R D Laing pops up again

“Madness need not be all breakdown. It may also be break-through. It is potential liberation and renewal as well as enslavement and existential death.”  R D Laing, 1927 - 1989

Yesterday morning I heard the Scottish psychiatrist’s son, Adrian Laing, speaking on BBC Radio 4’s Saturday Live programme (about 30 minutes in if you listen again). He recalled life with his father, a bittersweet combination of experiences also documented recently in The Daily Telegraph, and then outlined his participation in one of Laing’s more unconventional therapies – a “rebirthing”.

The story reminded me of a comment in Laura’s recent post on Thomas Szasz, where a reader made the link between Szasz and Laing. The Anti-Psychiatry page on Wikipedia pulls them both into the same camp, but as Laura pointed out – Szasz was not anti-psychiatry, it was the coercive nature of psychiatry as practised that he opposed. Nevertheless, the two psychiatrists are often lumped together in the political debate over psychiatry, and in pushing the view  “that psychiatric treatments are ultimately more damaging than helpful to patients”.

The debate, which was particularly vocal in the 60s and 70s, is regarded by some to have been “of its time” and no longer relevant. After all, mainstream psychiatry (relying heavily on drugs in its attempts to treat what are regarded as medical problems) seems to rule the roost, certainly in the developed world. However, it appears as if the debate is gaining renewed momentum of late...

I unexpectedly discovered a copy of Laing’s “The Politics of Experience and The Bird of Paradise” on a bookshelf here at home. (It’s not mine – G is also more well-read than me!) Yesterday after listening to Adrian I read the chapter on “The Schizophrenic Experience.” Here are a couple of, what I believe, are relevant quotes:

“It seems to us that without exception the experience and behaviour that gets labelled schizophrenic is a special strategy that a person invents in order to live in an unlivable situation.” (Following research studies made by Laing and two colleagues. His emphasis).

“’Schizophrenia’ is a diagnosis, a label applied by some people to others. This does not prove that the labelled person is subject to an essentially pathological process, of unknown nature and origin, going on in his or her body.”

Dr Joanna Moncrieff, a practising psychiatrist and critic of pharmaceutical drugs, said that “I was reading Thomas Szasz and R.D. Laing when I was at medical school – they were the only ray of interest I could find in the subject area.” With like-minded colleagues she set up the Critical Psychiatry Network which aims to debate issues such as “scepticism towards the evidence base, the biological basis to psychiatry, the efficacy of biological treatments, and an objection to the emphasis on coercion and medicalisation and the issues of social control.”

So... the debate does seem to be very much out there and current. What do you think?

PS: You can watch an intriguing 1989 Channel  4 documentary on R D Laing here. It’s 1.5 hours long (but absolutely worth it), so make sure you are sitting comfortably...

...a taste of mortality

STOP PRESS: 

I’m working out of the country for a couple of weeks and will be posting the odd spontaneous reflection on different places and spaces (see below). I hope it’s not too self-indulgent and of some interest to you!

Please make a note in your diaries and share the following information which, along with other exhibition-related events, is on a dedicated MORTALITY blog page.

Mortality: Death and the Imagination

8^th July – 16^th August 2013

Ian Breakwell | Felix Gonzalez-Torres | Douglas Gordon | Julian Opie 

Cornelia Parker |  Bob and Roberta Smith | Sam Taylor Wood

The Holden Gallery

Manchester Metropolitan University, Grosvenor Building, Cavendish Street, Manchester, M15 6BR

To mark the opening of Mortality, Dr Iona Heath will present a new paper, MEMENTO MORI.

“Today, we who live in the richer countries of the world have the unprecedented good fortune of a gratifyingly extended expectation of life but, apparently still dissatisfied with this, we seem to want to push it further and pretend that life can be indefinitely extended.”

For full details of this free public lecture on Friday 5th July and the private view go to: http://mortalitydeathandtheimagination.webs.com

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From DEATH-TALKING to DELIRIUM

On Monday 8th of July we are pleased to welcome some truly creative minds from the field of health, medicine and the arts to share some of their passions and ideas from their practice and as a response to the exhibition.

