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Sunday, 15 January 2017

Choices as to the 'cultural imagining' of the society we want to achieve and the amelioration of negative social constructs to help get there - an opinion piece by Dave Traxson.




What is our “ dominant cultural imagining” for a fair and healthy society and school communities? 
(thanks to Dan Goodley 12-01-17 
at DECP Conference)

                -the Cultural Amelioration of Negative Social Constructs of Difference
                  in the Context of Holistic Psychological Formulation.

“A negative focus on difference damages an individual human being’s ability to make relative progress in a range of important skill areas.” DT 2015

Reframing negative constructs of difference to being more positive manifestations of a human being's right to individuality, creativity, and potentiality is a process that is well under way in society but there is still along way to go. Aprocryphal tales abound of young people whose special talents were missed by the adults around them including educators and then suddenly when unleashed led to a transformational levels of progress. One of my own, is a young woman who was two days away from permanent exclusion as a fifteen year old, when I asked an obvious question about what she could see herself doing in her mid-twenties. Without hesitation she said, “ I am going to be a semi-professional footballer and a car mechanic.” No one in the circle of professionals and parents, including the careers guidance officer, knew that, but when the necessary curriculum adjustments were made to achieve this, she thrived and even stayed on to the sixth form to improve her chances further. We also noted profoundlythat she was co-operating previously in all subjects that, she could see, related to her ambition and was not co-operating in subjects that she could not see the relevance of , in achieving her clear goals.

It seems that there may have always been a part of the human condition that fears and often demonises difference in others compared to ourselves. This may have had a Social Darwinistic function for protection, to ensure that ideas and values of our own particular closed subgroup survive and even thrive.

The problem and question for us all is, can this be challenged and can tolerance of social variation 'genes' be woven intentionally into our collective values DNA?

I am optimistic that they can be and already the 'radiation' of ideas from the recent inclusion agenda, that have been emerging for the last thirty years, indicates that a dramatic evolution of societal values can occur e.g. the Tsunami of change occuring in front of our eyes with the massively improved tolerance and understanding of same sex relationships and the consequent legislative changes.

So what if we learn from this journey and apply the same 'selective pressure' to wider areas of intolerance to difference such as mental health or as 'medical modellers' would prefer, mental illness. If we can choose and promote a more socially and psychologically inclusive perspective on the normal range of human behaviours, that we mainly work with, then just imagine the long term benefits to us all:

·         less stigmatisation of children and subsequently adults.
·         many more people feeling a gteeater sense of belonging.
·         a massive reduction in the pathologisation of normality.
·         subsequent reduction to the costs of labelling for society.
·         a massive gain in individual and collective self-esteem.
·         empowerment of people with 'ups and downs' to succeed.
·         and a huge improvement in our collective Wellbeing.
·         And last but not least massive savings in NHS costs.



The acronym below tries to convey some of the key principles of ameliorating difference as a discriminatory construct:


D- ifference is beneficial to the community in which we live
I - ndividuality should be highly valued in schools and society
V- alidate childrens’ unique contributions to empower inner creativity
E- xpect relative progress by caring target setting and feedback
R- eview the progress achieved regularly and reinforce creativity
S- afety and security are fundamental to mobilising creativity
 I- nclusive ethos promotes the value and benefits of diversity
T- reat all childrens’ strengths and abilities as being equal in status
Y- ou are important and deserve personalised planning and outcomes.'

Schools as institutions are driven by uniformity and not creativity based on the wonderfully different skill sets individuals. Sir Ken Robinson in one of his seminal TED TALKS entitled “Schools kill creativity,”(2006 on Youtube) takes this argument to a logical conclusion. To progress successfully into a twenty first century of rapid change and challenge we need to discover the ‘Gold Nuggets’ of creativity that exist in everyone and maximise their abilty to follow their heart and soul in becoming a dancer, artist, sculptor, poet sportsperson or entrepreneur all of which are not as highly valued in our Education System as Maths, Science and English skills.

