Tag Archives: depression

Psychiatry: A New Understanding

Having been interested in psychiatry for a long while, I have now embarked on several months training in the discipline. And although mental health is never far from the public eye, it seems to be that a general understanding of mental health and disease is vastly lacking. But in my fledgeling understanding, I have begun to know things just that little bit more.

Psychiatry and the Mind

To begin with, the concept of normality, whether it is physical or mental health, is debatable. When it comes to physical health problems, like chest pain, we are quick to recognise what is ‘abnormal’ and would require action, how much action and the mode of action. It is not a necessarily binary situation, but we know enough about the natural history of a disease, biology and treatments to make a workable approach.

Psychiatry, however, is less clear-cut. Although science has, for a long while now, explained mental health problems in terms of physicality, biology and chemicals, the understanding of the human aspect of the disease still warrants expert judgement. Phenomenology, that is the study of words, has attempted to categorise mental health complaints within recognisable schema; what one may describe signposting depression should be generalisable.

My sadness and your sadness should be understood in a similar way, and their approach into depression more so.

This has had some success, and within the streams of both biological and psychoanalytic models of mental health, has allowed us to recognise disease in a functional way. By understanding the language of disease, as expressed by our patients and selves, we can learn to spot patterns in the same way we may read an ECG. To an extent. However, a psychiatric disease is not as simple as an ECG*.

The issue with psychiatry, which has been long debated, is the suggestion that, including psychotic beliefs (those not grounded in reality or truly understandable by doctors,) we do not classify disease purely on biology, but on their proximity to social norms. This is quite foolhardy philosophically since all of our norms are prescriptive and based on a shared belief, which when applied to metaphysical understands of the world is rendered mute.

Put simply, we have created the goal posts by which we measure psychiatric abnormality, and unlike physical problems (if treated as separate,) there is a great discordance between people on what disease actually means.  To some, their core beliefs may seem entirely rational and healthy, but to others, a clear indication of being unwell. And how do we make these judgements?

Apart from CT scans, biochemical markers and agreed diagnostic categories, we fray on the fringe of relative value.

And when you review popular media, for example blaming massacres on the mentally unwell, regardless of whether this is the truth (which it rarely is,) you can see how a moral value has been ascribed to behaviour, and how it can be used to suggest a diagnosis. You need to look no further than the ‘luny left’ and ‘liberalism is a mental disease’ to recognise this shortcoming of human understanding.

So when I meet my patients, I cannot fully assess them without realising that my diagnosis is shining a thin light on a large area, where the boundaries of normality are hazily defined. Does this mean that all psychiatry is value assessed, not necessarily, there is clear science and patterns, but we must be aware of where the evidence ends.

Evolutionary antecedents and Art.

We have known for a long time that the human brain is vastly imperfect. We also know that morality, that is our measure of the ‘goodness’ of things, is a relative concept. In fact, some philosophers such as Freidrich Nietzsche have gone as far as to claim there is no such thing as good and evil, and others have renounced all understanding and attributed such judgements to God alone.

What we do know is that behaviour is not unpredictable. We know those common traits are common because they are either useful to survival, non-affective or tied to something useful. For example, we know that running fast is useful alone, won’t tend to get you killed directly (unless you run off a cliff,) and works best with good hearing and reactions (for more on this, see co-adaptive genetics.)

Herego, mental health problems do not escape the scrutiny of evolutionary explanation, and this is where the science of anatomy, genetics, sociology, psychology, behaviour, chemistry and anthropology meet the human disciplines of art, literature, history, speech, song and expression. The human mind is a result of its best compromise and survival, and with it, mental health problems have shared a journey.

So when we interview our patients, we see the humanity of disease, etched through eons of evolutionary history, expressed in the contemporary terms of our sociocultural understandings. A psychotic belief is amoebic, and will likely include tenets of that person’s popular culture, as opposed to one of the ancient Egyptians. This cannot be avoided but can give us clues to an underlying constant process.

Psychiatric disease is likely part of our survival, for better or for worse.

The history of psychiatry and philosophy is intertwined, and before such things as brain imaging, it was the brain and its wake light pondering that allowed us to conclude the nature of things. Logic, experiment and results were used across a vast arena of disciplines, from which arose different schools of thought such as Freudian Analysis.

The later schools of medical models have all but usurped the philosophical and analytic, but the latter still play a vital role in our understanding. It is likely that with further science we may be able to pin psychiatric disease, or at least its base aetiology (ie cause,) on something purely biologic and explained through measurable variables, but until then, we rely on our interpretation of behaviour to guide us to the scan.

Diagnosis and Detention

So with the somewhat hazy and complex architecture of the interplay between evolutionary explanations of psychiatric disease, medical explanations, sociocultural norms, variable and diverse human expression and the legal system, the idea of diagnosis and treatment becomes one of great importance. And one that can cause great contention.

We can mostly all agree that someone at risk of suicide due to severe depression may need to be sectioned. We can also all agree that it is in their best interests to do so. This is because we value life, but also claim knowledge that psychiatric disease renders one incapable of deciding what’s best for themselves. At the extremes, we tend to agree, but in the middle ground, there is less commonality. We agree on death, but sadness is a different issue.

And when it comes to issues that have a socially contentious element, such as gender and health, we must listen very carefully.

I work in an acute psychiatric unit, which means the patients that I see are on the more severe end of the spectrum, that is that they very rarely occupy the middle ground of disease severity. I see patients who believe they are being monitored by government agencies (which arguably, we all are) or can see ancient ghosts wandering the halls.

My view of psychiatry is within the deep end of the human mind, the echoes of our ancient brains pushed to their limits. And as a growing student of the evolutionary explanations for psychiatric phenomena, it is becoming abundantly clear to me that a full understanding of the subjective nature of the disease is probably beyond pure science, it will be found in expression.

So how does this translate to sectioning a patient, or indeed, deciding if and when someone should or will be treated? To give a general answer to this is difficult, but I will give it a try, based on when the patients own subjective view of the quality of their life is jeopardised by their disease.

