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Weekly news round-up

27/3/2015

 
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Crash
Despite the claims of various tabloid newspapers and hyperventilated talking heads on TV, deliberately killing 150 people by flying an aeroplane into the side of a mountain is not a symptom of depression. The Germanwings plane crash this week is truly horrifying, utterly tragic and devastating for the families of the victims. We will never know why, when the pilot stepped out of the cockpit for a bathroom break on Tuesday morning, the first officer left in charge of the plane, 27-year-old Andreas Lubitz, locked the door, began a descent, and took aim directly at the French Alps. No-one can disagree with all the subsequent calls for improved psychological testing, screening and monitoring of pilots, but blaming depression seems absurdly simplistic, ill-conceived and unhelpful. We will never know Lubitz’s mental state in those ghastly, desperate last few minutes. Clearly he was a deeply troubled soul.

Claims about Andreas Lubitz's mental health only serve to stigmatise depression
From The Guardian:
Whenever a major disaster occurs, it’s a perfectly understandable human reaction that we need to find a reason behind it. However, trying to make sense of a terrible situation is one thing, and falling over ourselves to jump to ridiculous conclusions is quite another. And quite frankly, the UK press should be downright ashamed of themselves today. The way in which they’ve covered the news that Germanwings pilot Andreas Lubitz may have had depression is abhorrent.
“Madman in cockpit” was the Sun’s effort. “Why on Earth was he allowed to fly?” asked the Daily Mail. In case you’re wondering what the link that’s trying to be made is, the Daily Mirror is here to help: “Killer pilot suffered from depression”. It’s difficult to know where to start with such breathless ignorance about mental health issues, but I’ll give it a go anyway. Again.

• Mind's response to today's front pages on the Germanwings plane crash
• Co-Pilot in Germanwings crash hid mental illness from employer, authorities say (New York Times‎)

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U.K. news
Deputy Prime Minister launches mental health in sport initiative
From Gov.UK:
Sports bodies are signing up to the Mental Health Charter for Sport and Recreation to help remove stigma and prejudice around mental health.
A network of major sporting bodies will stand side by side with the Deputy Prime Minister today to commit to blowing the whistle on mental health discrimination in sport.
For the first time ever, a host of sport organisations – from the Rugby Football Union to the England and Wales Cricket Board and the Football Association – will sign a charter committing to removing the stigma and prejudice around mental health from the pitch to the playground.
The Mental Health Charter for Sport and Recreation comes from a shared desire among national governing bodies of sport and players associations to raise awareness of, and tackle issues around, mental health.
Nick Clegg has hailed this as a “momentous day” for the nation’s mental health, where the power of sport will be harnessed to bring mental health out of the shadows and help put an end to people suffering in silence.
With exercise proven to be as effective as antidepressants for those with mild clinical depression, the charter will also encourage more people to take up sport to help with their mental and physical health.
The move follows a report from leading mental health charity MIND, in October last year, which called for a national network to tackle mental health in sport following an increasing number of testimonies from high profile sports people about their own mental health struggles.

Mental health service budgets 'cut by 8%'
From BBC News:
Mental health trusts in England have seen their budgets fall by more than 8% in real terms over the course of this parliament, figures suggest.
The reduction, worth almost £600m, was revealed through research by BBC News and the online journal Community Care.
At the same time, referrals to community mental health teams, which help people avoid being admitted to hospital, have risen nearly 20%.
Care minister Norman Lamb said budgets were "not the full picture".
... Using Freedom of Information requests, annual reports and other extensive research, BBC News and Community Care compared the budgets of mental health trusts in England in 2010-11 with this year, 2014-15.
Out of 56 trusts contacted, 43 responded - but not all provided data on all areas.
Taking changes to trust structures and contracts into account, analysis suggests trusts have suffered a real terms cut of 8.25% - the equivalent of stripping £598m from their budgets.

Mental health patient detained in a police cell for almost TWO DAYS
From the Daily Mail:
A mental health patient was held in a police cell for almost two days because there were no beds available at nearby hospitals, it has emerged.
The patient is one of almost 200 people in Wiltshire held by the county's police force in the last two years because there was no suitable healthcare provision.
Meanwhile across the UK last year, 7,000 people with mental health problems ended up being held in police cells.
Of those, 236 children and young people were detained alongside criminals.
Mental health experts have branded the practice 'shameful', adding it highlights the fact there are not enough suitable crisis beds across the country.

Children's mental-health funding boost from government
From BBC News:
Groups offering mental-health support to children and young people are to receive a multi-million-pound funding boost from April, the government says.
The organisations will gain some £4.8m in top-up grants in 2015-16.
This is the first time they have been eligible for a share of the government's £25m voluntary and community sector grants.
Young Minds chief executive Sarah Brennan said the windfall would help it provide "a vital lifeline" to families.
The charity had been awarded £300,000 to support its helpline for parents "struggling to support their children's mental health", Ms Brennan said.
Young Minds says demand for the helpline, which depends on donations, is the highest it has ever been.

'Male victims of sexual abuse are treated as secondary'
From Telegraph.co.uk:
It was supposed to be a sign that sexual violence against men was being taken seriously.
But just over a year after the Government announced a male rape support fund - with £500,000 set aside exclusively to provide counselling for men who have been affected by sexual abuse – support groups are being forced to cut back on basic services.
Though the number of men who report having suffered serious sexual abuse in London has doubled over the last five years, the only organisation which offers dedicated support for male victims in the capital is now having to turn away new clients.
“We’ve had to close our group counselling sessions, which we were running weekly,” says Michael May, a director at London-based Survivors UK. “And we can’t take on new clients because we can’t say how long we will be here for them.
“These are vulnerable people so you can’t take them on and then cut off the support.”

Psychotherapy practice uses animal magic
From Western Morning News:
Even as a little girl, Louise Rolfe recognised the calming benefits and happiness which animals can bring.
From playing with her guinea pigs in the back garden to riding horses at her local Pony Club, she understood how interacting with pets can bring immense pleasure and unlock deep and powerful emotions.
The therapeutic attributes of friendly, unquestioning creatures is something she later took into her work as a counsellor and psychotherapist, helping people to deal with a wide range of problems from bereavement and depression to anxiety and self-esteem issues.
This recognition of the value which animals bring to humans, coupled with a desire help a wide range of people and creatures in need of a new home, is behind her drive to launch a new mental health wellbeing centre in the heart of Cornwall.
Louise and her husband Steve are the driving forces behind Rolfington Rescue, a non-profit community interest company which will combine her passions of working therapeutically with animals and a love of nature and ecology. Based on a five-acre site on the outskirts of Bodmin, the centre will provide psychological therapies, basic work-skills workshops, community allotments and educational training. It will also offer holistic therapies, student and volunteer placements, tai chi and meditation classes for the local community in a 20ft eco-friendly yurt.
As well as hosting nature retreats and classes available to people from across the UK, it will also care for rescue animals.
It is an ambitious project, which was conceived by Louise and her husband just 12 months ago. But even more impressive is that after turning to crowdfunding to help fund the centre, they are within touching distance or reaching the £12,000 target by their deadline of April 2.

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Blur: “We Went For Counselling”
From MOJO:
RELATIONS BETWEEN THE members of Blur were still in such a delicate state when they reunited in 2009 that they were compelled to seek help from a professional counsellor. Speaking in the new issue of MOJO, available on UK news stands from Tuesday March 31, guitarist Graham Coxon reveals that the problems stemmed from his dismissal from the group in 2002 in confused circumstances.
“Although we shoved it all aside when we got back together, I realised that passions were still slightly high about it all,” he says. “Y’know, in those years since [he left in 2002], I probably said a few stupid things in the press – because the circumstances of why weren’t together as a four-piece were quite unclear. We’d met a couple of times – one was some mediation thing where we had to go over stuff that was difficult… We were all raw and hurt by it, for quite a while.”

Bogus psychology doctor exposed
From the Daily Mail:
A fake psychologist was caught running a bogus counselling course after setting her students a series of increasingly bizarre tasks including climbing a tree and riding a bike in the rain.
Jacqueline Crane, 52, of of St Austell, Cornwall, pretended to be a professor of psychology and claimed she was qualified to train people to become counsellors.
She set her students bizarre tasks including scaling trees, cycling in bad weather and taking candlelit baths and would then ask for feedback on how the wacky practices made the students feel, a court was told.
But her students - who spent thousands of pounds on her courses - became suspicious because of her increasingly strange ideas and bad spelling.

Danny Dyer secret counselling ordeal: EastEnders star's mum reveals his childhood torment
From mirror.co.uk:
He has played more hard men than most East Ender's have had jellied eels - but actor Danny Dyer is not without his sensitive side - as his MUM reveals.
The cockney actor underwent counselling as a child after his dad's secret double life was fiercely exposed, leaving him with a single mum and another new family.
Mum Christina, 59, revealed son Danny, now 37, became withdrawn after discovering his painter and decorator dad Tony had a secret mistress.
His East End mum described the painful moment she discovered Antony had a secret mistress on the other side of London in November 1986.
She told The Sun on Sunday: “A posh woman called and said, ‘I think it’s about time you knew your husband has been having an affair for a year with a woman called Andrea’.