Cultural amelioration of difference is the systemically valued driver of wanting a school that you work in to collectively promote the importance of the unique human contributions that all children can make to any aspect of a hugely broad menu of curricular pursuits.

It is based on a triad of Ethos/Beliefs driving change in Actions/ Behaviour which in turn promotes collective Emotional Wellbeing/Mental Health.

The 5 Ms of Cultural Amelioration of Difference are :



1.                 1.  Moderate the use of labels of disability/disorder based on ‘Medical Model’ hinking.
  1. Modify educational programmes to allow a ‘Punctuation of the Day’ with creative activities that a young person demonstrably enjoys and engages fully in as a healthy learning process that promotes coping and resilience.
  2. Manage the individual’s needs /wants and the necessary resources to release their inner creative energies.
  3. Make appropriate adjustments to achieve success.
  4. Mollify conflict and prejudice against certain creative activities.

“Deliberately demoting difference effects can maximise the normalisation of childrens’ responses, as strengths and not difficulties.”

The ‘Medical Model” promotes ‘within child’ explanations of difficulty whereas the ‘Social Model’ promotes a holistic understanding of causation and possibilities for positive change. We as professionals are duty bound to see and recognise the rich palette of colourful skills as capacities, strengths and contributions which can enrich the sometimes apparent dullness of our communities and society as a whole.

Psychiatry applies the Medical Model conceptualisations to mental distress and anxiety whereas the new field of Psychological Formulation expounds an optimistic approach that maps the ‘Ordnance Survey Map’ of a young human being’s multi-various attributes, potentials, personality variables, interests and strengths and plots them in a way can help them determine the exciting journey that they are keen to embark on.

What is important is not to focus on arbitrary and prejudicial labels that are proliferating currently but to understand the complex web of interactions that results in an individual's mental distress. Understanding the interactive nature of a person's difficulties is a more progressive and inclusive way of finding how we can help them to succeed fully in an evermore complex world.



Reducing the continuous focus on difference and threat,that we see daily in our chosen media, axiomatically helps us to realise how similar we are and by focussing more on our 'common ground' we will develop the humanistic potentials of all individuals in our improved societies.

In essence creativity at all levels is the vibrant solution to our current shared ills and appreciating uniqueness and difference is the shared vehicle for progress.
  


