BIPOLAR TIMES

A triumph of marketing

We can't tell our left from right
But we know we love extremes
Getting to grips with the ups and downs
Because there's nothing in between
—Echo & The Bunnymen

In his excellent slim tome Strictly Bipolar, Darian Leader says the postwar period was the “age of anxiety,” the 1980s and ’90s were the “antidepressant era,” while now, today, “we live in bipolar times.”

For people with the genuine, extreme symptoms of what is called “bipolar disorder,” the too-high highs and the too-low lows can make for an extremely difficult, roller-coaster life with times of great recklessness and wretchedness, danger and despair, and only fleeting glimpses of the straight and narrow.

The diagnosis formerly known as manic depression has, says Leader, increased 4,000 percent in the past 20 years. Why?

Partly because the definition has expanded to include broader categories that accommodate many more people, pathologising everyday human reactions such as “responding strongly to losses.” Anyone who has ups and downs in life, which is to say anyone, could choose to identify with the label “bipolar.”

Increasingly, it has become a designer label, with some “celebrities” seeming to regard bipolarity as a lifestyle choice, a creed, an accessory to match the Hermes bag.

The manic highs—like real life but with the wattage turned up all the way—are portrayed as thrilling interludes of high-intensity work, love, creativity in keeping with the frenetic pace of modern life.

Stephen Fry, diagnosed at 37, says of his mania (it’s obligatory to include a quote from Stephen Fry in any story about bipolarity): “We are kings of the world, nothing is beyond us, society is too slow for our racing minds, everything is connected in a web of glorious colour, creativity and meaning.”

Who wouldn’t want some of that now and again?

On screens large and small, bipolarity looks rather attractive. Whether you agree with him or not, Stephen Fry’s star burns brightly, such as when he denounces religion. If you’re CIA agent Carrie Mathison in Homeland, played by Claire Danes, bipolarity makes you passionate and intrepid. If you’re Cameron Stuart in the new movie Infinitely Polar Bear, played by Mark Rufallo, being bipolar makes you an eccentric, lovable rogue (to be fair I haven’t seen the film—I’m just judging from the trailer).

The too-low lows barely get a look-in.

Is bipolar’s boom a sign of the times? Or is it a triumph of marketing fuelled by big—and big profit-seeking—pharmaceutical companies?

As Leader points out: “Historians of psychiatry have all made the same observation: it was precisely when patents ran out on the big-selling tricyclic antidepressants in the mid-90s that bipolar suddenly became the recipient of Big Pharma marketing budgets. Websites helped people to diagnose themselves; articles and supplements appeared all referring to bipolar as if it were a fact; and nearly all of these were funded by the industry.”

The system is predisposed to tell you that you are sick, and that there are pills to make you better. In fact, the pills might not work. And you might not even be sick. You might be simply human.
—John Barton


U.K. NEWS

Cuts to UK mental health services are destroying lives and families
The Guardian:

In the UK, we have some of the best emergency medicine in the world for physical health. But when it comes to emergency mental health we can make no such boast. In fact the system is in crisis.

Last year nearly two million people in this country sought help for mental health problems. But many didn’t get the what they needed. In June a report by the Care Quality Commission revealed thousands of people in urgent need of care received “inadequate support”.

My own family experience in the last couple of years has persuaded me that those with mental illness, particularly the young, get a raw deal. Early intervention can make a vast difference and yet there is no easy way to get help. It is haphazard. You may get help or you may not. It may happen quickly or it may not. Teenagers may be in a children’s unit or thrown into an adult one. Worse still, you may be sent hundreds of miles from home, where your parents struggle to be with you. It is absurd – no wonder the outcomes are so poor.

It is why on ITV News this week we are running a series of reports on the state of mental health care in Britain. An investigation by ITV News and the charity Young Minds has revealed that in the last year alone £35m has been cut from children and adolescent services, £80m in the past four years.


Independent report calls for more 'balanced' and 'truthful' reporting of mental health issues
Mirror.co.uk:

A new front opened this week in the battle to improve media coverage of mental health problems.

The Mental Health Foundation (MHF) has launched a report on what society should expect from psychiatry and vice versa.

The report, entitled "A Better Understanding, Psychiatry’s Social Contract’", explains that society must support doctors in delivering high quality mental health care.

Along with an appeal for government to tackle issues like unemployment, which contribute to mental illness, there is a powerful call out to the media.

The MHF is asking the press to report on mental health issues in a ‘truthful' and ‘balanced’ way.

If we want a caring society, we need to combat ‘irresponsible' newspaper reports that reinforce stigma and negative stereotypes. And the MHF says “journalists who work on mental health stories should have at least a basic understanding of the role and responsibilities of psychiatric services”.