But for those actively psychotic, i.e who have left reality behind, such subjectivity is lost, and we must use our own sociocultural norms and understanding of reality to make sense of their experience. And we do our best. Sometimes that means bringing people in against their will, and believe me, that is rarely an easy decision.

Treatment and Life

So having trawled, on a surface level, some of the complex themes that goo into diagnosing and deciding to treat a psychiatric illness, what of treatment? From my experience, the variety of methods out there provides hope. Whether it be medication (which addresses biological and chemical causes of disease,) ECT (which, as far as we know, derives its role in chemical and anatomical methods,) and therapy, which helps us to understand and correct aberrant thinking, we do see changes.

Sometimes these changes are drastic. I note one man who came in severely depressed, paranoid, almost catatonic, who after a few weeks of ECT is now back to shopping with his wife. His subjective view of the world and his disease has changed drastically as if some great mist has disappeared. Others are less pronounced, where a persistent delusional belief is still present, but less concerning.

In each case, our measure of success is built through understanding the subjective view of our patients, either phenomenologically through an interview, or objectively through an analysis of behaviour and biochemical changes. This is a far cry from the newspaper headlines and personal accounts that litter the blogosphere, but good is being done. Psychiatry, a discipline of the old and new, saves lives.

Placed in context, however, we must always remember that our view of success is based, at least in part, on prescriptive sociocultural norms, derived through evolutionary behaviours and limited by our own bias and cultural beliefs. The solution to the malady of psychiatric disease is one that may never be fully answered, but until then I find myself in a world where I can make a difference.

So far this has been an enlightening journey. But to be a good psychiatrist means truly understanding your patients, their views, expectations and dreams based upon their understanding of a world that we may not agree on. We must be prepared to listen more than talk, read more than present, understand that we know little.  Crucially, we must know ourselves to know our patients.

It means understanding history, evolution, biology, neuroscience, art, writing, speech, religion, social causes and much more. It is by no means simple. I hope to be starting to get to grips, but I can always improve.

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The opinions expressed in this article are those of Dr Janaway alone and may not represent those of his affiliates. Featured image coutersy of Flickr.

*Note, the interpretation of an ECG is far from simple. However, in relative scales, the number of clear diagnostic changes available comparing ECG to phenomenology is vastly disproportionate. This is an academic and rather histrionic comparision, so apologies to the Cardio Reg.

 

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‘Mental health myths you wouldn’t believe still exist’

myth mental heath care

Mental health issues are more common than you would think. And in fact, mental health problems are amongst the leading causes of disability worldwide. Astoundingly, 1 in 4 of people in the United Kingdom alone will experience mental health issues a year.

So when you look at the world overall, that is an awful lot of people.

Regardless of the universality of the problem, many people still labor under false beliefs. So we hope that by breaking some of these myths down that we can not only eliminate some undeserved stigma, but encourage a community driven empathy toward those who ask for it.

And with that in mind, I have invited some wonderful friends along with me to spread the message of what we have learned. I have also talked to psychiatrists and other medical professionals who have been kind enough to lend their time.

It is my belief that through knowledge we can really make a difference and, hopefully. together we can shine some light.

mental health depression compassion

By correcting misunderstandings we can build a community around empathy. Image courtesy of Flickr.

1. Mental health problems only affect ‘weak people.’

Being diagnosed with a mental health problem, be it depression or any other, can make one feel fearful and insecure about themselves and their future. This is a natural response, as any drastic change to our lives and sense of structure will influence our emotions.

‘Everyone can have a mental health disorder. If I were to lose someone, I would suffer and could get depression. I would not consider myself a weak person. We are all human, we are all built the same way.’ – Scott McGlynn, Present and LGBT+ Activist.

But let’s not confuse sadness with weakness, it is simply human. And since we know that the commonality of these issues is so great, it’s fair to say that just about anyone can suffer.

And from what we know about the causes of these problems, be they social, biological, psychological or a combination, we can say confidently that a ‘person’ is only part of the recipe for developing a problem. Some predisposing causes include childhood abuse, social issues and adult trauma, as well as genetic or biological antecedents

myth mental health

Even those that society elevate as heroes can feel the same pain as the rest of us. Image courtesy of Flickr.

And although there are many more factors prevalent in developing a disease, you would be hard pressed to conclude that a personal ‘weakness’ is solely to blame for somebody becoming unwell, or that a mental health issue is a sign of that weakness.

These issues can strike anyone, from military leaders to doctors, from artists to authors and beyond. Much like any disease, the human at the centre of it is who matters, not their job or what society demands. And many with mental health issues become world leaders. This is despite what society tmay wrongly consider a flaw.

Incredibly, they do this knowing that some members of society would reject them simply for their diagnosis. Former US President Abraham Lincoln and War-time UK Prime Minister Winston Churchill both presided over tumultuous times, but both were alleged to have suffered with mental health issues. 

depression stigma myth

Winston Churchill famously battled depression whilst leading the British war effort during WW2. Image courtesy of Flickr.

So instead of considering those with mental illness as ‘weak’, we would better reconsider what we define as making a person ‘strong.’ I think you would agree that Churchill’s tenure was one requiring a tremendous personal strength.

And on a personal note, living with depression requires more resilience and strength than you would realise.  And to make a difference in the world, to enrich the lives of others, whilst battling every day, that is true strength by any definition.

2. People with ‘mental health problems’ are a ‘drain on society.’

A particularly uncomfortable idea, some believe that those with mental health issues are simply faking it. Or worse still, doing so with the intention of sponging ‘off the state.’ This is a particularly divisive attitude worsened by some social media commentators going as far to claim that depression isn’t a real condition.

depression stigma myth welfare

To some, Depression is not considered a real disease. But to the patients, the story is very different. Image courtesy of Flickr.

Although it is true that in acute episodes of some mental health issues people may require time off work, it is important to note that the vast majority of patients work regularly. In fact this can be as high as 70% in those with anxiety or depression.

Furthermore, the idea ignores the very fact that: patients want to get better and businesses have a legal obligation to provide ‘reasonable adjustments’ to ensure an unwell employee can return to work. It is clear that many wish to return to a relative normality, and work with their employers to facilitate this. According to the Health and Safety Executive UK (HSE);

‘Most people who have ongoing mental health problems continue to work successfully. But when someone needs support, managers can work with them to ensure flexibility to suit their health needs.’