Tuesday, 3 January 2017

Drop the Disorder by Jo Watson - 3-01-17 Courtesy of the MadinAmerica Website


It was February 2016, the UK-EU referendum debate was beginning to warm up and my tolerance for absorbing toxic tweets and frustrating Facebook posts was dwindling fast. What then pushed me over the edge was yet another celebrity-inspired media frenzy about a psychiatric “illness.”
Despite the progressive image conveyed by British critics of psychiatry (both professionals and survivors), the biomedical discourse in the UK is still deeply embedded in public consciousness and actively promoted in anti-stigma campaigns and media reporting. Actor, writer, and national treasure Stephen Fry's documentary “An exploration of manic depression” told of how he needed to take lifelong medication for his “bipolar disorder.” Celebrity and comedian Ruby Wax was on a riotous roll, and everywhere you looked, it seemed, someone was promoting the “broken brain” message.
The mainstream narrative, which tells of discrete diagnoses and disorders, was all over the place.
I am a psychotherapist, and somehow, when we weren’t looking, this “disorder” narrative managed to sneak into the field of psychotherapy and counseling. Despite all our knowledge about attachment, trauma and relationships, many of my colleagues have ended up colluding with the message that people are “ill.”
I see an increasing number of clients—and particularly young people—who arrive at their first appointment convinced that they have bipolar, or even worse ARE “bipolar.” Many, by the time they get to me, have internalized this as part of their identity along with the understanding that it's a lifelong situation. Others come with crippling anxiety and a parallel belief that it is something that is part of them, that their brain is dysfunctional and they have no control over it.
I finally thought: I have to do something or risk getting a diagnosis myself!  I figured that getting people together to initiate a conversation about psychiatric diagnosis would be a pretty good start.
This conversation led to the creation of a daylong event on October 15 in Birmingham, England with Dr Lucy Johnstone, clinical psychologist, MIA blogger and author of A Straight Talking Introduction to Psychiatric Diagnosis. Lucy had been a Twitter ally of mine for some time, and within a couple days of advertising the event, which we titled “A Disorder For Everyone!”, we had people eager to travel from afar. People came from London, Wales, Scotland and Ireland to discuss the culture of psychiatric diagnosis, evidence of a growing popular resistance to the “broken brain” narrative.
The day was a huge success! Survivor Jo McFarlane got us started with a moving live performance of some of her powerful poetry.
Lucy then talked the audience—a mixture of professionals, current and former ‘service users’, carers and interested lay people—through a critique of diagnosis and an overview of the alternatives. In the afternoon there was time for discussion and trying out some of these ideas.
Finally, spoken word artist Jasmine Gardosi ended the day by bringing one of my own poems—inspired by voice hearer and activist Eleanor Longden—to life.
Feedback on the day was excellent, and we have been invited to repeat the day in several other cities, starting with ‘A Disorder for Everyone!’ days in Edinburgh and Bristol this coming March.
After the Birmingham event, I started the Facebook group 'Drop the Disorder?!' with the aim of providing a supportive forum for the discussion of all matters related to psychiatric diagnosis, ‘medication’, and medicalization of emotional distress. In three months, membership has risen to over 2400 members globally.
The members of ‘Drop the Disorder?!’ come from a variety of backgrounds: they are professionals, survivors, ‘service users’, carers and people with a general interest in the debate.  We have been delighted to welcome some well-known figures in the movement, including  Rufus May, Rai Waddingham, Michael Cornwall, David Oaks, Bob Nikkel, Jim Gottstein, Kermit Cole, Malcolm Stern, Mary Maddock, Ted Chabasinski, Terry Lynch, Bonnie Burstow, Peter Kinderman, Lucy Johnstone, John Read and Katinka Blackman Newman and Paula Joan Caplan who I had the pleasure of meeting in New York in November. As you can see there are several MIA bloggers among the mix and we hope to welcome more soon.
Joining me on our admin team are activist and blogger Nicky Hayward, clinical psychologist and author Gary Sidley, counselor Teri Tivey, lived experience educator Joanne Newman and social worker Lanie Pianta.
The group provides a space to discuss important but controversial issues that arouse strong feelings, and at times it has felt like a bit of a roller coaster. However, I have been moved by the thoughtfulness and warmth people have shown to each other as they share feelings, experiences and dilemmas about working in, and being on the receiving end of, the psychiatric system. Many such issues that have been discussed and debated include "ADHD," ECT, "Personality disorders" and "medication."
We share lots of great pieces by critics of mainstream psychiatry around the world, passionately promote appropriate events and publications as well as doing the crucial networking which makes our movement stronger by the day.
It feels as if there is an appetite for new ideas and for change. There is definitely a sense of energy and excitement as connections are being made, views are being endorsed rather than silenced, and emotions are being expressed and heard.
People have told me that they feel hopeful, and that the group is a precious space for them. I too am hopeful.
One of the shared ambitions of the administrator group is that we can ultimately develop this resource into a much-needed "Mad in the UK" site.
In the meantime, I urge you to take a look—we welcome members from across the globe, and are indebted to Mad in America for links to some of the most popular articles and blogs. It’s time to 'Drop the disorder!'

Jo Watson
Jo Watson is a UK psychotherapist trainer and activist who started out in the Survivor & Rape Crisis movements 25 years ago. Jo campaigns for a paradigm shift away from the bio medical model narrative of mental distress toward a more appropriate trauma informed response. Jo formed the Facebook group "Drop The Disorder?!" in September 2016 and organizes the event "A Disorder For Everyone!" that is currently making its way around the country.

Thursday, 1 December 2016

Mental Distress in Children - a brief perspective after 40 years of working in the field.