Coronation Street's Sue Cleaver training to be a psychotherapist
From Digital Spy UK:
Coronation Street star Sue Cleaver has revealed that she is training to be a psychotherapist.
The actress, who plays Eileen Grimshaw in the ITV soap, revealed that she has psychotherapy once a week and is currently doing a course which will leave her fully qualified to give the therapy herself.
Speaking to Soaplife, she said: "I have it constantly - once a week. I've learned so much about myself by doing it, and it really has changed my life.
"It has given me complete understanding of certain behaviour - why we react in the way we do. It can't help but affect every relationship in your life. I get excited about having therapy each week. It's a bit like going to the gym, but for your mind.
"I've always been fascinated by the good it can do. Personally, I think it should be mandatory. It's a great confidence builder. I am qualified to take clients and have another 18 months to go before I can finish my four-year course in Analysis Psychotherapy at the Manchester Institute for Psychotherapy. It's hard work fitting it in with Corrie, but I love it."

Trauma for One Direction fans
From ITV News:
Counselling service ChildLine have warned that young people may be feeling "very distressed" after hearing the news that Zayn Malik has left boyband One Direction, and urged adults not to "undermine" these feelings.
Sue Minto, head of ChildLine, said: "There are young people who are going to feel seriously distressed at the news, and people are going to have to get their head around the fact that for some this will be very distressing and not to undermine it, even if they don't quite understand it."
She added: "Lots of people have pop stars or celebrities or actors who they hold in high esteem, and there is a lot of sadness and impact for people when something happens to any of them."

U.S.A. news
Measuring empathy
A report from USC News on an initiative to “measure” empathy and thus turn the art of creative, in-the-moment psychotherapy into a numerical science, such that in the future therapists (or robots) can robotically provide highly-rated expressions of empathy at computer-determined optimal moments. Isn’t this the very antithesis of genuine, authentic, human presence and connection which lie at the heart of true empathy? This is empathy for engineers:
According to the American Journal of Psychiatry, about 10 million Americans undergo psychotherapy treatment each year.
For USC Viterbi School of Engineering Professor Shrikanth Narayanan, this prompts the question, “How do we know how well psychotherapy works? What works and what doesn’t?”
Narayanan is part of an interdisciplinary team developing a new way to evaluate psychotherapy and therapists, relying on the science of signal processing to measure empathic processes. This includes automatically detecting “empathetic opportunities,” as well as characterizing “expressions of empathy.” Eventually, this system could lead to better matches — and better outcomes — between patients and therapists.
... Narayanan’s current research on empathy only evaluates vocal behavior—speech, language and non-verbal cues such as laughter. Computers analyze audio recordings of therapist-patient interactions — the system may eventually analyze visual behavior, such as gestures and facial expressions.
“In our experiment, we have accomplished a prototype system that is able to assess therapist empathy from audio recordings and give quantitative scores of empathy in a human, interpretable way,” said Bo Xiao, a Ph.D. candidate in electrical engineering who has worked on the project since 2011.
Although the experiment is in the early stage, a recent test demonstrated that the system is over 80 percent accurate in its rating ability, Xiao said. The system analyzes audio recordings from therapist sessions, identifying empathetic opportunities hidden within conversations.
... “Empathetic opportunities” is not a new term within the medical field. Physicians often struggle to identify and respond to empathetic opportunities. A 2008 study suggested that, on average, general physicians miss 90 percent of empathetic opportunities, according to The New York Times.

Popular club drug assists therapy for the terminally ill
From Engadget:
MDMA is widely used both on and off festival grounds. But the drug is quietly making a comeback as a therapeutic aid. Last week, the DEA approved a clinical trial that will use a combination of the psychedelic drug and psychotherapy to treat anxiety associated with terminal illnesses. Multidisciplinary Association for Psychedelic Studies (MAPS) has initiated the study as part of their on-going efforts to validate the effectiveness of MDMA in a scientific setting. This isn't the first time it's been used to assist psychotherapy. But if the study is successful, it will introduce a new use for the drug.
The California-based association has been studying the effects of psychedelics on patients with PTSD since 2001. They've been approved for all studies before, but the latest nod seems indicative of a shift in the DEA's stand on the dangers of the drug.
Pure MDMA, manufactured legally in a lab for research, is different from the adulterated concoctions (Molly, ecstasy, etc.) available on the streets. What makes MDMA one of the most sought-after drugs is that it brings on a bunch of ecstatic feelings –– stimulated senses, empathy and a strong urge to hug the nearest neon-clad raver. In effect, MDMA lowers anxiety, which explains its use in the upcoming trial. But in some cases, the come down from the drug can include anxiety and depression, which seems counterintuitive. According to Brad Burge, director of communications at MAPS, that anxiety is temporary. It fades as MDMA wears off.

World news
Tormented refugees receive counseling in Chad
From AllAfrica.com:
THOUSANDS of refugees that have fled the Boko Haram crisis to Chad will receive psychological support and mental healthcare amid the strain and deplorable living conditions in the neighbouring country.
Stéphanie Giandonato, Medecins Sans Frontiers'/Doctors Without Borders' (MSF's) Head of Mission in Chad, said such support would be a key component of MSF's medical activities in response to this situation.
In the coming days, MSF psychologists will begin providing mental health care through individual and group sessions in Dar as Salam refugee camp, in Bagasola and Ngouboua.
MSF will also provide psychological support and medical assistance to victims of sexual violence.
"People are extremely fearful after experiencing the trauma of the attacks first in Nigeria and then in Chad," said Giandonato.
"Many have lost family members, they are anxious, and they do not know what the future holds for them."

Ghana: mainstreaming mental health
From GhanaWeb:
Metropolitan, Municipal and District Assemblies (MMDAs) have been urged to mainstream Mental Health Issues into Medium Term Development Plans to help address mental health challenges.
Members of the Upper East Regional Alliance for Mental Health and Development, who made the call during its first quarterly meeting held in Bolgatanga on Friday, stressed that, per the Mental Health Act, the MMDAs were expected to play a key role in providing resources to help address issues relating to mental health.
Whilst commending the efforts of some few MMDAs for mainstreaming mental issues into their Medium Term Development Plan, they stressed the need for them to ensure effective implementation to achieve good results.
The Alliance also lamented that mental health and epilepsy patients have not been benefiting from the Disability Common Fund, and that, they were supposed to benefit from it to enable them to address their needs including the purchasing of drugs and to undertake advocacy programmes.
Among some of the success chalked by the Alliance, include the holding of the World Mental Health Day, sensitization programmes on radio and an engagement with the Media, among others.

India: prisoners to enjoy 'magical' counselling
From Times of India:
Undergoing counselling sessions is nothing new to prison inmates. But on Tuesday, the inmates of Poojapura Central Jail will get to undergo an off beat session in the form of illusions and magic. The innovative programme has been designed by popular magician Gopinath Muthukad and psychologist L R Madhoojan. The act has been titled Psycho Magic Transformation.
Home minister Ramesh Chennithala will inaugurate the programme at 3pm on Tuesday at Poojapura Central Jail.
According to Muthukad, the programme aims to transform prison inmates into better citizens by reaching out to them and understanding their problems through magic and psychology. While magic helps to open up a doorway into prisoners' minds, psychology helps in understanding their problems. Once this is achieved, it is easy to give the prisoners directions and tips for leading a better life.

Singapore: 24-hour help via webchat for problem gamblers
From AsiaOne:
An online counselling service for gamblers is now available round the clock after a three-month test run ended last year.
During the trial from September to December, 360 chat logs were registered.
Most of these users were deemed to require face-to-face counselling thereafter, said a spokesman for the National Council on Problem Gambling (NCPG).
Set up by the NCPG and the National Addictions Management Service, the webchat allows problem gamblers to chat online with paracounsellors who offer a listening ear but are not certified to provide professional counselling.
"The webchat caters to those who feel more comfortable seeking help online for problem gambling issues," said the spokesman.
He declined to comment on the profile of the users or the nature of the calls, noting that the helpline was fairly new.
Though it is not known how many of the users who needed face-to-face counselling eventually sought it, counsellors say the webchat is a good platform to serve as their first entry point in getting support.

China: mental health issues triggering insomnia in youths
From Xinhua:
Saturday is World Sleep Day, and this year’s theme in China is on mental health. A recent report from the Chinese Sleep Research Society has revealed that nearly 40 percent of adults in the country suffer from insomnia. Our reporter Hu Chao visited a local hospital and found out that more and more young people are now having sleeping problems, and they're frequently caused by mental-health issues.
Sixteen-year-old Ren Jian has been suffering from insomnia for a few months. Since he went to a boarding high-school, he’s been having difficulty falling asleep and often wakes too early in the morning. It makes him tired during the day and even causes headaches.
"Maybe I haven’t gotten used to living in the dorm. I fall asleep quite late every night. And I feel very tired in the morning," said Ren Jian, student from Taiyuan, Shanxi Province.
According to the hospital, Ren Jian is among many young people who are having sleeping problems. And mental health issues are a major cause.
"As the development of society accelerates, an increasing number of young people are suffering from insomnia. Many students say they feel academic and employment pressure, while many young adults say they feel stressed at work and in relationships," said Zheng Rong, chief physician of Shanxi Provincial People's Hospital.
Doctor Zeng says about two thirds of her patients with insomnia suffer from depression and anxiety. Psychologist Wang Jie also has similar patients.
"In fact, most of my patients suffering from depression, anxiety or emotional problems often have sleeping problems at the same time," said Wang Jie, psychologist, Shanxi Psychology Society.