Dr Sam Guglani is a consultant in clinical oncology and curates ‘Medicine Unboxed’ an NHS initiative engaging the public and front-line NHS staff with a view of medicine that is infused and elaborated by the humanities. Molly Carlile has a clinical background in specialist palliative care nursing, counselling and education and manages Palliative Care Services at Austin Health in Australia. Victoria Hume is an NHS arts manager, who has written a series of songs about hallucinations in intensive care, based on interviews with people who have been through this extraordinary experience, and with the staff who care for them.

For dates and times and more details about this free event, go to: http://mortalitydeathandtheimagination.webs.com

Please don’t write to Clive as he is not able to reply to email at the moment. Contact details for MORTALITY are on the dedicated pages.

Hope blooms out of depression

Last week my sister-in-law told us that she had successfully completed Level 2 of a creative floristry qualification, and she spoke so passionately about the impact that learning her new skill had had on her wellbeing that I asked her to write a piece for the blog. Thank you Linda! 

"I first started suffering from depression when I was 17. I feel the reason for this was partly genetic and also the fact that I was developing a tumour on my pituitary gland which was not diagnosed until I was 24. I am from the generation where educating girls was not a priority. All that was expected of me was to get married and have babies! My last 2 years at school were not happy - my older brother went to the same school and also my very gifted cousin who is a concert pianist. I was constantly compared to them both. 

I grew up feeling I was not particularly good at anything despite knitting and doing crochet for Harrods and Browns. I knew I had to be perfect but due to my total lack of self esteem I took no pride in the fact and felt so what, anyone can knit or crochet! These feelings stayed with me most of my life and I suffered some very severe bouts of depression that meant I needed to be hospitalised.

I was told my handwriting was nice. I could write poetry. I have bought up two children who are nice stable adults but still my lack of self worth persisted. I constantly compared myself to other people - they were all more intelligent than I was, they were nicer than I was etc etc etc!

In October 2011 my husband paid for me to do a flower arranging course for my birthday. This was something I had wanted to do for at least 30 years but there again my negative attitude stopped me. My first college lesson fell on my birthday and to say I was terrified of going is putting it very mildly. I begged my husband not to make me go, and he actually had to take me and it was just like my first day at school. I loved it once I started.

At the end of the six weeks I was really sad that the course had ended although I still felt I was not particularly good at it. My tutor asked me to stay behind after the last lesson and told me they were now taking Disability Living Allowance as a benefit and why didn't I enrol on a qualification course. My answer I remember was "what, me?"

I have a very complex medical history and am in a lot of pain but my tutor convinced me that she would help me as much as I needed. I enrolled in September 2012 at level 1 in NAFAS (National Association of Flower Arrangement Societies) qualification in creative floristry and my Thursday at college, although I found it difficult pain wise, soon became the best day of my week. I passed my Level 1 at Christmas 2012 and to my utter surprise people were actually wanting to buy my Christmas wreaths! My final level 1 assessment was a hand tie for a bride with white roses and tiny pearl beads bound with antique lace and secured with pearls. I achieved a grade 3 - the highest grade! Way hay! I thought to myself I can actually do this.

The course involves a massive amount of course work and I hated studying at 18 let alone at 60 but I have come to enjoy the business side of floristry. I embarked on level 2 in January 2013 and finish at the end of June. It has become very challenging now, both the practical and theory tests my brain somewhat. I had my practical assessment for level 2 last Thursday and chose to create a heart shaped wreath and passed at the highest grade again. The comments that were made on my practical work were that it was highly saleable and showed a high standard of creative talent. This is me I thought, I am now qualified enough to work in a florist’s and beginning to get more orders from family and friends. I love selecting my flowers, and I know my colour co-ordination is good (yes, I did say good!) and I love seeing what I can create from them.