Gottman Institute

Link to Linkedin - https://www.linkedin.com/pulse/mental-distress-children-dave-traxson?trk=hp-feed-article-title-share
"Thinking of your child as behaving badly - Disposes you to think of punishment. Thinking of your child as struggling with something difficult - Disposes you to help them deal with their distress."

- APPLIES TO PARENTS AND TEACHERS
After 40 years of working with children I return a full circle to the seminal book that informed my teaching and psychology, 'Children in Distress,' by Sir Alec Clegg the inspirational Director of Education for the West Riding of Yorkshire where I was lucky to teach, who believed and promoted meeting childrens' emotional needs by art, poetry, drama, self-expression and physical outlets and only then can you meet their wider educational needs.
In an after dinner speech in 1972 he highlighted some important principles for his audience of teachers in training at Bretton College, Yorkshire, which he helped found:
  • that there is good in every child, however damaged, repellent or ill-favoured he or she might be;
  • that a child's strengths / successes on which a teacher can build must somehow be found for every child;
  • that all children matter and all can make a unique contribution to society;
  • that happy relationships between head, teachers, and pupils are all-important;
  • that the life of the child can be enriched by the development of their creative powers;
  • that encouragement and recognition of relative progress is far more important than punishment;
  • that teachers just as much as pupils need support and thrive on recognition and specific high quality positive feedback.
A VERY PRESCIENT AND MODERN PERSPECTIVE METHINKS.
I consequently believe like Sir Alec that mental distress is the root of all traumatised or anxious behaviour patterns in schools and society, not biochemical imbalances or brain cell malfunctions - I passionately believed this then and still do even more today.
The British Psychological Society more recently in a paper entitled,'Psychological Health and Wellbeing,'(2009) stated,
"Psychological models of mental health, quintessentially, emphasize the key role of a healthy, supportive, connected childhood in producing well adjusted adults. + We fully support the proposals in the 'New Horizons' initiative to develop policies to ensure a healthy start to life for children."
My attempt at a useful working definition of 'Mental Distress,' in the children we work with, is the gradual and even the not so gradual accumulation of inner anxieties and mental confusions which can trigger negative thought patterns, associated behavioural responses and the increased release of stress hormones, which in turn can further exacerbate feelings of the loss of personal power over the world they inhabit. Increasingly debilitating emotional responses can then interfere with their effective daily functioning in both educational and social settings.


My Stress Bucket Metaphor which was first published in 1993 in a chapter entitled,'Destressing Children in the Clasroom,' and has been used widely since in a therapeutic way indicates that there are three different levels of stress triggers going into the child's mental virtual vessel for accumulating stress. These are teaspoons, cupfulls and kettlefulls in ascending order. Clear 'kettlefulls' going into a child's bucket are abuse, bereavement, bullying, domestic violence, family dysfunctionality, neglect and toxic drug harm. All of these have major Safeguarding responsibilities for society and child mental health professionals believe these key ones are responsible for the vast majority of mental distress in the children with whom we work.When using the Stress Bucket I do a 'My turn - your turn' script where I illustrate the different sizes by relevant age appropriate examples and then pose the open question, "And what about in your life at the moment?" It is very rare not to engage a child in this process but obviously there will be different degrees of success.
The earlier simply stated but transformative views for professionals and parents of a child's complex and interactive needs may help us to better provide for the emotional needs and wellbeing of children in our schools. The following principles may also inform our decision making and the strategies we choose to support vulnerable children.
Nurture not narcotic prescriptions are the answer to meeting a vulnerable child's emotional needs in schools and the wider society and enabling a sense of belonging are paramount. The success of nurture groups in many schools and their Inclusive Ethoses has conclusively proved this in my view.
Tender Loving Care is the answer not punishment based regimes that culminate in crazy ideas such as repeated 'Isolation,' Saturday morning detentions and Permanent Exclusions, which can cause significant harm to children. Exclusion from a family and exclusion from a school are two very destructive approaches for vulnerable and already damaged children. We have to sort isues out in the five hours a day we have to care for children within the Inclusive Ethos that we have chosen to create. Italy has not excluded children from local schools since 1979 and Ontario has been fully inclusive for a similar period of time. The proven strengths for childrens' collective wellbeing speaks for itself as can be witnessed on any visit to communities in these societies.
Hope, personal strengths and collaboratively finding creative solutions are the lifesprings of positive change in children and always will be.
"There is no more apt window on the soul of a society than the way it treats its children." Nelson Mandella.
And now to return to the finale of Alec Clegg's speech which he found in Rome about a world famous artist there -
"The bearer of these presents is Michelangelo the sculptor. His nature is such that he requires to be drawn out by kindness and encouragement. But if love be shown him and he be treated really well, he will accomplish things that will make the whole world wonder."

