netherlands around doctor-assisted suicide for depression sends a shiver down my spine. It's all been triggered by a controversial new clinic, the pragmatically named Life-Ending Clinic, which is now proudly ending the lives of people with chronic depression. Clinic Director, Steven Pleiter, has said:

"We consider it self-evident that someone who is terminal can turn to euthanasia. Now we are entering a phase in which there will be more debate about about patients who are not terminally ill, among them psychiatric patients…" 

A jaunty press release from the clinic stated 'The figures over 2013 show a strong growth of euthanasia in these groups' (referring to those with dementia and psychiatric problems). If that kind of marketing sound-bite doesn't raise a red flag for you, I suggest you look into your heart and see whether some small part of it hasn't turned to stone. For when the day comes that business models and growth projections are applied to the practice of killing our fellow humans, we have truly turned out all the lights on truth and dignity.

Picture the scene: a board meeting at the Life-Ending Clinic, with share-holders seeking higher return on investment and demanding a greater recruitment drive from administrators, setting targets for increasing 'customer buy-in'; the advertising agencies weighing in, the PR machine cranking up, twisting and distorting the minds of those whose minds are most vulnerable.

The Dutch legalised euthanasia in 2001 The law, as implemented back then, allowed doctors to end the lives of patients, but only in close consultation family physicians who had known the patient over many years. Termination of life was intended to be limited to those with 'unbearable and hopeless suffering' who were in full command of their mental faculties and had no hope of relief.

Compare this model to one highly publicised case last year in which the Life-Ending Clinic terminated the life of a 63 year-old man described as having severe psychiatric problems. The customer in question, after an active career in government, could not face the prospect of his up-coming retirement. Gerty Casteelen, the clinic's psychiatrist, told Dutch newspaper NRC Handelsblad that the man:

"...managed to convince me that it was impossible for him to go on. He was all alone in the world. He'd never had a partner. He did have a family but was not in touch with them. It was almost like he'd never developed as a person. He felt like he didn't have the right to live. His self-hatred was all consuming."  

Hey Gerty, well that sounds like a good reason to bump him off then, doesn't it? Maybe your October quota was a little shy of where it needed to be and, well, it must be awful to be in such a terrible position in life, mustn't it? This sounds conspicuously like a man who needed help dealing with some very painful realities and feelings, but not a man who needed to be enabled to die.

We were warned, weren't we, that legalising euthanasia was the thin end of the wedge. And with moves afoot to allow the depressed to choose to die, it would appear that we that we are now boldly scaling that wedge, with barely a 'by your leave'. Anyone who knows anything about depression knows that it is often a wake-up call for a need to change, a precursor, when handled effectively, to a richer and more profound experience of life. Not only that, but those who have been depressed are graced with an empathy, an ability to help others which is a benefit and a gift.

It would appear that the Culture of Death is playing some serious trump cards. But the game isn't over yet.

Written by Jacqui Hogan