Not only do I love my floristry it has made me look at all the other gifts I have been given. I believe that not many people are creative enough to work for Harrods. I am a nice, reasonably intelligent person who dresses well and am quite articulate. It is never too late to follow your dream whatever the obstacles you may have on the way. There is always a way around things!"

Is It Time For A Timeout? 4 Tips For Managing Your Anger

By Uyen-Khanh Quang-Dang, M.D., M.S., Resident Psychiatrist, UCSF School of Medicine &

Arshya Vahabzadeh, M.D., Resident Psychiatrist, Emory University School of Medicine Follow @VahabzadehMD

When does anger become a problem?

Anger is an emotion that everyone experiences at some point in their life. Anger in and of itself is not a bad thing. Anger becomes a problem when the anger itself, or how we express the anger, causes problems in our lives. For example, anger can be felt too intensely, too frequently, or it can be expressed inappropriately, leading to harm to oneself or to others. Poorly managed anger can result in damage to our mental health, physical well-being, social relationships, and employment.

When we feel angry, the most important consideration is how we manage this emotion. In many cases, we may manage anger in a similar way to people around us. Many children learn how to deal with anger from observing their parents and other family members. The way that we respond to anger may also be as a result of what happens when we become angry; it may help us to get things that we want, thereby reinforcing our behavior. There are many practical strategies which may be adopted to help overcome problems with anger management. Here are four tips on how to deal with anger:

#1 Make a list of events or situations that trigger your anger. It can be a helpful perspective to notice that each of us get triggered by different things – while some of us may get outraged by an inconsiderate roommate who leaves dishes in the sink, others may instead fume while driving in congested traffic. Having a better awareness of triggering events will help you to better manage and possibly prevent your anger.

#2 Take a timeout. Timeouts aren’t just for kids – they are an essential anger management strategy that should be in everyone’s anger management “toolbox”. Basically, timeouts help us think instead of impulsively reacting in the heat of the moment. Timeout strategies can range from taking a few deep breaths and taking note of how your anger is experienced in your body, to leaving the situation that is causing the anger. You can have a pre-arranged agreement where any of the parties involved can call a timeout during an upsetting interaction and return to the conversation at a later point.

#3 Engage in Exercise! We all know that exercise is good for your physical health, but it’s also great for your mental and emotional health as well. Regular exercise can be an effective preventative anger management strategy. In addition to cardiovascular exercise, try yoga – either in live classes or through videos available on iPad apps and YouTube videos if live classes are too expensive.

#4 Use the A-B-C-D Model. The A-B-C-D Model (developed by Albert Ellis) helps us to change our underlying irrational beliefs that perpetuate our anger.

“A” stands for an activating event that triggers our anger.

“B” stands for our beliefs about the activating event. What do you tell yourself in reaction to the triggering event? What are your beliefs and expectations of others? For example, when a friend arrives late, you may tell yourself, “This friend is a bad friend. If he respected me, he wouldn’t be late. I can’t be friends with this person.”

“C” stands for consequences – emotional responses about the triggering event based on your self talk. For example, you may feel sadness or contempt.

“D” stands for dispute, where you examine your beliefs related to the event, identify any irrational beliefs, and dispute them with more rational or realistic ways of reacting to the activating event. The point of this model is to replace maladaptive self-statements that exacerbate anger with adaptive self-statements that reduce anger and help you have a more realistic reaction to the event.

While these tips may be helpful, you may need support from a counselor or mental health professional. Keep in mind that you don’t have to deal with anger all on your own. There are effective anger management therapies available in individual and group settings that can help you learn healthy ways of managing anger. 

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Who will sponsor mental health research?

The good thing about blogging on mental health is that everyone looks out for topics for you! Last week a colleague told me about a new mental health research charity – it’s called MQ and wants to be “the Cancer Research UK of mental health research.” The Wellcome Trust has pledged £20 million to pump prime the charity’s activities, and the first MQ Fellows programme has been announced. 

Many people seem to be aware of the huge amounts of research work being done by cancer and heart charities into their specific areas of interest (let’s face it, we have either walked ourselves or sponsored family & friends to raise funds), but what about mental distress? There seem to be so many unanswered questions (not least those recently debated here about the validity of a mental health diagnosis), so surely there would be a corresponding numbers of projects?