Tuesday, 22 November 2016

Combination Therapy of Exercise and Computer Based CBT Can Be Better than SSRI's by Marta Pagán-Ortiz Courtesy of the Mad in America Website.





In a new study published in The British Journal of Psychiatry,Sweden-based researcher Mats Hallgren, PhD, and colleagues discuss the findings of their research comparing the effectiveness of exercise, Internet-based cognitive-behavioral therapy (ICBT) and usual care for treating individuals with depression. The results of their study, which was the first in comparing the long-term effectiveness of these treatments, suggests that all of the interventions were associated with reductions in depression severity, and that compared with usual care, exercise and ICBT provided “clinically relevant improvements” in depression symptoms.
“Compared with usual care by a physician, prescribed exercise and clinician-supported ICBT are at least equally effective long-term treatment alternatives for adults with mild to moderate depression.

In their study, Hallgren and colleagues argue for the need to explore and develop additional treatment options for depression. Depression is considered a public health concern, which also represents a heavy burden for individuals living with it. Pharmacological interventions, which are seen as a mainline treatment for depression have been questioned and criticized, both for their lack of efficacy, as well as their detrimental side effects.
Both exercise and ICBT, which were used in this study, have been found to be effective in reducing symptoms of depression. A study investigating the benefits of exercise in treating depression found it to be comparable to psychological and pharmaceutical treatments. Other studies have found that the antidepressant effects of exercise have been underestimated. Meanwhile, Internet-based interventions have been lauded for both their accessibility and their efficacy compared to face-to-face CBT.
For this study, the researchers aimed to compare the long-term effectiveness of a 12-week exercise intervention and a 12-week ICBT intervention, with usual care for depression by a physician. Individuals were recruited for the study through primary healthcare facilities in Sweden. Participants were individuals aged 18 and older, who met a score requirement on the Patient Health Questionnaire (PHQ-9). After being recruited, study staff members screened them for trial eligibility. Individuals eligible to participate (n=945) were randomized to one of the three treatment groups.
Participants in the exercise group received three 60-minute sessions a week of light, moderate, or vigorous exercise. Those randomized to the ICBT group received treatment through an online self-help manual structured in modules. Participants who received the usual care typically visited their primary care physician, psychologist, or psychiatrist once a week. Most often, participants in this group participated in a 45-60 minute cognitive-behavioral therapy session. Individual were assessed at three time points: baseline, three months later, and 12 months later. 78% of participants returned the 3-month questionnaire, and 84% answered the 12-month survey.
Results from the study showed that individuals in all three groups had a reduction in depression severity between baseline and 3 months, and from baseline to 12 months. Also, individuals in the exercise group were found to have even higher rates of improvement.
"Findings from our robust trial show that exercise, even at low levels of intensity, is more effective in the treatment of mild to moderate depression than usual care by a physician (medication and/or counseling). ICBT is certainly another effective treatment option, which may be especially useful for patients with mobility issues," Dr. Hallgren stated, in a press release to Medscape Medical News.
Among the study’s major weaknesses, was the fact that the researchers were not able to collect the number of individuals invited to participate in the study, therefore limiting their understanding of the condition within their target population. The authors conclude with discussing the clinical implications of their findings, in particular, highlighting the importance of physical activity to treat depression in those who are at risk due to physical diseases, such as diabetes and cardiovascular conditions.