Being unwell is as simple as being unwell, and it seems that ‘mental health issues’ are viewed as a less legitimate to need time to recover than a more obvious physical illness. And where those with conditions like cancer are given worthy encouragement, those with depression may not be extended the same courtesy by the public.

medicine chemo depression mental health myth

It seems that ‘mental health’ problems are viewed as less legitimate than other ‘more medical’ problems. Image courtesy of Flickr.

By comparing the statistics we can see the bigger picture. Although the total number of work days lost to mental health was around 40% of the total during 2016/17, the vast majority of time off was due to other problems. So, we are forced to ask why the minority cause of time off receives such disproportionate stigma.

Are people with cancer a drain on society? What possibly makes people think that an illness of the mind makes you lesser than anybody else? We need to realise that mental health is not a failing. The connotation is that these problems are some sort of societal betrayal. – Mike Stuchbery.

Instead of considering those with a mental health issue as a ‘drain on society,’ the truth is rather different. Like patients with all diseases there will always be a relative loss of work, and this is necessary to their recovery.

Even better, since most with mental health issues do choose to work, it is clear that the problems are taken in hand where possible. So you may ask why people would attack those with mental health issues when the evidence is so clear?

work myth drain on society mental health

Despite the myth, the majority of those unwell continue to work. Image courtesy of Flickr.

Personally,  I think it’s because content creators recognise just how financially powerful encouraging that stigma can be for their channels, or perhaps that because stoking division is an effective political move. If this is true, then the problem does not lie with the patients themselves.

“Cinema, radio, television, magazines are a school of inattention: people look without seeing, listen in without hearing”  – Robert Besson.

If society can be so easily hoodwinked, then combatting the stigma is that much more important.

3. ‘All people with mental health problems are dangerous’

Another dramatic misconception is that ‘all people with mental illness’ are dangerous, and when the public are repeatedly told that those committing mass shootings are ‘mentally ill,’ you can understand why there is a concern.

But the fact’s don’t support the sensationalism. In fact, the Canadian Mental Health Association reassures us;

Mental illness plays no part in the majority of violent crimes committed in our society. The assumption that any and every mental illness carries with it an almost certain potential for violence has been proven wrong in many studies.

Although it is true that some people may commit a crime while unwell, only 1% of people in a recent survey believed that individuals with mental health issues pose a threat. There is something lost between the public and some of the papers here.

But thankfully, many in print media are very aware of the misconception.

In my time as a journalist I met a good number of people who could be described as violent. Some were guilty of some shocking deeds. Yet, I cannot recall a single one who had a recognisable, distinct mental health issue. But I think when it comes to misconceptions, it’s not just journalists making the leap but society as a whole – Andy West, Broadcaster and Writer.

crime myth mental health

The majority of violent crimes committed in the UK and US are not committed by those with Mental illness. Image courtesy of Flickr.

Given that an estimated 7 million people in the UK have a mental health disorder, the average homicide rate is just between 50 -70. And over 2016-2017,  this represented a tiny fraction of the 790 homicides in the UK (8.9%.)

This means that 91.1% of UK murders are committed by those without a mental health issue, and when it comes to acts of violence,  those with mental health problems are responsible for only 3-5 % of crime compared to 96% (approximately,) within the general population in the United States.

In addition, within mental health overall, those with schizophrenia have a only slightly higher risk, mostly associated with substance abuse. But in the same vein, the vast majority will never commit a violent crime.  But what of psychosis itself?  During a psychotic episode, where in some psychiatric conditions a patient may lose contact with reality, only 6% may present any risk.

What about mass shootings? Well, less than 1% of all gun related deaths in the United States are due to those with a mental illness, and in that small number, the majority are suicides.

suicide harm

Contrary to popular belief, those with mental health issues are more likely to harm themselves than someone else. Image courtesy of Flickr.

So, why the overinflated preoccupation with risk? Perhaps misconceptions about serial killers being insane, the vilification and over-dramatisation of mental health in movies and television, and most insidiously, the use of mental health patients as scapegoats.

Let us consider the US, where gun laws are under constant scrutiny. It is much easier to blame a mass shooting on a ‘mentally unwell lone wolf’ than admit that you may have a culture problem and access to firearms. For some gun advocates, perpetrating this horrible myth serves them well.

So all in all, those with ‘mental health’ problems commit less violent crimes than the rest of the UK (and US,) and are a greater risk to themselves than others.

scapegoat mental health violence

It seems sometimes that those with mental health problems are made scapegoats by those who should know better. Image courtesy of Flickr.

Although there is some risk, the data bears out nothing significant beyond specific cases to a population level. The very idea that everyone with a mental health issue is dangerous is demonstrably false, stigmatising and worryingly, seemingly deliberately sold.

‘The only thing we have to fear is fear itself.’ – Franklin D Roosevelt

4. There is ‘no getting better’

‘People succumb to an idea that things don’t get better. You can’t see mental health, it’s not like a broken leg. There is an ‘end point.’ It’s clear, but with mental health its a lot more difficult for people to believe that there is a definitive fix.’ Ralf Little, Health Advocate and Actor.

For some, a mental health problem can last a long time, but for others, they may only brush with it briefly, once in their lives. Everybody’s experience of life is different and with that comes a different experience of mental health issues. It can be easy to feel trapped in disease, only to wonder why you felt so helpless months later.

Mental health disease future

A mental health problem can seem like the end of the world. But for most, if not all, the veil is lifted with time. Image courtesy of Flickr.

It is often with the benefit of hindsight that the truth becomes clear. When it comes to mental health, this often shows us that recovery may require lifelong treatment to maintain. or nothing at all – it all depends on the person and their journey. In fact mild to moderate depression may need drug treatment for no longer than a year, if at all.

The misconception that these issues are ‘permanent’ or ‘inescapable’ is very much hyperbole, and does not take into account how different people define their quality of life. Or indeed, what people consider being ‘unwell.’

It is up to the patient to decide when they have escaped the disease, which for many is the cessation of its symptoms, and for others, never feeling them again.