U.S.A. NEWS

Juvenile detention centers actually suck for kids with mental health issues, study finds
MTV.com:

In 2011, more than 60,000 young people were placed into juvenile detention centers, and new data is raising questions as to the efficacy of the system when dealing with mental health issues. A new study from Stanford University School of Medicine looked further into the mental health of kids in the juvenile justice system, and found that “juvenile inmates are much more likely to be hospitalized for mental health problems than children and teenagers who are not incarcerated.”

The study, which tracked roughly 2,000,000 hospitalizations of California boys and girls over 15 years, suggests that these detention centers probably aren’t helping kids who are already struggling with mental health. To put that into perspective, according to the study, “Mental health diagnoses were responsible for 63 percent of hospital stays by young people in the juvenile justice system, compared to 19 percent for those not in the system.”
 

US schools introduce mental health programs to address teen cutting problem
Fox News:

Schools around the country have begun offering new classes and mental-health programs to help stem a sharp rise in the number of adolescents found to be engaging in self injury, especially cutting. 

School officials, from high school to elementary levels, are working with adolescent psychologists to train their mental-health staff and teachers to counsel at-risk teens and to educate all students in dealing with stressful emotions. A growing number of the programs are based on a treatment called dialectical behavior therapy, or DBT, which aims to help people regulate their emotions and teach skills for avoiding self-injury when the urge arises.

What is believed to be the first randomized, controlled study of DBT in self-injuring adolescents was published in October and showed the treatment significantly lowered the frequency of self-injury in 77 teens compared with other common therapies.


WORLD NEWS

Preventing long-term mental health issues in Nepal
Aljazeera.com:

More than 8,700 people have died since the April 25 earthquake struck Nepal. As the country begins to rebuild, mental health professionals are reaching out to those in need. 

"I saw a lot of grief in people," says counsellor Dristy Gurung.

"If it doesn't get treated or if you don't intervene in such grief or trauma, in the long run it might create some mental health issues for people."

According to the UN Resident Coordinator in Nepal, 2.8 million people are still in need of some form of assistance. 

Gurung works for Transcultural Psychosocial Organization (TPO) Nepal, one of the country's leading psychosocial associations.

While the organisation advocates for mental health laws and acts, Gurung says the country always puts physical health first and that mental health is put in the shadow.

Gurung and other mental health professionals in Nepal say this can have major repercussions after a natural disaster of this scale. Gurung says they have already heard of cases of suicide and post-traumatic stress disorder.


Qatar: counselling centres urged for expats
Gulf Times:

In view of the stress felt by expatriate workers who have to live away from their families for long durations, some residents have called for counselling centres across the country, especially in areas with a high concentration of single workers.

Besides low-income workers, many middle-income expatriates - particularly those facing financial problems - may also require psychological support, say residents.

The counselling centres should be staffed by specialists who can effectively address the problems faced by workers, including depression and stress, they pointed out.

“As there has been a huge increase in the number of workers in recent years and many more are expected to come in the next few years, there should be adequate facilities to cater to the psychological needs of expatriate workers, a majority of whom is living here without families,” said an engineer working on a major infrastructure project in north Doha.

In Qatar, depression affected about 18% of the population, according to earlier reports. Cases of suicide involving expatriate workers are also reported at times.



New Zealand: Kiwis crave advice to support young people
Mental Health Foundation of New Zealand:

New research by Common Ground shows another side to youth mental health.

Nearly three quarters of the New Zealanders surveyed say it’s the responsibility of the community, not just the immediate family, to support young people who are experiencing personal issues however only 23% say they felt they could help out, with 15% saying they would like to help but don’t know how or don’t feel equipped to help.

Common Ground is a dedicated website for those helping troubled young people is part of the Prime Minister’s Youth Mental Health Project and developed with collaboration from the Mental Health Foundation, Youthline, Skylight, Innovate Change and Curative.

The new research shows that communities really want to help, Dr Theresa Fleming, University of Auckland psychological medicine senior lecturer and youth mental health advocate says.

“Mental health is not just up to the experts. If family, friends and communities reach out, then no-one needs to struggle alone. This research highlights that Kiwis do care, and with a little info and support all of us can make a difference.”


VIEWPOINTS

Should I stay or should I go?
Jannah Walshe in the Mayo News:

To properly assess your current relationship, I’d recommend you first have a think about your own perspective on your relationship before going through it with your partner. It’s a good idea to write it down so that you remember it when you do speak about it together. The following questions may help you.

>    Is this relationship serving us both or just the other person?
>    Do I spend more time questioning whether the relationship is right or wrong than enjoying it?
>    Is there more to learn for me in this relationship, or can I best learn and grow outside of this relationship?
>    Would leaving this relationship be an act of self-care?


7 signs your therapist is good at their job (because some of us are weirdos)
Kathleen Smith, in Bustle:

Finding a good therapist is a lot like shopping for a good pair of pants. You’re going to have to try a few on and maybe even make a few alterations before they start working for you and help you feel great about yourself. Science tells us that psychotherapy works just as well if not better than medication, but unlike a pill, your therapist is a human. This means that personalities can clash, misunderstandings can occur, or occasionally people can just be outright weirdos. But once you get started, how do you really know you’ve found a good therapist? 