On sex and sexuality: Are you “normal"?

24/3/2015

 
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Writing about music is like dancing about architecture. This famous dictum, variously attributed to Laurie Anderson, Frank Zappa, Elvis Costello and Thelonius Monk, to name a few, could also be applied to museum exhibits about sex: They are destined to dissatisfy, to miss the point, to prove hopelessly inadequate compared to the experience of the thing itself. Nevertheless, undeterred, notebook in hand, world of therapy went to investigate the Wellcome Collection’s Institute of Sexology exhibition, where you are invited to “undress your mind.”

There’s an area devoted to Sigmund Freud, as you might expect. The father of psychoanalysis did more than anyone to bring sex out into the open as, in his view, not bringing it out into the open was a problem—the major cause of neurosis. You can read some of his philosophies, listen to a marvellous self-righteous recording of him from a 1938 BBC interview—it sounds like a Monty Python parody—and see a small sample from his vast collection of cultural artifacts. His favourite was a small bronze of Athena from the 1st or 2nd century which has lost her spear—a perfect symbol for Freud of penis envy.

Freud was also fond of double-faced figures. There’s a 3rd century BC Etruscan bronze with one face of a Satyr and another of a Maenad, which for Freud illustrated the binary nature of human existence. We are governed by antagonistic forces, polarities that pull us in opposite directions. We are made from a male and a female, and both parts live within us (according to Freud humans are inherently bisexual). We love and hate; live and die (Freud spoke of Eros and Thanatos—our libido duels with our “death drive”). We want intimacy, we want to be alone—come here, go away (another exhibit from Freud’s collection, another metaphor, is a porcupine—Freud noted that they huddle with others for warmth but then they poke each other, get hurt and separate). Maybe you have your own particular polarities, too—perhaps you are a rebellious conformist, or a privileged outsider (or deprived insider). A self-sacrificing narcissist (or a greedy do-gooder). Highly emotional yet numb. A cheerful depressive. A creative accountant. Spiritual atheist. Champagne socialist. Fully alive, but deeply diseased. And so on. Life is an oxymoron; a double bind.

And so it is with sex, too. Personally, culturally, historically, there are powerful opposing forces of liberation and repression at play. Stop! No, don’t stop! Both are on display at the museum. One the one hand there are early copies of the Kama Sutra (written between the year 200 and 400), ancient phallic amulets, saucy postcards and other erotica. On the other there are old papers detailing the moral dangers of sex, female desire resulting in “hysteria” for instance, or masturbation causing a range of disorders from nervousness to paralysis. In Berlin on May 6, 1933, three months after Hitler came to power, the forces of oppression broke into the library of sexologist Magnus Hirschfeld—an outspoken advocate for the study of sex and justice for sexual minorities—seized his vast collection of books, documents, photographs and artifacts, and threw it all on a bonfire. Hirschfeld was Jewish. He was out of the country on a speaking tour at the time; he never returned to Germany.

Besides Freud, the exhibition details the lives of some other notable names:

• Richard von Krafft-Ebing’s influential Psychopathia Sexualis, published in 1886, was the first book to describe in forensic, scientific detail the variety of human sexual practices. It popularised words like sadism and masochism and became the definitive psychiatric and legal guide to sexual pathology. Despite his professional interest, von Krafft-Ebing believed sex was strictly for procreation, not recreation.

• Havelock Ellis wrote the first textbook on homosexuality, Sexual Inversion, in 1897 and went on to study narcissism, autoeroticism and transgender phenomena. Ellis married a lesbian, and suffered from impotence until the age of 60, when he made the surprise discovery that he could become aroused by the sight of a woman urinating.

• Marie Stopes’ incendiary book Married Love, turned down by several publishers, was an instant hit when it was finally published in 1918. She dared to speak the unspeakable, dispensing advice of relationships, sex, marriage, children and birth control. The Wellcome exhibition includes some touching letters of gratitude to her from people who had no one else to turn to for guidance. Today, Marie Stopes International is an NGO devoted to sexual and reproductive health around the world. (These pioneers weren’t unanimously enlightened. Stopes, like Ellis and many prominent Victorians of the day, believed in the oppressive and usually racist philosophies of eugenics and social Darwinism: the elite decides it wants to improve the human gene pool by encouraging breeding by the “right” people—people like them—and discouraging the “wrong” people, sometimes with extreme measures such as compulsory sterilization or “ethnic cleansing.”)

• From 1915 to 1918 anthropologist Bronislaw Malinowski studied and lived alongside the inhabitants of Papua New Guinea’s Trobriand Islands, detailing a society where sexuality "dominates in fact almost every aspect of culture," and where some sexual behaviour among children was the norm.

• In a similar vein, Margaret Mead’s study of the people of Samoa in 1925 also highlighted a relaxed, permissive culture of sexuality that challenged the more constrained attitudes in the West.

• Wilhelm Reich was an Austrian psychoanalyst who like Freud believed that neurosis could be a symptom of thwarted or denied sexual desires. Unlike Freud, however, for Reich, sex and psychoanalysis were also political: He believed the rise of Nazism in 1930s Germany to be the result of a national culture of sexual repression. Reich, author of The Function of the Orgasm, among other works, invented the “Orgone Accumulator”—a cabinet that patients sat in and got blasted by “orgone” radiation that he claimed could cure cancer, liberate repressed sexual energy, and heal the world. The “sex box” became increasingly controversial, Reich became increasingly delusional, and he was charged with contempt of court in his adopted home country, the U.S. He died in prison in 1957.

• Alfred Kinsey discovered there was more scientific literature on the sex lives of farm animals than people. In the mid-20th century decades, McKinsey and his team set about filling in the blanks: They interviewed more than 18,000 Americans about their sex lives, highlighting the prevalence of homosexuality, extramarital sex and other sexual activity which departed from the supposed “norm.”

• William Masters and Virginia Johnson recorded physiological changes during sex—their results, published in 1966, revealed the intricacies of the “female sexual response cycle” and bolstered the feminist movement and calls for women’s sexual liberation.

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Fifty shades of sex
The Wellcome exhibition leads us on a historical journey of sexual culture. Where has it led to—where are we today? Is society generally more permissive about sex? Or are the forces of repression and discrimination still at play?

Yes, and yes. Evidence abounds that from the 1960s onwards there has been a kind of sexual awakening in western life and culture. But all the action has inevitably been met with an equal and opposite reaction.

Psychotherapist Tanya Glyde writes in The Lancet that today there is much more acceptance of alternative, kinky, BDSM practices, and a hunger for them, as evidenced by the Fifty Shades of Grey phenomenon—the book has been bought by more than a hundred million people (evidence too of a masochistic tolerance for painfully poor writing).

“Is BDSM an orientation, a lifestyle, or both?” writes Glyde. “Some people are wired to be dominant or submissive from birth. Some discover a love of it when young, and some get into it later in life. This could be because they discover that it enhances their sex life, or because conventional genital sex doesn’t work for them, and they are looking for other ways to deepen physical and mental connection. People tell me they have experienced a personal renaissance when exploring BDSM ... Many report profound, life changing, therapeutic, and even spiritual experiences.”

But Glyde argues that, while kink is far more widespread than we think, it happens in secret because of prejudice, not least from a prudish mental health establishment. The free-spirited “id” goes underground (sometimes literally); the restrictive “super-ego” is given free reign.

The cultural anthropologist Gayle Rubin describes the “charmed circle” of sexuality: if the sex is heterosexual, married, monogamous, procreative, non-commercial, in a couple from the same generation, in private, and involving bodies only, then it is considered “normal.” The “outer limits,” by contrast—bad, unnatural, damned, perverse, socially unacceptable—is sex that is homosexual, promiscuous, recreational, commercial, alone or in groups, casual, cross-generational, in public, sadomasochistic, or involving pornography or sex toys.

Continues Glyde: “This is not taught on psychotherapy courses (at least none that I know of) because awareness of gender and sexual diversities is barely taught at all. And in some branches of psychotherapy, the further a person departs from being heterosexual, monogamous, vanilla (non-kinky), and cisgender, the more disordered and perverse they are labelled by default.”

I once went to a talk entitled, “Help! My client wants to talk about sex.” The speaker said that people in therapy will often desperately want to talk about their sexual difficulties—a taboo subject with everyone else in their lives. So, battling shame, they gingerly try to raise the topic, often very subtly, in coded language, testing the waters. An experienced therapist will respond and open up a space for exploration, but many do not because they are uncomfortable with the material. Or if they do engage, they might subtly or not-so-subtly try to steer the client back toward some kind of societal norm instead of being interested in them, their experience and their difficulties.