Personally, I view my depression as companion who raises it’s head from time to time, and during those periods inbetween I consider myself ‘better.’

For me, its about assigning value to the moments and realising my choice in doing so. Perhaps many of you will understand this.

myth value life

Sometimes a mental health problem can reveal what is truly valuable to us. Image courtesy of Flickr.

Yet somehow, society forces a double standard when comparing mental health issues with more physical ones. A cancer remission is treated as ‘getting better’ whilst many would say recovery in a depression is ‘only temporary.’ Both have a chance of returning, but we consider the time without illness as being ‘healthy again.’

While appreciating the complexity of the comparison, its fair to say that both have periods of being unwell and less unwell. Or not unwell at all, with a potential with recurrence or not. But in most cases, there is some level of improvement.

Have faith that on the other side of your pain is something good. – Dwayne Johnson

Whether this improvement is enough is up to you, but from personal experience and the stories of others, life can be just as good, if not better than before, when a condition is well managed. For me, my depression has added such value to my life that I appreciate living it all the more.

So, by using a medication, therapy, or lifestyle changes (or some combination of them), we can have great success in treating a wide variety of conditions. And, although many years ago these conditions could be something lifelong and debilitating, today’s patients can live rich and fulfilling lives.

life mental health myth

It is up to us as individuals to decide what matters to us, and when life is worthwhile. Image courtesy of Flickr.

What is important is realising that each patient is an individual, that treatments may need to change over time and that each step back can be regained. To suggest that there is ‘no escape’ poses only one limitation, on how well you understand human life.

5. ‘Mental health only matters when you are unwell.’

If you are reading this through twitter,  you may have already seen the ‘I have mental health’ campaign. And for those who haven’t, the grassroots movement included people from all walks of life holding up a sign with the statement.

But why?

The idea was to make normal what many do not consider reasonable: that mental health is a constant and ongoing entity, one that we all share and one we can all lose. This idea is uncomfortable to some. But why?

mental health myths all of us

All of us have mental health, and it can waver just like our bodies. Image courtesy of Flickr.

Perhaps because of the idea of ‘weakness’, some societal expectation, or fear, many do not like to entertain the idea that their mind is like the rest of their body. Something that can become ill, and requires maintenance to work well.  Just like our skin that can become itchy and red, things can change in an instant.

‘Mental health isn’t all of me, but it’s a massive part of my journey and a massive part of my whole being.’ – Adwoa Aboah

It seems that many only realise the fragility of our minds when something breaks. But unlike a precious vase, we rarely handle our minds with care. We expect them to be indestructible, when in fact all of us have our limits.

Since 75% of mental health problems begin before the age of eighteen,  it is clear just how beneficial teaching people how to take care of their mental health can be.

When we consider the theories around mental health disorders, we can see that many explain problems as the result of misbalance. Either too much work, too little sleep, a significant life event, a loss of purpose or one of another million things. It can take just one extra thing to tip the scales.

myth mental heath care

Mental health can be fragile, so it must be valued and taken care of. Image courtesy of Flickr.

In addition, when we consider treatment, the same can be said. Whether it be medication or therapy, a change is made to tip the scales back to equal. Mental health is an ongoing and organic process, the sum of our experiences and way of thinking.

It deserves as much kindness as our greatest treasure. And with that, it may be of huge societal benefit for all of us to embrace our own mental health, learn how to manage it and ensure that this is done from an early age.

6. You can ‘just snap out of it.’

I am sure many of you reading this will have heard a statement just like this, and for many, it will be very frustrating. There seems to be a belief that you can just ‘buck up’ and ‘snap out’ of mental health issue.

‘The idea that you can ‘positivity your way out of it’ is ludicrous. Its strange to believe that those unwell are just ‘being silly’, there is a real issue happening. Why do we collectively believe that such issues can dismissed so easily?’ – Ralf Little.

Almost as if its something flippant, volitional and subject to change at your whim.

From what we know about mental health conditions, this is not true, and often problems like depression can be pervasive, and take some time to sort out. This is also true for anxiety and a wealth of other issues.

clock mental health

Mental health issues may not be solved quickly. They can develop over a long time, so treating them may take a while. Image courtesy of Flickr.

The very complexity and individual nature of these conditions dictates that the right amount of time be taken.

The primary misconception lies in the general understanding of the problem, and that comes from familiarity. But if you have never had a disease, you simply don’t know as much about it as someone who does. That is forgivable, I wouldn’t personally understand how it is to live with heart disease.

However, there is information out there, it is just a process of making it available. I feel rather than ensuring everyone experiences a mental health issue first hand (although 1 in 4 do,) we can explain the problem instead. Most people are incredibly empathetic once talked to, it is the silence between conversations that breeds misunderstanding.

“I’m here to tell you that if you get broken, it’s possible to put yourself back together. I’m here to tell you that if you get lost, it’s possible that a light will come, dancing, on the horizon, to lead you home.”  – Nick Lake

According to Health Communities, depression itself can take weeks to truly manifest and if untreated can last up to 18 months on average –  and with treatment, can still take a number of weeks or more to even out.

therapy time treatment

Therapy can take a number of weeks to months. But the time is important. Image courtesy of Flickr.

When it comes to anxiety, those with generalised anxiety disorder (GAD,) the treatment process can take up a number of months before you see results. After that, continued treatment may be necessary. These are just two examples, but the same is true across the spectrum.

So, if we can help others to understand that mental health issues are not a quick fix, we can change their expectations. I feel that this would help both those with a mental health issue and without.

7. ‘Everyone will think I am crazy!’

 ‘People with mental health conditions are worried that others will judge and be afraid of them just because they are ‘different.’ Awareness needs to be brought forward that people with diagnosed conditions should never be ashamed of who they are. And just because someone is different doesn’t mean that they are dangerous in the form of being ‘crazy’. Never judge a book by its cover. – Paul Manners, Recording Artist and Influencer.

There is a lot of confusion around ‘psychosis’. But what is psychosis? According to the National Health Service (NHS);

Psychosis is a mental health problem that causes people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions.