Well, according to the Mental Health Foundation – “Mental Health Research investment is disproportionately low in relation to the relevant disease burden.” 

The charity Mental Health Research UK  has an innovative idea – but it too depends on a sponsor. One of the co-founders of the charity, “the first UK charity dedicated to raising funds for research into mental illnesses, their causes and cures,” has set up a fundraising blog called The Backpacking Barrister. Lawyer Dr Laura Davidson is currently working in Rwanda, “assisting the government with its mental health policy and legislation.” She writes powerfully from her experiences as a lawyer about her motivation for setting up the charity and the blog, describing a British system “of trial and error…. and legislation which permits the forcible medication of those detained in psychiatric hospitals means patients often feel like guinea pigs.”

The MHRUK website has links to the research projects that the charity has funded, including “Development and evaluation of an online intervention for the treatment of depression in university students” by Bethan Davies at Nottingham University.

What areas would you like to see new research focus on? Maybe if we had some good ideas we could pass them on to that new charity MQ and they could start spending the £20 million....? 

‘Reject the pantomime of equality in which we are expected to perform.’

                          The BRILLIANT 
                             ROMOLA GARAI on
 PUSSY RIOT and
          MARIA ALYOKHINA

              JEREMY DELLER is 
                 BLOODY SUBLIME

        The first job is advertised for our 
DEMENTIA & IMAGINATION 
                                  research project

            AMAZING 
     NEW 
      FUNDING
                    △
                         ⨷
                             ⨳
                                 ⨈
...thank you for dropping by

Paid workers – a voluntary group’s “essential” or “luxury”?

Another debate that has been very much “in the air” recently, is about whether or not groups of people who come together to pursue a common goal should receive more formalised support, particularly in the early stages. This could apply to any type of voluntary group, not just those focusing on mental health issues. Just because individuals decide they want to work together to campaign, for example, for better or different services, does not necessarily mean that they have the skills required to set up, run and sustain the group.

Working at Powys Association of Voluntary Organisations for the last few years I have come across many people volunteering across all spheres – health, the arts, heritage, sport and more. The one thing which brings them together is their passion – in my own case, volunteering for The Quilt Association in Llanidloes, it is a love of quilts both old and new that is the common bond. In mental health people might want to press for new services in a particular geographical area, or provide support for a specific group such as carers, for example.

But... what all these people (including me), with their diverse range of interests and skills and goals, suddenly find they also have in common – is the need to skill-up fairly quickly on the day-to-day basics of running and maintaining a group and the implications that has for them all. This is particularly the case for those groups which decide to become charities, where legal and financial responsibilities can create a lot of work – work which has absolutely nothing to do with the original reason why the group was set up!

So, whether promoting heritage quilts or campaigning for increased mental health services... we suddenly all need chairs, treasurers, secretaries and incredibly hard-working individuals who don’t mind finding out the nitty-gritty about insurance, equal opportunities policies, expense procedures and so it goes on...

The question is, should some of these groups – in the area of health often referred to as “user-led organisations” - be provided with a paid development worker in the early stages to help them? According to the Social Care Institute for Excellence (SCIE) “strong user-led organisations help commissioners tackle inequality, build social capital, contribute to prevention, and be more responsive to the local community.” You can read some of the guidance given to people commissioning services to develop and strengthen these organisations here.

What do you think? Are you involved in a voluntary group yourself, or thinking of setting one up? (Wales Council for Voluntary Action has useful information hereif you are).  And if you believe paid support is required on a regular basis – who is going to fund it?

PS: Whilst reading around the issues for this post I discovered that the Office for Disability Issues has a Strengthening Disabled People’s User-Led Organisations Programme - short-term grants to groups in the UK. “The programme is a £3 million investment over four years (until 2015) that will aim to promote growth and improve the sustainability of DPULOs.”  You can find specific advice for organisations based in Wales here.