There are many sexual difficulties. The Diagnostic and Statistical Manual of Mental Disorders (DSM) includes complaints such as: delayed ejaculation, erectile disorder, female orgasmic disorder, female sexual interest/arousal disorder, genito-pelvic pain/penetration disorder, male hypoactive sexual desire disorder, premature ejaculation, and unspecified sexual dysfunction. Sex addiction, like any addiction, can devastate lives. If any of these sound like you, don't suffer in silence—specialist help is available. But beyond these pathologised realities, so many sexual problems—and so much of human distress—are the result of trying and inevitably failing to live up to some supposed ideal, to be who we think we should be instead of who we are, to conform to other people’s standards or desires. These “shoulds” are so often in conflict with our innate personhood, and with each other, and can be profoundly unhelpful. Being a slave to such strict internalised demands is bondage of a most unenjoyable kind—a guarantee of suffering.

In and out of the bedroom, our challenge is to find ourselves. Instead of conforming to some imagined uniform, plain-vanilla conception of normality, we are free to embark on a postmodern exploration of individual preferences and practices in all their glorious multicoloured variety (and we are free not to, too, of course). There are infinite enjoyable ways of expressing libidinal energy; straight sex is but one.

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The new rules of sex
So how are we to proceed in this confusing modern world? If none of the old rules of engagement apply, and "anything goes," how are we to live and love?

In Rewriting the Rules, Meg Barker summarizes the tired old prevailing western “rules” about sex:

• Sex is very important, and a defining feature of our relationships and identities.
• We should have normal sex in our relationships.
• We must not stray into abnormal sex.
• It should be great sex.
• We mustn’t communicate openly about what we really want sexually.


Then Barker rather splendidly rewrites the rules. She too invites us to undress our mind:

• Sex can be wonderful but it doesn’t need to define us or our relationships. It is something that ebbs and flows throughout our lives.
• There is a wide diversity of ways of expressing sex and sexuality.
• It is fine to be sexual in whatever ways feel right to you, so long as it is consensual for all involved.
• Sex can be all kinds of things at different times, just like food. Expecting it to be great every single time is a lot of pressure to put on it.
• We must communicate openly about what we do and don’t want sexually (with ourselves and with the people with whom we are sexual).


It's up to each of us to make and break our own rules. The answers lie within ourselves, our experiences, our relationships. And there is guidance, too—from partners, therapists, workshops, books, and from people like Barker who, from Marie Stopes to the present day, have given us permission to be ourselves. They are on the side of freedom, expression, discovery and release. Our most pressing question is: “Am I normal?" They respond unanimously, with a resounding verdict: “Yes! yes! yes!"

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The Kiss by Eadweard Muybridge, from the 1870s/80s. It's thought to be the first smooch ever filmed.

Weekly news round-up

19/3/2015

 
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International Day of Happiness
By decree, today is the International Day of Happiness. The United Nations has apparently commanded our planet’s 7,302,469,431 citizens (and counting) to be unrelentingly cheerful today. All day. You must paper a smiley face over all of your problems today. You must snap out of it, pull your socks up, pull yourself together. Feeling bad? Well stop it! We can all go back to being miserable, depressed, anxious, bereaved, in pain, despairing and so on tomorrow. OK?
     Says United Nations Secretary-General Ban Ki-moon: "I wish everyone around the world a very happy International Day of Happiness! The pursuit of happiness is serious business. Happiness for the entire human family is one of the main goals of the United Nations."
     There are many things in life that make us happy. Is a demand for happiness from a giant, bureaucratic coalition of governments around the world one of them? Isn’t there something slightly creepy about Bhutan’s model of “Gross National Happiness”? Isn’t your happiness your business?
     What this means is that if you’re not feeling happy today, now you have one more thing to feel bad about. Perhaps in solidarity, instead of subserviently smiling along with the U.N., we should subversively spend today reflecting on unhappiness—yours, mine and the world’s.
     And anyway, who wants to be only happy? That’s not what life is about. As Ralph Waldo Emerson wrote: “The purpose of life is not to be happy. It is to be useful, to be honorable, to be compassionate, to have it make some difference that you have lived and lived well.”

• UN's International Day Of Happiness: How can we define or achieve it ... and who’s profiting? (The Independent)
• International Day of Happiness: 10 easy shortcuts to making yourself happier (Metro)
• International Day of Happiness: how happy are you? (Telegraph.co.uk)
• UN creates 'happy songs playlist' to mark International Day of Happiness (Daily News & Analysis)
• Smile, we're happier than the French: EU table of happiness (Daily Mail)
• 10 Things to Keep in Mind About Happiness (Huffington Post)
• How To Rewire Your Brain For Happiness (Forbes)
• 22 songs of maximum joy to mark the International Day of Happiness (Mashable)

UK news
Children's mental health to get £1.25 billion boost
The Coalition's commitment to extra mental health spending marks a "once in a generation" opportunity to improve outcomes, according to Nick Clegg. From Liberal Democrats:
Nick Clegg has announced a £1.25 billion of new funding for children's mental health services.
The money, spread over five years, will help treat 110,000 more children with mental health issues, and also provides rapid access to treatment for pregnant women and new mothers.
As part of the package, Nick also announced that the first ever-waiting time standards for children’s mental health will be introduced, and specialists in children’s talking therapy will be available in every part of the country by 2018. The funding will also extend access to services for children under five and those with autism and learning disabilities. 
Three children in every classroom have a diagnosable mental health condition and research shows that left untreated it can blight their adult lives. But until now, provision of appropriate care has been insufficient to meet their needs.
Children and young people with conditions like depression or anxiety, self harm or at risk of suicide will now get access to more therapy, parenting support and care closer to home or in their community (such as local cafes, youth centres and shopping centres).
The Liberal Democrats have made improving mental health a priority, both in Government, but also in our Manifesto for the next parliament. This announcement is just the latest in a series of improvements to mental health services that we have delivered over the last five years, including:
◦   £7 million in new beds for children and young people, as well as more case managers to make sure they are cared for in a suitable environment
◦   £150 million over the next five years to help young people deal with issues like self-harm and eating disorder
◦   Introduction of a new waiting time standard, backed by £33 million, to make sure young people with psychosis get prompt treatments
◦   £54 million investment into improving access to Psychological Therapies for children and young people.
• Charities welcome shake up of youth mental health care (from Mind)
• NHS England welcomes new plans for radical shake up of youth mental health care (from NHS England)
• Health minister about son's mental health struggles (from BBC News)

Mind matters: the politics of mental health
In the run-up to the General Election, mental health has emerged as a surprise must-have manifesto topic. A review from Politics Home of how far we’ve come—and how far we have to go:
Support and recognition of the importance of the issue has sprung forth from leading figures in each of the main political parties during this Parliament.         
The Liberal Democrats have been particularly vocal in their commitment on the subject, with Nick Clegg pledging to end the “second-class treatment that people with mental health issues have had to endure for decades.”  
Ed Miliband has also committed the Labour party to improving services and will include key promises on early intervention and mental health resources for children in its 10-year plan for the NHS.
In a landmark commons debate in 2012 MPs from across the political spectrum made moving admissions on how they had coped with various forms of mental health issues.
Labour MP Kevan Jones described a battle with “deep depression” and Conservative MP Sarah Wollaston revealed that she had suffered “severe” postnatal depression that left her suicidal.     
Mental health charity Mind welcomes the progress that has been made on addressing the stigma associated with mental health and has led the way with its Time to Change campaign (run with partner charity Rethink Mental Illness), which aims to end discrimination faced by sufferers.
As the general election approaches Mind is now keen to use the momentum that has been created to secure better funding for the sector.   
Mind’s CEO Paul Farmer says that “broadly speaking the rhetoric is fine but the reality is that many still aren’t getting the help that they need
“You could characterise the last five years in parliamentary terms as being the period of awareness where people have really been genuinely engaging and learning about it.
“From our point of view over the next five years, whoever is in power, it is all about the phase of action, so that that awareness and interest is turned into policy change.”
The charity would like to see mental health achieve “parity of esteem” with physical health and is calling for a funding increase

Wales: older men action call by Mind Cymru
From BBC News:
A charity is warning that more needs be done to help older men in Wales who are suffering from mental health problems.
Mind Cymru says older men are more prone to suicide than younger adults, but many do not receive the support and medical guidance they need.
Its figures show that one in four have symptoms of depression, severe enough to warrant intervention.

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USA news
“President Obama has elevated the conversation about mental health to the national stage”
From ThinkProgress:
One in four adults across the United States suffers from a mental illness — including schizophrenia, bipolar disorder, depression, post-traumatic stress disorder — according to the National Alliance on Mental lllness (NAMI). Among that group, less than 40 percent receive professional treatment, choosing instead to battle their ailment in silence, often to their detriment and that of others.
But in the months and years after a young man opened fire on students and teachers at Sandy Hook Elementary in Connecticut, President Obama has helped elevate the conversation about mental health to the national stage.
The current administration has taken several significant steps forward in this area, potentially ensuring that President Obama has found his place as the most progressive executive on mental health issues in the last 30 years. Some of the desired results, however, have not yet come to fruition.
Under the Affordable Care Act (ACA), Obama has expanded access to mental health treatment for afflicted Americans as part of an effort to destigmatize this silent killer and prevent future massacres. In February, the president signed into law the Clay Hunt Suicide Prevention for American Veterans Act — legislation that would improve veterans’ access to mental health treatment — after it passed through the House and Senate. And earlier this month, First Lady Michelle Obama announced the launch of “The Campaign to Change Direction,” her attempt to raise mental health awareness among Americans.
“With President Obama being a prolific figure in our society, this act of stepping out and advocating equal access for all is crucial,” Lanada Williams, licensed psychotherapist and CEO of Alliance Family Solutions Counseling, told ThinkProgress. “I don’t think that I’ve seen that in other administrations.”