Put simply, and it isn’t quite as simple, psychosis is a loss of touch with reality manifest in either some hallucination (seeing, hearing or otherwise sensing something that others cannot,) and/or delusion (believing in something that is in conflict with reality.)

media misconception drama

The fear of being seen as ‘crazy’ is one based in hyperbole and insensitive media portrayals of mental health issues. Image courtesy of Flickr.

Psychosis can occur alongside numerous psychological issues when they become severe, including depression and schizophrenia. It can also be caused by medications, other organic illnesses such as dementia, and can relent when treated. Insanity is not necessarily permanent and resolves when the cause is dealt with. In each case it is important to not that a trigger can precipitate an episode, or that something can come on gradually. 

So, now we know what ‘actual medical insanity’ is, we can remind ourselves that the symptoms of a depression or anxiety disorder (amongst others,) do not mean that you are ‘crazy’. The fear is very much in the mind, but that is understandable.

“Perfect sanity is a myth propagated by straitjacket salesmen. – Rebecca McKinsey

Given that society is so demanding, and that mental health issues are so emotionally depicted in media, people often associated mental health problems with psychotic symptoms. However, this is only relevant in the small fraction of people with psychosis. 0.7 % of those over 16 years old in 2016. And, unless you work in a psychiatric facility, your chances of meeting a psychotic person are vanishingly low. The issue lies with expectation, not reality.

fear crazy myth

Most people who are mentally unwell would not stand out from a crowd. So you shouldn’t worry about it. Image courtesy of Flickr.

So, when you compare this 0.7% percent with the number of those with active mental health problems (25% approximately,) you can see how rare actual ‘craziness’ is. It’s up to us to convince the public that the 25% are not the 0.7%.

If you perceive crazy as ‘abnormal’, i.e to exhibit the symptoms of a mental health issue, then it is worth reminding yourself that we all experience mental health symptoms. It is the duration and strength that differs, and how they affect our lives.

By realising that, the idea of others judging you can go away rather quickly, all it takes is a conversation to correct a misunderstanding.

8. It’s ‘all made up’

‘Nobody thinks that the pharmaceutical industry is completely above board. But problems with big pharma do not equal that everyone is lying. The idea that psychiatric diagnoses are made up is incredibly dangerous.’ Ralf Little.

One of the more insidious claims made is that ‘mental health’ conditions are not real, and worse still, they have been invented by ‘Big Pharma‘ or ‘government agencies’ to control people and make money.

Having already dealt with the logical fallacies inherent in conspiracy theories in my work on climate change, we can surmise that conspiracy relies on misconceptions and fiction to be believed. Where science relies on evidence, conspiracy relies on imagination.

conspiracy big pharma fake

Conspiracy theories rely on fantasy and the ignorance of evidence to persist. Image courtesy of Flickr.

Instead of accepting any evidence to the contrary, a conspiracy theorist will say that ‘it’s all part of the conspiracy.’ There are simply some people that are harder to convince. But when asked to provide evidence of their conspiracy, it often falls apart. As journalist and author Christopher Hitchens once said;

What can be asserted without evidence can be dismissed without evidence.
To truly understand why people purvey this myth, we need to consider motivations. Some may have had bad experiences with the pharmaceutical industry (and rightly so, it needs improvement!), and others may wish to manipulate the unwell to offer them some ‘alternative’ treatment for money.

Others may point to the apparent difference between psychiatric diseases and more ‘common physical ones.’ They claim a paucity of verifiable evidence for these diseases, and when comparing them to the more easily believed metrics of physical disease, that the proof simply isn’t there.

This is what we call an argument from incredulity, the idea that the complexity of an explanation undermines its truth. And within psychiatry, there are physical changes in certain conditions we can demonstrate objectively, but diagnosis is a complex process looking at behaviours over time.

diagnosis psychiatry

A psychiatric diagnosis is made on a patients behaviours, as well as other factors. Image courtesy of Flickr.

But those changes are real, and to suggest that things are being made up is quite a leap. Whilst we hazard to claim that Einstein’s equations are untrue,  most of us won’t understand them. So why the double standard?

Personally, I suggest that when it comes to psychiatry there is a huge personal and societal stake involved. When emotions are riding high, people are more likely to make snap judgments, and when it comes to identifying with an idea, or joining a group, the idea becomes a sense of identity.

Being part of a movement fulfils basic psychological needs.

group identification myth

Being part of a group, or one believing in an idea, is a powerful and comforting thing. Image courtesy of Flickr.

For many, their belief in a conspiracy becomes part of who they are – they may think they are ‘in the right’ and ‘helping’, so don’t judge them too harshly. But there are those who knowingly manipulate, and they are a different story.

So in the end it comes down to which is most plausible;

  1. Psychiatric conditions are complex and individual problems require expertise to diagnose and treat. There are replicable behavioural and physical changes that can be used to aid this process. There will always be some financial gain to those producing medications, but that is a separate issue to the truth of the disease.
  2. Psychiatric issues are made up, the evidence is ‘false’ and it’s all done to ‘make money’ or ‘control people.’

I think when you view the two side by side, one looks rather less believable.

9.  Mental health issues are ‘simply biological problems’

‘There are reams of papers and journals dedicated to the idea that things like upbringing and trauma can have a remarkable effect on health. To say its just ‘chemicals whizzing around in your brain’ is just ludicrous. Demands on life are often unworkable, and this can lead to problems. It is important to realise that environment and behaviour factor heavily in mental health disease.’ – Mike Stuchbery, Writer and Broadcaster.

From what many understand about disease, this myth is an understandable one. We are brought up to only recognise diseases in terms of physical problems (a sneeze, runny nose, a painful stomach,) and it makes sense that we would attribute biology to their causes too.

These ideas are developed early on in our lives, and are hardwired.

With a move within psychiatry to reconcile behaviour with neurology, one could be forgiven to treat the two as one – but it is a little more complicated than that.

biology mental health

Although it may be tempting to reduce mental health issues to purely biological problems, the fact’s say otherwise. Image courtesy of Flickr.

What we know from medicine places a larger influence on psychological and social factors than you would realise. For example, we know that patients with depression are more likely to suffer from heart disease, and that mental health problems find some cause in social factors.