****
Hallgren, M., Helgadóttir, B., Herring, M. P., Zeebari, Z., Lindefors, N., Kaldo, V., ... & Forsell, Y. (2016). Exercise and internet-based cognitive-behavioural therapy for depression: Multicentre randomised controlled trial with 12-month follow-up. The British Journal of Psychiatry209(5), 414-420. (Abstract)
Previous articleA Best Kept Secret
Marta Pagán-Ortiz
MIA-UMB News Team: Marta E. Pagán-Ortiz is a doctoral student and research assistant in the Counseling and School Psychology PhD program at UMass Boston. Marta is currently working on research studies related to mental health treatment guidelines for chronic illnesses, issues of structural violence within minority populations, and the reduction of disparities in mental health status and class.

Saturday, 10 September 2016

BMJ STUDY - Most Anti-depressants don't work on teens or kids - By Kimberly Leonard




Anti-depressants like Prozac and its competitors may increase the risk of suicide risk in younger users.PAUL S. HOWELL/LIAISON AGENCY/GETTY IMAGES
Prescribing antidepressants to children and teens appears to be ineffective at best and can increase the risk of suicide among users, leading authors of a new study to conclude that the drugs do "not seem to offer a clear advantage."
The analysis, published Wednesday in the British medical journal The Lancet, examined 14 antidepressants given to young people in various randomized trials conducted through May 2015. Fluoxetine – widely known as Prozac and the most commonly prescribed medication for young people with depression in the United Kingdom – was the only drug found to be effective at relieving the symptoms of depression. Sertraline, known as Zoloft, was the most commonly prescribed antidepressant in the U.S., but it was not the one found to be the most effective in relieving the symptoms of depression.

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Prozac is the world's most widely prescribed antidepressant; it has been used by more than 35 million people worldwide. While it cannot be said to 'cure' depression, it does help to control the symptoms of depression. (Photo by Paul S. Howell / Liaison Agency)

Money for Nothing


The most severe side effects were associated with venlafaxine, or Effexor, which was linked with an increased risk of having suicidal thoughts and attempts, compared with a placebo and with five other antidepressants.
The increased risk of suicide because of certain antidepressants has already been recognized. In 2004, the U.S. Food and Drug Administration placed a black box warning on antidepressants for those under 24 years old, after evidence suggested a suicide link. These medications are used to treat commonly diagnosed cases of "major depressive disorder," which affects roughly 3 percent of children and 6 percent of adolescents.
Along with Effexor, other drugs evaluated – including Imipramine, which is known as Tofranil, and duloxetine, known as Cymbalta – had the highest chance of being discontinued by patients, who reported that they did so because they couldn't tolerate their side effects. The study didn't go into what the specific side effects were, but the FDA has listed a few, including weight gainanxiety or changes in sex drive, depending on the drug.
The Lancet analysis involved 34 trials and 5,260 young participants, and authors warned that data likely were underestimating adverse events, including suicide. They also noted that many of the clinical trials they relied on for evaluating antidepressants were funded by drug companies, which can result in poorly designed trials and in selective reporting of findings.
In an accompanying comment, Dr. Jon Jureidini from the University of Adelaide in Australia questioned whether more suicidal events would have been reported if the data had been more reliable. For instance, he cites that in trials of the drug paroxetine – most commonly known as Paxil – 3 percent of adverse events were reported, but individual patient-level data has revealed an incidence closer to 11 percent.
He wrote that there was "little reason to think that any antidepressant is better than nothing for young people."


"Prescribing might help the doctor feel like he or she is doing something, or help parents feel that something is being done, but the adolescent might feel it to be dismissive of their distress," he wrote.
One of the co-authors of the study, Prof. Peng Xie from The First Affiliated Hospital of Chongqing Medical University in Chongqing, took a more measured approach, saying that children should be monitored closely regardless of the antidepressant prescribed.