Mental health: A new priority in Corporate America
Hardworking Americans look across the Atlantic at Europe’s more leisurely, Epicurean approach to work and life with a mixture of pity, disgust and envy. Now, however, Corporate America increasingly is realizing that employees aren’t machines, mere cogs in the capitalist machine, but people susceptible to mental as well as physical ill-health (they may have also noticed the amazing “coincidence” that psychologically healthy employees are more productive).
     Some HR ideas include: meditation and yoga programs, mental health education, bootcamp classes, breakdancing lessons, hula hoop sessions, even offering employees a certain number of “wellness hours” in a week, as well as some goodies such as “reusable water bottles, fresh fruit, healthy snacks and wellness resources.”
     From U.S. News & World Report:
One in four adults--approximately 61 million Americans--experiences mental illness every year, according to a study by National Alliance on Mental Illness.
While many nonprofits, government agencies and local communities participate in initiatives such as the Campaign to Change Direction to raise awareness about mental health, some leaders in the corporate world have also adopted emotional health of their employees as a priority.
“At Booz Allen Hamilton, we pick up emotional well-being, emotional health and mental health as part of our leadership culture,” said Sifer, who now leads more than 4,000 employees. “It is essential to how we work as a people-based enterprise.”
Dealing with mental illness can be just as challenging as dealing with physical disabilities at a workplace where you have to constantly interact with people, Sifer said, and sometimes these issues make top employees unable to perform their best.
“We know that mental health has no boundaries, and we also know that most of the day is spent in the workplace,” said Andrea Inserra, senior vice president at Booz Allen Hamilton. “As corporate leaders, we need to be concerned for the well-being of our colleagues.”
Emotional health issues can also directly impact a company’s business. A survey by Employee Benefit News magazine revealed 31 percent respondents choose mental illness as the number one cause of lost productivity, increased absenteeism and other indirect costs.

World news
India: call for better focus on mental health in Kerala
From The Hindu:
The burden of mental illnesses and mental retardation in Kerala is much higher than the national average, yet, mental health is given less importance than physical health in the State’s health sector plans, the Economic Review 2014 points out.
As per the national Census 2011, 0.20 per cent of the population in Kerala suffers from some form of mental illness in comparison to the national average 0.06 per cent. Similarly, 0.20 per cent of the State’s population suffers from mental retardation, against the national average of 0.12 per cent.
The special features with regard to the State which might have serious bearing on the burden of mental illnesses include high suicide rate, alcohol consumption, breakdown of marital relations and families, problems of ageing, stress due to the mismatch between high parental aspirations and children’s academic achievements, high rate of migration, and the increasing number of single-parent families.
The State Mental Health Policy 2013, which improved upon the policy of 2000, envisages the convergence of various departments for the care and rehabilitation of the mentally ill.

Australia: mental health services spending on the rise
From the Australian Institute of Health and Welfare:
Expenditure on mental health-related services in Australia has increased in recent years, according to new figures released today by the Australian Institute of Health and Welfare on its Mental Health Services in Australia website (available at mhsa.aihw.gov.au).
'Estimated national recurrent expenditure on mental health-related services was over $7.6 billion in 2012-13, or $332 per person, an increase from $302 per person in 2008-09,' said AIHW spokesperson Geoff Neideck.
State and territory governments funded almost 60% of this expenditure, with the Australian Government funding just over 36%, and the private health insurance funding 4% of mental health-related services.
Funding by state and territory governments of mental health-related services increased by an average annual rate of 3.5% between 2008-09 and 2012-13, while funding by the Australian Government increased by an average annual rate of 5.0%.
The figures released today also include new mental health information on defence-funded programs and private hospital programs.
'For the first time, data are available on Department of Defence funded mental health programs, which indicate that in 2012-13, $24 million was allocated to these programs,' Mr Neideck said.
There were 1,578 public and private specialised mental health care facilities in Australia in 2012-13, providing 11,410 specialised mental health beds.
Over 2 million patient days were provided by public hospital mental health services during 2012-13.
There were 30,298 full-time-equivalent staff employed in state and territory specialised mental health services, with 51% employed as nurses in 2012-13.

Other stuff
The computer will see you now
From The Atlantic:
If there was any question about whether the mental-health profession would be safe from technological disruption, the answer is now clear—and it’s a resounding “no.” BetterHelp, Talkspace, and other online counseling services can now connect clients with licensed professionals in an array of specialties. In the past year, these startups not only have increased in popularity, but also have gained the adulation of mainstream media outlets.
A Wall Street Journal writer who recently used both services called BetterHelp a “positive, professional experience” and said his Talkspace sessions were “identical to what I had experienced in traditional therapy, except I had access to it any time I pulled out my iPhone.”
However, despite the praise heaped on these counseling sites, some professional counselors worry about the privacy and quality of online therapy.
As recent hacking scandals have demonstrated, nothing connected to the Internet is 100 percent safe. Some counselors worry about the possibility that a client’s deepest secrets could be exposed.

Run from your problems: why counselling during a workout is an effective form of therapy
A personal account of therapy on the run. From the Evening Standard:
This is my first therapy run but Will Pullen, a psychotherapist with six years’ experience, has been counselling on the move for two years now. He says it’s a highly effective form of therapy because you are figuratively moving on while, well, literally moving on.
The session starts on park bench for some “grounding”. Pullen asks how I am. I disclose that I’m a little “stressed”. He discloses that he can tell.
The next 50 minutes, he says, will be spent “unpacking” that stress, and looking for “solutions”.
As it’s a one-off, I don’t burden him with my tortured inner child but concentrate on the more manageable topics: the daily grind of life in London. He deals with this a lot — work problems, relationship problems, “people stuck in marriages; those are the most common”.
 
Happiness is a needle and thread away: new data on benefits of knitting
A good yarn from Yahoo:
Turns out, it is possible to knit yourself into a better state of mind.
Clinical psychologist Ann Futterman-Collier who runs the Well Being Lab at Northern Arizona University, is studying what Arizona Public Radio station KNAU calls “Textile Therapy” — the emotional benefits of knitting, as well as crocheting, weaving and quilting.
"People basically have a vacation from their problems," she tells KNAU. "They can forget about what’s bothering them, and they get into something in the moment that energizes them, that leads to the repair in mood."
Futterman-Collier studied 60 women suffering from various levels of stress. She had them either work with textiles, write or meditate. During their respective activities, the women kept track of their moods. And for good measure, Futterman-Collier also took saliva samples, monitored their heart rates to determine their stress levels and measured their inflammation. She then compared the stress-reducing results of each of the three activities. 
"Textile handcraft making was associated with the greatest mood repair, increases in positive, decreases in negative mood," she tells KNAU. "People who were given the task to make something actually had less of an inflammatory response in the face of a ‘stressor’."

World of Therapy launches on Instagram

17/3/2015

 
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It's an obvious thing to say, but many things are therapeutic besides therapy. All the senses are involved: A beautiful piece of music, a meal, a massage. A sunset, a beach, a poem. The sound of rain—and the smell of grass afterwards. Woodsmoke. Waking from a deep, satisfying, dream-filled sleep. A human exchange of one sort or another. Sometimes such things can offer some kind of fleeting spiritual transcendence, as if it is the exact, perfect thing for you, in that particular place, at that a particular moment.
     What we see shapes our psychology, too—and the reverse is true also: our psychology shapes what we see. When we're feeling down, it's all too easy to see the world like Hamlet did: as an an unweeded garden that grows to seed, possessed by “things gross and rank in nature." As the poet David Whyte writes:
     “When your eyes are tired/the world is tired also.
     “When your vision has gone/no part of the world can find you."

     To help soothe those tired eyes and see the world afresh, World of Therapy has launched an Instagram page of photographs for troubled souls. To view the gallery, go to instagram.com/world_of_therapy. And if you too have an Instagram account (free and easy sign up on a mobiie device), feel free to share your inspiring images, or photographs that describe your distress, by posting them with the hashtag #worldoftherapy.