Disease is the result of an interplay between biology, psychology and the environment. Some diseases are a tad more ‘biological’ in nature, and others seem to be purely ‘genetic’, but most fall between the categories, where one factor is just part of their makeup.

‘To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.’ – William Osler.

To dismiss mental health issues as ‘purely biological’ sells them short. Crucially, it means we are missing vital information in helping us treat them. If we can recognise the psychological and social determinants of disease, and understand their contribution, it gives us more avenues for treatment.

As such, psychiatrists and other doctors use a ‘Bio-psycho-social’ model of disease in their diagnoses.

freud mental health

Sigmund Freud was one of the first to popularise the idea of past experiences being part of mental health issues. Image courtesy of Flickr.

With depression for example, although there are genetic factors and talk of biological antecedents, we know that stress, sleep deprivation and trauma are highly predictive. And for anxiety, childhood experiences of fear and hopelessness play a role.

So when we treat psychiatric issues we combat each domain, where therapy and medication can be just as important as each other. To separate psychiatric diseases from biology is incorrect, just as saying that they are ‘only’ biological.

‘Doctors and patients need as much data as possible to make an informed decision about what treatment is best’ – Ben Goldacre.

The truth is somewhere inbetween, and with it, our best chance of making people’s lives better.

10. ‘Mental health issues are rare.’

The final myth is particularly pervasive, and you may have already been convinced otherwise of its assertions. Mental health problems are extremely common, it is the severity that differs.

global burden disease

Mental health problems are a global issue. And extremely common. Image courtesy of Flickr.

All in all, 1 in 4 people in the UK will suffer from a mental health issue at some point in their lives.

Depression is the leading cause of disability for women across most of the world and will be the lead the world in disease burden by 2030.

The very idea that these issues are rare can be traced to a misconception about what they are. Many consider mental health issues to be exemplified in rare cases of psychosis, or those dramatised in media. But mental health problems are not always as dramatic.

I don’t think it’s a healthy way of living to assume mental issues are a rarity, everyone will probably stumble across a mental issue at some point in there life, it’s how we deal with it that determines our outcome and if we’re prepared to accept it. ‘ – Charlie Parsons.

But they are worth knowing about. Considering just how common they are, and that they are becoming more common, we can build a community that wants to recognise why and do something about it.

learning mental health

By learning the truth of mental health problems, we can become wiser and more empathetic as a society. Image courtesy of Flickr.

By correcting the idea that ‘mental health’ issues convey only the extremes of behaviour, we miss the vast majority of people who suffer. We owe them the time to recognise not just how common mental health issues are, but how they affect each and every one of us.

There is no standard normal. Normal is subjective. There are seven billion versions of normal on this planet.” – Matt Haig.

One in four is a big number, so next time you are out shopping consider just how many around you are suffering in silence.

Let’s end the stigma.

For small creatures such as we the vastness is bearable only through love.”  – Carl Sagan

I hope that this work has explained why some of these myths exist, and what the real truths actually are. And I hope that by taking the time to explain them that we can correct some of the harsh inequalities experienced by those with mental health problems.

Crucially, we can see that whilst each myth can be debunked,  there is always some believable idea behind it. It is what happens next that builds a misconception into a commonly held belief.

stigma learning together

Learning is the first step in ending the stigma that drives us apart. Image courtesy of Flickr.

Stigma against mental health problems, like any stigma, is founded on misconception and fear. And like any stigma, it disappears as the truth of the matter becomes well known. We have seen it time and time again, but it takes work from the ground up.

When it becomes clear that the public will no longer tolerate the abuse of the mentally unwell, (and why should they?) the financial and political motivations will die along with the stigma itself.  People are generally good, so if we can respect each other and work together the sky is the limit.

‘Mental health stigma is killing a lot of people, especially men. This is not addressed in dialogue, men try to ‘power their way through.’ Mental illness is ‘not a challenge to be overcome’, it’s a whole load of added pressure. It’s an illness.’ – Mike Stuchbery.

I hope that in some way I have given you something  that you can discuss and share. Together we can end the stigma, so here is as good a place as any, So please help by sharing, and let me know your thoughts in the comments below.

In memory of R.O

If you wish to reproduce this article, in full or in part, please get in touch.

What’s next? Join our wonderful community!

The opinions above represent those of Dr Janaway alone and do not necessarily represent his affiliates. Any quotation or contribution made by a third party (signposted in text,) has been done under volition and without financial compensation. There is no direct financial gain to either the author or contributors from the publication of this work, it is all done for free in our own time to help others. All text has been discussed and reviewed with senior mental health professionals to ensure accuracy. There are no concerns of breaking patient anonymity or confidentiality.

Several twitter posts were originally going to be used, but due to the confusion noted of others in questioning the users intent these have been omitted out of courtesy. Apologies to those wishing to be featured, but your responses were incredibly valuable. And to those I was not able to get back in touch with, I appreciate your willingness to help and look forward to new opportunities to work together in the future. If you are concerned about your health please see your local healthcare provider. Featured image referenced above.

A special thanks to; Scott McGlyness, Paul MannersAndy West, Ralf Little, Charlie Parsons, Mike Stuchbery, Ayden Callaghan , Stephen Ritchie and Chloe Whichello and my twitter community for providing such great feedback. And not forgetting Ashleigh Howells for her patience in reading and editing, as well as much needed encouragement, as well as Dr David Denton for his keen insights.

Search Engine Data May Help Diagnose Depression Earlier

A new study published in JMIR Mental Health has revealed that searches relating to Depression and its treatment spike at different times of the day. The data shows that searches around depression peak between 11pm and 4am daily, showing a clear focus overnight. The reason for this isn’t immediately clear but may tell us more about the day to day lives of patients. With depression a growing problem, these insights may help us to recognize depression earlier. And, with that, to help people access treatment.

Depression and Diurnal Variation.