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Seeing comes before words. The child looks and recognizes before it can speak. But, there is also another sense in which seeing comes before words. It is seeing which establishes our place in the surrounding world; we explain that world with words, but words can never undo the fact that we are surrounded by it. The relation between what we see and what we know is never settled.
--John Berger in Ways of Seeing

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Weekly news round-up

14/3/2015

 
PictureLucy in the Sky with Diamonds: psychedelic drugs might even improve mental health.
Report: Tangerine trees and marmalade skies
Psychedelic drugs ‘not linked to mental health problems’
From UPI.com:
A new study from the Norwegian University of Science and Technology has found there is no connection between psychedelic drugs and mental health issues.
The researchers analyzed data from the U.S. National Health Survey (2008-2011). The data includes over 130,000 randomly selected adults, including nearly 20,000 psychedelic drug users. The analysis showed people who use LSD or psilocybin mushrooms do not have an increased risk of mental health problems.
“In general, use of psychedelics does not appear to be particularly dangerous when compared to other activities considered to have acceptable safety," the study says.
“Over 30 million US adults have tried psychedelics and there just is not much evidence of health problems," said author and clinical psychologist Pål-Ørjan Johansen.
“Drug experts consistently rank LSD and psilocybin mushrooms as much less harmful to the individual user and to society compared to alcohol and other controlled substances," said co-author and neuroscientist Teri Krebs.
The researchers claim it is more likely there is a link between improved mental health after using psychedelic drugs. However, they acknowledge certain people are at a higher risk for mental health problems in general and should be careful.
The study is published in the Journal of Psychopharmacology.

UK news
Open approach to mental healthcare
From The Guardian:
Last week, a report by the all-party parliamentary group on mental health said people with mental health problems receive substandard care (Report, theguardian.com, 4 March). In response, the president of the Royal College of Psychiatrists, Professor Simon Wessely, asked to see “good words translated into good deeds”. The good news is that some of these good deeds are already happening – but at the frontline. On NHS Change Day on Wednesday nearly 500 people attended the first national conference, in London, on peer-supported “open dialogue”. They heard firsthand reports of the profound changes this approach is bringing to patients and families.

Strengthening rights for people with learning disabilities
New government consultation seeks views to strengthen rights of people with learning disabilities, autism and mental health issues to enable them to live independently. From Gov.uk:
Norman Lamb, Minister of State for Care and Support, and Gavin Harding MBE, Co-Chair of the Transforming Care Assurance Board, announce the launch of ‘No voice unheard, no right ignored’ consultation.
The consultation ‘No voice unheard, no right ignored’ explores options on issues such as how people can:
◦  be supported to live independently, as part of a community
◦  be assured that their views will be listened to
◦  challenge decisions about them and about their care
◦  exercise control over the support they receive with a Personal Health Budget
◦  expect that different health and local services will organise themselves around their needs
◦  know that professionals are looking out for their physical health needs as well as their mental health needs
The document also seeks to explores views on a number of issues relating to the Mental Health Act which were raised during the recent consultation on the revised Mental Health Act Code of Practice.

Dreading Mother's Day? Advice from counsellors on how to cope
From BACP:
If you think the day is going be difficult for you, plan ahead and arrange to do something that will help you get through it. There are a variety of different self-care strategies you can use. Some involve distraction and others involve reflection. It depends on you. For example, some people find physical exercise helpful, whether it’s going to the gym, doing yoga or going out for a country walk. Others find a duvet day comforting, curled up watching a favourite film or reading a good novel. Some people find solitude helpful in giving them time to reflect on their thoughts privately, while others enjoy spending time with friends or family. Do whatever is right for you and whatever you think will help you best.

PictureDiaz: "My life would not be half as fulfilled without therapy."
USA news
Cameron Diaz in marriage counselling?!
From RumorFix:
They’ve only been married two months but is there already trouble in paradise for Cameron Diaz and Benji Madden?! According to Star magazine, yep!
The gossip rag is claiming Diaz and Madden are both already seeing a marriage counselor. A source spills to the tabloid, “They didn’t know each other for very long before getting married, and they want to avoid any potential stumbling blocks that may pop up.”
The story goes on to say that Nicole Richie is encouraging them to go to counseling, as she told Cameron, “this is how you make a marriage work.”
Cameron is all for hashing things out in therapy. “My life would not be half as fulfilled as it is without therapy,” Diaz has mentioned. “I take care of myself. I enjoy taking care of myself. It also helps keep my head clear, and it helps me stay focused on my work and my life, and I just use it as a way of maintaining a certain standard of life.”

PictureMogadishu, Somalia: Many Somalis will take their mentally ill relative to traditional or Khoranic healers for treatment.
World news
Mental healthcare in sub-Saharan Africa: challenges and opportunities
From RAND Corporation:
The World Health Organization Comprehensive Mental Health Action Plan (PDF) for 2013 to 2020 outlines targets for member countries, which include updating existing mental health policies and laws, integrating mental health care into community-based settings, and strengthening evidence-based research. One major concern of the plan is the limited research in mental health care in the sub-Saharan region. However, studies have shown that the absence of mental health treatment doesn't mean there is a lack of need.
Moreover, the stigma tied to mental disorders is also an obstacle to care. In the sub-Saharan region, this reaction is deeply rooted in cultural beliefs and associations that some communities make between mental disorders and witchcraft.
Freelance photographer Robin Hammond has put a human face on mental health challenges in Africa. In his award-winning photo book “Condemned,” he documents the absence of mental health care in conflict-affected African countries. His photographs show the deplorable conditions under which the seriously mentally ill must struggle, and the absence of help or infrastructure to address their special needs. Unfortunately, governments there have used incarceration as a solution to ostensibly prevent the mentally ill from injuring themselves and also protect the public.
Despite the challenges the region faces and the constraints that many mental health professionals labor under, new efforts aimed at improving the scenario are emerging in sub-Saharan Africa.

Liberia: with new graduates, African nation now has 144 trained mental health clinicians
From The Carter Center:
The Carter Center's Mental Health Program in Liberia, in partnership with the Liberia Ministry of Health and Social Welfare, congratulates the newest class of 21 clinicians who have joined the effort to continue improving access to mental health services in Liberia. With the addition of these graduates, 144 mental health clinicians are now trained, working largely in primary care clinics and hospitals across all 15 counties to provide much needed care.
Liberia is on course to reach its goal of expanding access to mental health care to 70 percent of the population within the next few years. Previously, this nation of 3.8 million had one psychiatrist to meet the needs of at least 300,000 Liberians suffering from mental illnesses.

Weekly news round-up

6/3/2015

 
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Facebook’s bid to help prevent suicides
Facebook is introducing a new initiative aimed at reducing suicides. The social media site is partnering with Now Matters Now, the National Suicide Prevention Lifeline, Save.org and Forefront: Innovations in Suicide Prevention, to offer help and support to Facebook users in distress.
    Here’s how it will work: If someone on Facebook posts something concerning, indicating thoughts of suicidal intent for instance, any of that person’s Facebook friends will be able to click on an icon to contact the friend in need, contact another of their friends for support, or contact a suicide helpline.
     Facebook, too, will be alerted, and if the post is sufficiently distressing, it will send the distressed person messages of support and useful resources.
     It's all a bit Big Brotherly, something devised by the "thought police." And yet, even if it is generated by a programmed bot in a vast, humming underground computer bunker somewhere in Silicon Valley, a well-timed message of hope really can make all the difference. It’s a helping hand, a voice in your darkest hour, a reminder that you’re not alone in this world.
     There are 1.4 billion active Facebook account users. That’s about a fifth of the population of the world.
      From ThinkProgress:
Preventing suicide is a difficult undertaking because it’s an action that’s carried out swiftly and desperately by those struggling to deal with their mental anguish alone, even if they may lead a seemingly normal life. However, not all cries for help are silent — especially on social media, where you may come across melancholic statuses from friends on your newsfeed.
Now, Facebook wants to capitalize on the confessional nature of its platform. The social media giant is rolling out a new suicide prevention tool — which it created in partnership with a few mental health organizations — that allows users to reach out to their troubled loved ones virtually and connect them with online resources after spotting the first sign of trouble.
While mental health experts believe that the app could better help concerned family and friends spark much needed conversations and connect distressed people with resources, some warn against overly depending on the social media platform for help with these sensitive matters when direct contact may prove more effective.
With the suicide prevention app, users who are concerned about a friend’s post can directly “report” it by contacting their friend, another friend for support, or a suicide prevention hotline. Facebook then examines the reported post to see if warrants intervention. If so, the friend in question will receive a message that gives him or her the option of reaching out to a friend, calling a suicide hotline, or looking over a host of suicide prevention materials, including video messages and relaxation techniques.
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U.K. news
Julie Andrews: Counselling led me to love
From Film News:
Julie Andrews went to therapy to "get rid of some garbage" and ended up meeting the love of her life.
The actress is famed for her appearance in 1965's The Sound of Music and four years after it was released she married Blake Edwards. The pair met because they were both seeking counselling at the same place, with Julie explaining she needed help coping with her sudden rise to fame.
"We actually, our cars - I was going one way and he was going the other and Blake rolled down the window after smiling a couple of times and said, 'Are you going where I just came from?' And I was going to a therapist and he was coming from. Very corny, sorry about that!" she explained to British TV show Good Morning Britain.

The future of mental health in the UK: an election manifesto
Following on from the Royal College of Psychiatrists mental health manifesto for the next UK Government, Making Parity a Reality, comes this “secret manifesto” in The Lancet with further suggestions:
It is disheartening that half of the things we called for— proper liaison psychiatry services, a minimum unit price for alcohol, and investment in parenting programmes— have such robust evidence bases that they should have happened years ago. It is disgraceful that the remainder— adequate numbers of hospital beds for people with mental health problems, a maximum waiting time of 18 weeks to receive treatment for a mental health problem, and safe and speedy access to quality crisis care that does not often involve police cells—would just lift mental health up to the level of physical health care.

Children's services hit rock bottom – so what's next?
The government has fuelled a rise in mental health problems in children while at the same time dramatically slashing services designed to help them, as I’ve written before. Here Simon Newitt in the Guardian assesses the dire way we are treating our children, our future, concluding: “If we are going to continue to organise our society in such a way as to make the incidence of poor mental health more likely, then we can’t ignore the human and financial cost of not providing adequate public services to mitigate the consequences”:
It’s encouraging to hear leading politicians now talk and pledge openly about mental healthcare. In the past year or so, the state of our services – particularly for children and young people – has slowly risen up the political agenda. It’s a scandal that it has taken near systemic collapse to achieve this, but when even Norman Lamb, minister of state for care and support, is able to conclude that children’s mental health services “are not fit for purpose”, it is clear we’re about to hit bottom. Maybe we already have.
Multiple investigations and reviews have found the same failings, which might be summarised as the result of chronic long-term underinvestment in the face of growing demand. Mental health issues represent about a third of our overall burden of disease in the UK and cost more than £100bn a year.
Spending on services represents only 13% of the total NHS budget, with 67% of clinical commissioning groups spending less than 10% of their budget in this way. Worse, given half of all adult mental health problems (excluding dementia) start before age 15 and three-quarters by 18, it’s hard to understand why only 6% of these already limited funds go toward child and adolescent mental health. These are services which have also had to manage cuts of £50m since 2010. Funding for mental health research represents 5% of overall health research spending.
• Scotland: child mental health wait increases 'are horrifying'
From BBC News:
The number of young people waiting more than a year to be treated by mental health services has increased 10-fold in a year, according to figures released by Scottish Labour.
The party said the Scottish government "is letting down some of the most vulnerable children in Scotland".

“The Troubles” linked to half mental health cases in Northern Ireland
From BBC News:
A new study has claimed the Troubles are linked to half the cases of mental health issues in Northern Ireland.
The research was conducted by Ulster University on behalf of the Commission for Victims and Survivors.
It found almost 30% of the NI population suffer mental health problems, and nearly half of those are directly related to the Troubles.
The Department of Health said it had no official figures on "the level of directly associated mental illness".
However, it said "emerging evidence indicates that Northern Ireland has high levels of, often untreated, post traumatic stress disorder as a result of decades of violence".

USA news
Michelle Obama promotes awareness of mental health
From U.S. News & World Report:
Mental health care is not just a policy and budget issue for America, but also a cultural issue, Michelle Obama said on Wednesday.
The first lady said more than 40 million Americans experience a diagnosable mental health condition— like depression or anxiety— and there should be no stigma around mental health care.
"At the root of this dilemma is the way we view mental health in this country," she said. "Whether an illness affects your heart, your leg or your brain, it's still an illness, and there should be no distinction."
Mrs. Obama spoke at a mental health summit and the national launch of the campaign to "Change Direction."

World news
Kenya: How one woman is “fighting the funk” by helping others
From Public Radio International:
Sitawa Wafula had two strikes against her. But the Kenyan woman is making a huge difference for thousands in her nation in an area that receives scant attention: Mental health. Despite suffering from bipolar disorder and epilepsy herself, Wafula has been able to create a route to help others.
According to the Africa Mental Health Foundation, there are only 79 working psychiatrists in the East African nation. That’s one for every 500,000 people. Short of training more, Wafula wanted to find a way to make mental health resources more widely available.
In September 2014, Wafula launched an SMS-based helpline called “My Mind My Funk.” People can text in for free from any mobile network. General inquiries get an automated response, but desperate or suicidal messages are answered with a call from a licensed therapist.
Wafula knows all too well what it’s like to have no one to turn to for help. She was diagnosed with epilepsy, a condition that's often stigmatized in Kenya, when she was a teenager. Then a sexual assault sent her into a downward spiral.
“I got really, really depressed. I was suicidal. I didn’t have anyone to talk to tell what had happened to me,” Wafula says, speaking at her small, bare office in Ngong, a town on the outskirts of the capital city Nairobi.

Israel: 350 soldiers received psychiatric counseling after Gaza War: report
From Al-Bawaba:
More than 350 Israeli soldiers who took part in last summer's military onslaught on the Gaza Strip have since received psychiatric counseling for post-traumatic stress, an Israeli report has revealed.
The report, published Wednesday in the Israel Today newspaper said that soldiers had undergone treatment for symptoms associated with post-traumatic stress, including disorientation, low productivity and recurring nightmares.
The newspaper quoted a senior Israeli official as saying that the number of soldiers to receive psychiatric treatment following last summer's onslaught on Gaza was higher than those who did so following previous operations.
For 51 days this summer, Israel pounded the Gaza Strip by air, land and sea. More than 2,310 Gazans, 70 percent of them civilians, were killed and 10,626 injured during unrelenting Israeli attacks on the besieged strip this summer.
According to the UN, the Israeli military killed at least 495 Palestinian children in Gaza during “Operation Protective Edge.” The al-Mezan Center for Human Rights puts the number at 518, while the Palestinian Center for Human Rights puts it at 519.
All three figures exceed the total number of Israelis, civilians and soldiers, killed by Palestinians in the last decade. 

Saudi Arabia: counseling helps 2,950 extremists mend ways
From Arab News:
Maj. Gen. Nasser Al-Mutairi, director of the Mohammed bin Nayef Center for Counseling and Care, said that his facility has reformed 2,950 young men who are now all fully integrated in society.
Nasser made these remarks on Monday, during a lecture at the headquarters of the Muslim World League, where several Saudi experts talked about the experience of fighting terrorism in the Kingdom. However, the center's success of retrievals of youth in danger of becoming extremists currently stands at 13 percent.
Despite the grim data, 120 individuals coming from Guantanamo Bay were successfully integrated in society thanks to the center, with 98 percent of them giving up extremist ideas.
Al-Mutairi said the center has a five-year strategy based on three propositions: psychological treatment, rehabilitation and reintegration into society.

Australia: Large gap between rich and poor areas in use of mental health services revealed
From The Guardian:
Large socioeconomic and geographical inequality exists in patient use of mental health services, despite Medicare’s aim of providing universal health care.
Using substantial data obtained through freedom of information requests, researchers from Melbourne’s Monash University assessed more than 25m instances of mental health care over the four years to June 2011, undertaking the largest ever national study into mental health services.
The most highly qualified mental health staff – psychiatrists and clinical psychologists – were used up to three times as much by people in wealthier areas compared to those in the most disadvantaged ones, they found. However, use of less qualified mental health staff, like general practitioners, general psychologists and social workers, was more equitable across the country. Out-of-pocket costs to the patient are significantly less for these services compared to that of clinical psychologists and psychiatrists, for which a larger co-payment gap exists.
With research consistently showing higher rates of severe mental illness in the most disadvantaged areas, it was concerning that people living in those areas were accessing specialist services less, the authors of the research published in the Medical Journal of Australia on Monday said.

The developing world: When mental health is the best investment
Report on the global cost of mental health problems in GOOD Magazine:
Mental health disorders are among the most common debilitating afflictions in the world. This reality is almost certainly exacerbated in poorer countries, given a lack of mental health resources and the demonstrated linkage between poverty and the risk of developing adverse psychological conditions. Yet pervasive social stigmas about mental health still make it difficult to convince governments, businessmen, and donors to invest in campaigns for greater resources, especially in economically struggling countries. Fortunately, there may be a way to convince hardheaded people all over the world that contributing to mental health provision efforts will be in their interest. Even if they don’t participate out of the goodness of their hearts or the recognition of the realities of mental health’s personal ravages, there’s a good argument to be made that providing these service just makes practical business sense. Because these days, a growing body of literature suggests funding improved mental health resources is one of the best economic investments a country or company can make.
Among its constituent countries, the Organization for Economic Cooperation and Development conservatively estimates that up to four percent of national GDP can be lost in a given year to mental health’s blow to productivity. In the U.S., these direct and indirect costs make mental health issues perhaps the most expensive chronic health issue in the nation. Thanks to a lack of data or serious investigations in many developing countries, we often don’t know what the equivalent numbers would be. But some estimates put the global costs of mental health at $2.5 trillion per year, with two-thirds of that amount coming from indirect expenses. And up to 45 percent of that global impact seems to be concentrated in the developing world. So the numbers may be fuzzy, but we’re still looking at hundreds of billions of dollars a year in preventable losses to the national economies of a collection of limited, small, and fragile nations. 