It is common knowledge that the symptoms of depression vary in severity over the day. The classical picture of waking up ‘sad’ and ‘feeling better’ later is one of just many. But little has been done to actually quantify this in real terms over a large population. The researchers reviewed search data of key terms around ‘depression’ to elucidate a pattern. They found four peaks between 11pm and 4am, and relative ‘troughs’ between 5am and 10pm. Essentially, people were trying to learn more about depression and take ‘online tests’ during the night.

depression data diurnal medicine

Depression is a common and difficult problem. Data may help earlier diagnosis and treatment. Flickr.

It’s hard to directly claim what this may mean without considering multiple factors. The first is the simple issue of time availability, with daily work commitments limiting free time to search. The second is that more people are likely to sit on computers overnight, increasing the likelihood of searching for anything.  However, the team’s statistical analysis shows a clear difference between searches at different times, suggesting something significant. What this may mean in actuality will require further study. But it could be very useful information indeed.

Why May People Search For Depression At Night?

Aside from the reasons discussed above, it may be that this pattern is well explained by what we already know. Depression is known to be associated with anxiety and sleep disturbance. We also know that with depression, in many cases people feel better later in the day. It is very possible, with a number of assumptions, that the combination of these two factors may explain the findings. If people feel more energized later in the day and overnight, and cannot sleep due to their symptoms, there would be peaks in activity. The data would seem to support this idea.

depression sleep diurnal data diagnosis

Depression is associated with sleep problems. Flickr.

However, further research is needed to compare these findings with the actual patients themselves. It would not be fair to assume without more supporting evidence. The data itself does not reveal whether those looking for ‘depression’ related information were actually suffering from depression, suspicious of being depressed, or simply interested in the condition. There is a lot of conjecture. But what the study does provide is strong evidence that people are more active in learning about depression at night.

Given what we know about depression, this may provide a new way of recognizing depression in the undiagnosed, and helping to monitor treatment success in patients.

A New Way Forward

Depression is a growing problem and early intervention is key in its treatment. This new data shines light on the daily lives of patients and the undiagnosed. It may be that recognizing the patterns tells us not only more about the nature of depression but could provide an early warning system for those at risk. But how this may work in practice is another question altogether. The first step may be interviews with those concerned, establishing the nature of their condition. Only then could a suggestion be made that ‘search engine’ data be instrumental in earlier diagnosis.

So what do you think? Could search engine data help doctors diagnose depression earlier? Are you concerned about privacy? Is there a happy medium between? Let us know in the comments.

What’s Next?

  • Learn more about Depression and why early diagnosis is best.
  • Follow Ben on Twitter so you never miss an article from drbenjanaway.com

The opinions expressed in this article are those of  Dr. Janaway alone and may not represent those of his affiliates. Featured image courtesy of Flickr. If you are concerned about your health please see your local healthcare provider. Sources available within main text via hyperlinks. If you find new information that contradicts this article, or feel that an error has been made, please do let me know via benjanaway@outlook.com. I will be happy to hear from you. 

 

 

Fed Up Of Feeling Sad? Learn The Trick To True Happiness. Stop Waiting, Start Doing.

“Happiness is different from pleasure. Happiness has something to do with struggling, enduring, and accomplishing.” – George Sheehan

Sadness is not just a human problem. It is a problem shared by animals, and likely present since soon after the dawn of life. What sets us aside from most animals, with notable exceptions, is our ability to question our purpose. Humans, according to Maslow’s Hierarchy, see self actualisation as the pinnacle of aspiration. Disregarding the basics of food, shelter, love and ego, it is making a change to the world that matters to us most.

A Loss Of Purpose

‘Working hard for something we don’t care about is called stress.; working hard for something we love is called passion.’ Simon Sinek, Author, Consultant and Motivational Speaker.

In a popular video, Simon Sinek explains that millennials find traditional jobs difficult as they feel that they are not making a change. And whilst this generation is blessed like no other, it is also the most sad. Information is made easy to find, health is at an all time high, and opportunities almost endless. And yet, within this machine of progress, the very cogs are rusting and breaking apart.

But as the world gets smaller, so do we. Instead of being the centre of our community, someone who seems to matter, we are just one of seven billion. We are saturated by news of the successes of others, taught to envy and idolise celebrities, and regard great thinkers with a theological awe. We are set against impossibly high standards, and it can seem fruitless to even try.

For a species that thrives on purpose, and achievement through it, this could not be more troubling.

Achievement Is Not Happiness

Some of the happiest people in the world go home smelling to
high heaven at the end of the day (Morgan Freeman, playing God in Bruce Almighty.)

It is a common myth that achievement buys happiness. When you look at PhD students (as Psychologist Jordan Peterson explains,) they become sad, or even depressed, when they finally hand in their work. When you finish reading a book most often the thrill of the story dies, the elation of conclusion concluded. So why is it that when we work for something, its achievement leaves us hollow?

The answer may be something spiritual, cultural, biological, all or none. Religion teaches us to live as God would like, to aspire to holiness through his attribution. Spirituality promises unity between self and the universe, achievement through the dissolution of the delusion of separateness. Culture dictates that we must have the right job, make money, marry or have children. Biology rewards achievement with chemicals, and does so over and over. Each asks, with  the caveat of some spiritual beliefs, that we attain a malleable goal that can be recorded.

And yet those of religious faith, spiritual leaders, great men and women and even animals at the top of their ecological niche will continue to want and to be sad. So there must be something else. Something you can’t hold, display or record.

Define who you are to find your purpose

You may not associate actor Matthew McConaughey with sage wisdom (a tragedy of media and preconceptions,) but in a 2017 speech to the University of Houston, he explains that the start of self actualisation is the deciding what you are not. He argues passionately that by actively addressing who you aren’t, you are only left with who you are. He said;

“The first step that leads to our identity in life is usually not “I know who I am,” but rather “I know who I am not.” 

Finding identity is instrumental to happiness, as  the true and honest realisation of who you are can open your mind to what you want. What you dream, and the purpose that you have. And by purpose I do not mean achievement, but the process of following that process with all you are and what you have to give. But first we can ask, what can you forget?

What you are is not a job. It is not a document, or a bank account. It is not your Facebook, your diet or your friends. These are just measurements we give ourselves to place value on our existence. But we exist in mind, and indeed purpose, regardless of these things. To live in the knowledge that you are following your purpose, that honest dream, stripped of all accolade, is the true process of self actualisation.

It does not require applause or award, the pleasure is in the doing.

Living with Purpose is the key to happiness.

We know that many creatures can feel sadness, and that achievement of a goal will not always bring happiness. We know that although our opportunities are unparalleled  compared to any other time in history, depression is at its highest level. We know that who you are remains when all labels are removed, and that lesson is a Universal truth. So how can you find happiness by simply living?

The answer is to live true to your purpose. Find joy in the doing, regardless of the result. Reading a book is more pleasurable than finishing it, climbing a mountain more valuable than planting the flag, playing an instrument more challenging that listening back. Happiness is found when the future is forgotten, and the present is found joyful in its encapsulation of activity.

So instead of worrying about being great, remembered, rich or powerful, enjoy living toward your purpose without needing recognition. Whatever that may be.

What’s Next?

  • Follow Ben on Twitter so you never miss an article
  • Watch Matthew McConaughey’s speech to Houston University
  • What makes you happy? Tell me in the comments or on Twitter.

The opinions expressed in this article are those of Dr Janaway alone and may not represent those of his affiliates. If you suffer from depression, or suspect that you may, please seek medical advice.  Image courtesy of Aainlm

 

 

 

 

Why Do We Worry So Much? Turns Out, Its Nature Falling Behind. Inside; The Science Of Anxiety.

There are times when I feel that the world is exploding around me. My heart is racing, hands shaking and breath hard to catch. Often there is no clear reason for these symptoms, or the panic that rushes through my brain. Other times I find myself unable to sleep, and as I watch the hours pass in the twilight hours I wonder why I feel like this. But the answer is something common to us all, Anxiety.

“To venture causes anxiety, but not to venture is to lose one’s self…. And to venture in the highest is precisely to be conscious of one’s self.” Soren Kierkegaard

So what is Anxiety, what does it feel like and how can we live with it? I teamed up with Metro journalist and Mental Health Advocate Hattie Gladwell to get to the bottom of it.

What is Anxiety?

Anxiety is a term used to describe the symptoms of a number of ”Mental Health” conditions ranging from ‘Generalised Anxiety Disorder‘ through to specific phobias. These can include agoraphobia (fear of being out of a safe place.) It can also include such things as ‘Panic Attacks’ and be linked to conditions such as Obsessive Compulsive Disorder.

Really it represents a whole spectrum of conditions where the world can be uncomfortable to the point of disease. The official definition given by the ICD-10 (a national registry of disease,) reads like this;

‘A category of psychiatric disorders which are characterised by anxious feelings or fear often accompanied by physical conditions associated with anxiety’

A rather less than elucidating definition. But what does Anxiety actually feel like?

What does Anxiety feel like?

“I am exhausted from trying to be stronger than I feel.” -Unknown (source: paintedteacup.com)

Dr Google will tell  you many symptoms, but it seems that the experience of anxiety is very individual. At the centre of it is worry, which can be accompanied by physical symptoms. These symptoms, if clustered together, can present a ‘syndrome’, which can lead to a specific diagnosis. This is all rather complex, and without seeing a doctor, self-diagnosis is dangerous. But we aren’t here to talk about specific types, but what it can feel like to live with it.

‘I have health anxiety, its all or nothing. I will get a surge in adrenaline, hot and cold flushes, shaking.  It happens more when I’m isolated and have more time to think about it. Most days I am panicking that my whole life will be put at hold.’

For me the experience is not entirely different. As a patient of depression, I consider anxiety (a well recognised association of depression,) as an uneasy partner. For me the problems started young, fear of making a fool of myself in front of friends, or fear of being disliked. Over time this changed, and my concerns became focussed on relative fame, (if you could call my experience that,) of being judged by others for my words and opinions.

I promise you nothing is as chaotic as it seems. Nothing is worth diminishing your health. Nothing is worth poisoning yourself into stress, anxiety, and fear’  – Steve Maraboli

This may seem silly to some, but I have had panic attacks after tweeting. I have stayed up for hours refreshing a timeline, worrying what others may say. These feelings have become more general, to a point where a phone call from an unrecognised number begins a spiral. Its uncomfortable, draining and often completely unnecessary, For me anxiety is a terrible affliction that seems bizarre later.

Living with Anxiety

If you suffer from unhelpful feelings of anxiety or catastrophic thinking, your Chimp is in control. – Dr Steve Peters, Psychiatrist 

Anxiety, for many, is a lifelong problem. Depression has its ‘Black Dog’ (mine is named, and I have grown kind to it,) but Anxiety may need a different animal. You can pick yours, but mine can be a Vulture. Treatment is difficult, but there is great success in Cognitive Behavioural Therapy  and medication. These treatments recognise the problem as a system of thought, action, reaction and behaviour.

By identifying your own, and making adaptions, you can begin to recognise when you are being taken over and do something about it. In his best selling book ‘The Chimp Paradox‘, Psychiatrist Steve Peters describes these feelings as being hijacked by ‘The Chimp’, an analogy for the emotional centre of the brain.  By recognising this, and through several techniques, Peters believes that you can take back control.

It is a great book, so give it a read.

Interestingly, these ideas are not new. In fact, Neuroscientist Sam Harris has discussed the overlap between neurocircuitry, religion and spirituality at length in his book ‘Waking Up.’ It is a big subject, but it may be that ancient religions, such as Buddhism, have already figured out how to deal with the pressures of the world by reconsidering their significance.

‘I am undergoing CBT, which I am finding very helpful. I use apps, but they aren’t a cure, but can be short term relief. They help me calm down. I tell myself that although things are horrible right now, it will pass’ – Hattie 

So if you are like me, there is hope.

If you enjoyed this article and would like to discuss it, or pitch ideas for follow ups, follow me on twitter or email me at benjanaway@outlook.com. I am happy for this work to be reposted, just let me know if you do!

What’s Next?

The views above are those of Dr Janaway alone and do not necessarily represent those of his affiliates. They should not be taken as medical advice. If you are concerned about your health please access your local health provider. Please feel free to follow Dr Janaway on twitter. Image courtesy of Pixabay.