Two opposing views
Looking for meaning in your life?
From psychotherapist Dr Aaron Balick on Huffington Post UK:
Finding the right therapist for yourself is important, and your progress with them will depend a lot on chemistry. If you don't click with the first one you meet or speak to, try someone else. If you're meeting a therapist in the real world, you might want to book a session in with a few different people, so you can get a taste before you decide.
And then you can begin your journey - now, more than ever, we need to access the deeper parts of ourselves, so we can operate better and more authentically in this fast moving world. A depth psychotherapy is a bit like slow food in a fast food culture. Once or twice a week you slow down, chew slowly, and taste all the flavours. It's you're life, as far as we know you've only go the one, so make it count and find out who you are.

“It just exacerbates everything”
Creator of Seinfeld, Curb your Enthusiasm, and king of neurosis Larry David, via Mia Farrow (former partner of the kind of neurosis Woody Allen, on twitter.com: 
Larry David on psychotherapy: “I think it just exacerbates everything. Then you just become more focused on yourself. It does no good at all."

Trauma: the aftershocks of human inhumanity

6/3/2015

 
PicturePrivate Paul never recovered from the horrors of combat.
A sad story last week about the suicide of a British soldier who suffered terrible injuries from a roadside bomb blast in Afghanistan.
     Private Bradley Paul of the 1st Battalion The Mercian Regiment severed an artery in his neck and had multiple bone fractures from the explosion in Helmand Province in November 2012. He was airlifted home and spent more than a year undergoing physical rehabilitation.
     “Through the usual strength of character we all came to love about him and with the love of those around him he made a good recovery,” says the Go Fund Me appeal page set up to raise funds to pay for his funeral.
     But the psychological wounds, less visible than the physical ones, became impossible to live with. On February 17, he was found dead at his home in Timperley. He was 23.
     It had been a “silent struggle” according to Paul’s infantry platoon commander, Captain Chris Middleton. “He was a great character in the platoon. He was one of the guys that the other lads looked up to and respected. He was physically and mentally very strong and he had a very good sense of humour.
     “As the front man of his patrol every day, Brad carried the weight of responsibility for lives of his mates on his shoulders every time he stepped out the gate.”
     The government sends people like Paul off to the dark places of the earth, often for highly questionable purposes. They witness death, destruction, massacres, unspeakable acts of barbarism. They suffer great injuries. They see friends killed right in front of them. They kill.
     Then they’re supposed to come home, keep calm and carry on as normal. Help with the school run, go to the cash and carry, Saturday night at the movies. “As you were, soldier.”
     The return to civilian life can be some kind of nightmare. Everything looks roughly the same, yet everything has changed. You find you can’t go home again. You’re still at war. No one has prepared you for peace. There’s a good chance you’ll end up in prison, or homeless.
     The Armed Forces have presented you with a cruel double bind: your experiences in the military might have damaged you psychologically, but you’ve been trained that you’re supposed to be tough and resilient and self-reliant—someone who doesn’t tolerate vulnerability, let alone ask for help. You’ve been chewed up, spat out, and now left to cope on your own. Thanks a lot for your years of service, your courage, your sacrifices—now go away.

PictureEven in the most peaceful of surroundings, with PTSD you're always at war.
Red alert: Post-Traumatic Stress Disorder
Trauma is an unbearable, horrific fact of life. As with Bradley Paul, the suffering is usually silent, the wounds invisible. And it doesn’t just happen in war zones, far away. “Trauma happens to us, our friends, our families, and our neighbors,” writes Bessel van der Kolk in The Body Keeps Score. “One in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; one in three couples engages in physical violence. A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit.” The statistics for the U.K. aren’t quite the same--1 in 20 British kids have been sexually abused, for example; domestic abuse will affect 1 in 4 women in their lifetime—but still shockingly high.
     Trauma can cause a broad range of distress. There is traumatic stress, there is post-traumatic stress, and then there is full-blown Post-Traumatic Stress Disorder. PTSD is a prolonged reaction to a traumatic event; it can also be triggered many years later. The Diagnostic and Statistical Manual of Mental Disorders (DSM), which has included PTSD since 1980, lists potentially traumatic events as combat, sexual and physical assault, being held hostage or imprisoned, terrorism, torture, natural and man-made disasters, accidents, and receiving a diagnosis of a life-threatening illness. Sometimes, however, events that seem quite small and insignificant to the outside observer can be profoundly traumatic. Most people experiencing a trauma do not develop PTSD—some helpful factors, writes Babette Rothschild in the seminal trauma book The Body Remembers, are: preparation for the expected stressful event, if possible; a successful fight or flight response; good developmental history, belief system, and internal resources; prior experience; and good support from other people.
     PTSD is, like most psychological disorders, highly variable in its presentation of symptoms. But those symptoms are generally horrendous, dangerous and hard to resolve. It’s as if the traumatic event is still happening, right now, with your body responding as it did at the time, on high alert—heart pounding, fast-breathing, adenaline flooding the system. Another common symptom is dissociation—a shutting down; a kind of escape when there is no escape. Common dissociative symptoms include amnesia, fragmentation of identity, and feelings of detachment and unreality about one’s self, body and environment.
     The DSM claims that a complete recovery happens within 3 months in half of PTSD cases, but that “some individuals remain symptomatic for longer than 12 months and sometimes for more than 50 years.” In fact, PTSD requires a lengthy, painstaking spell of support and psychotherapy. It takes time to build the necessary trust, and then time for the delicate process of revisiting the hideous trauma, physically and emotionally re-experiencing it, arriving at some kind of accommodation or resolution—what Peter Levine in Waking the Tiger calls a “renegotiation”—and starting to heal. The story is told and retold, imagined and reimagined. The losses are mourned. The trauma is named, described, spoken out loud. “Without a voice,” writes Kim Etherigton in Trauma, the Body and Transformation, “our body finds other ways to speak for us.”
     Rothschild stresses the importance of “braking and accelerating” during the work with a therapist—the client gently revisits elements of the original event at their own pace, and if things become too overwhelming, one or both of you hit the brakes: slow down, do a breathing or mindfulness exercise, change the subject, stop. The potential for retraumatisation—the very opposite of healing—is great. Much more ammunition is needed to fight the enemy within than some Citalopram and a handful of sessions of CBT.
     It’s particularly difficult work because the clients often feel highly ambivalent about it.  The tendency for veterans is to downplay the problem and not seek help. Counselling is a foreign land for many of those who have served in the Services. How could a counsellor—especially a mere civilian—possibly help? They surely couldn’t even begin to understand what you’ve witnessed, the things you’ve done. What could they know about being in a constant state of super-anxious, hypervigilant high-alert, waiting to attack or be attacked at any moment. The fear of crowds. The rage. The isolation. The sleepless nights, the flashbacks. The urge to escape into drink, drugs, gambling. Or dissociation: the memory loss, the blackouts, those disturbing episodes where you find yourself in another town, miles from home, with no recollection of how you got there, or why. The powerful undertow of suicidal thoughts.
     In her research on veterans’ experiences of psychological therapy, Camilla Stack concludes: “Practitioners working with ex-military clients should gain an understanding of military society and culture and appreciate its lasting influence, particularly in terms of power dynamics. They should be sensitive to significant cultural differences between the military and civilian worlds, and watchful for the concomitant risks of misunderstanding and judgment.”

The politics of trauma
The U.K.’s the Ministry of Defence (which has had its moments as the Ministry of Attack) has been reluctant to recognise PTSD, because it doesn’t want to pay for treatments or damages or otherwise be held responsible.
    “It suits the MoD to minimise the numbers in order to reduce the extent of liability,” Tony Gauvain told The Guardian. He is a retired colonel, psychotherapist and chairman of the charity PTSD Resolution. (Another charity, founded 95 years ago, is Combat Stress , which provides specialist clinical treatment and welfare support to UK veterans suffering from a range of psychological injuries like PTSD.) “But given the numbers of people suffering symptoms now, and the latency of the condition likely to result in increasing numbers, there would seem to be a determination to avoid admitting there is a problem.”
     How many deeply traumatised people, victims of domestic abuse, rape, violence, torture, organised crime, terrorism, wars—the old kind and the new, more insidious kind—are walking on the earth today, right now, in pain, having received no treatment at all? Very many. Trauma work, writes Judith Herman in Trauma and Recovery, is political because the sufferers are generally the oppressed, and the oppressed usually have no voice. The truth does not come out. There is no reconciliation. Human wrongs are not righted.
     “Moral neutrality in the conflict between victim and perpetrator is not an option,” writes Herman. “Like all other bystanders, therapists are sometimes forced to take sides. Those who stand with the victim will inevitably have to face the perpetrator’s unmasked fury. For many of us, there can be no greater honor.”

Picture
Most great instigators of social change have intimate personal knowledge of trauma. Oprah Winfrey comes to mind, as do Maya Angelou, Nelson Mandela, and Elie Wiesel. Read the life history of any visionary, and you will find insights and passions that came from having dealt with devastation.
          The same is true of societies. Many of our most profound advances grew out of experiencing trauma.

--Bessel van der Kolk


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    John Barton is a counsellor, psychotherapist, blogger and writer with a private practice in Marylebone, Central London. To contact, click here.

DR JOHN BARTON IS A PSYCHOTHERAPIST, BLOGGER AND WRITER WITH A PRIVATE PRACTICE IN MARYLEBONE, CENTRAL LONDON
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