I know the first time I went to see a counselor, he told me to tap my shoulder blade three times and say out loud that I loved myself. Then he expected me to write him a $200 check for his oh-so-random nonsense. Rather than see someone else, I shied away from the idea. It wasn’t until I considered the profession as a career for myself that I began to see how talking, processing, and strategizing with a professional can be an invaluable resource. Because sometimes having someone with skin who can actively root for you and shine the light on new insights is better than any self-help book.

 

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It’s summertime, that supposedly easy-living season when you might be able to slow down a little, maybe take a holiday, and possibly even read an actual book. If so, my personal top-10 ranking of the best self-help books can be found here.

Since it began in 1859, the self-help publishing industry has grown into an $11 billion business that shows no signs of slowing down. There are thousands upon thousands of self-help books, and some are truly terrible. But the worst I’ve ever encountered is the pernicious bestseller You Can Heal Your Life, by Louise Hay, which inexplicably has sold over 50 million copies.

“I believe we create every so-called illness in our body,” declares Hay. If you can limit yourself to having only “joyous, loving thoughts,” she says, you won’t get ill. And if you already are ill, you can cure yourself—all you have to do is “consciously release any mental patterns ... that could express as dis-ease in any way.”

Psyche+Soma
I do believe that the physical and the psychological cannot be separated, despite Western medicine’s tendency sometimes to do just that. There is a delicate interplay between the two—as the book Why Do People Get Ill? argues, we are psychosomatic beings and illness could certainly better be treated in a more holistic manner. And as a counsellor, I have found it can be enormously useful in the therapy room to explore the possible psychodynamic or symbolic meanings of clients’ symptoms.

But Hay goes to the absurd, simplistic extreme of arguing that the cause of any illness—or even any accident or injury—is all in the mind. It’s the kind of rigid cause-and-effect certainty, based on nothing more than Hay’s imagination, that would make that old Scottish skeptic David Hume turn in his grave.

More seriously, Hay rejects every basic principle of biology and medical science—most doctors, she says, only work “in one of two ways: They poison or they mutilate.” Peddling false hope for profit is dangerous and unethical. Anyone who follows her lead and shuns modern medical help in the wishful hope of being able to think themselves better is taking a huge risk. They are taking their life in their hands.

Hay represents a return to the Dark Ages, The Unenlightenment, when disease and disability were seen as some kind of divine retribution for moral lapses or sins. If you’re guilty these days of the crime of not thinking positively enough, of finding life difficult, unfair or frightening, well then, says Hay, you will be punished with some ghastly affliction. So not only are you ill, you must now also suffer the additional toxic burdens of shame and guilt, born of Hay’s oppressive judgement that you did this to yourself.

Here’s an extraordinary excerpt from a 2008 interview in The New York Times: 
When I asked her if, since people’s thoughts are responsible for their conditions, victims of genocide might be to blame for their own deaths, she said: “I probably wouldn’t say it to them. I don’t go around making people feel bad. That’s not what I’m after.” I pressed harder: Did she believe they are to blame? “Yes, I think there’s a lot of karmic stuff that goes on, past lives.” So, I asked, with a situation like the Holocaust, the victims might have been an unfortunate group of souls who deserved what they got because of their behavior in past lives? “Yes, it can work that way,” Hay said. “But that’s just my opinion.”

Making Hay
Hay, 88, is a former fashion model who was diagnosed with cervical cancer in the 1970s, something she attributes to her fury and lack of forgiveness over the abuse she suffered as a child, including reportedly being raped at age 5. She refused medical treatment for the cancer, and claims to have cured herself with positive thinking, diet and enemas. Writes The New York Times: “There is, she says, no doctor left who can confirm this improbable story.”

She wrote a small pamphlet of “cures” in 1976. This became the book Heal Your Body which spawned a vast New Age publishing empire whose innumerable titles promise health, wealth, and visitations from angels.

A big chunk of the book is “The List”—a compendium of various ailments and their causes:

• Cancer, for instance, is “caused by deep resentment held for a long time until it literally eats away at the body....the individual lives with a sense of self-pity....people with cancer are also very self-critical...carrying hatreds.” How does that message go down at, say, Great Ormond Street Children’s Hospital, or in oncology wards the world over, or among families that have been impacted by cancer, which by the way is most families: cancer will afflict 50 percent of us in the U.K. at some point in our lives.

• I’d like to see Hay address a roomful of people with diabetes and tell them its supposed cause: “Longing for what might have been. A great need to control. Deep sorrow. No sweetness left.”

• Aids is not caused by the HIV virus but from “a strong belief in not being good enough. Denial of the self. Sexual guilt.”

• “Most bladder problems come from being ‘pissed off,’ usually at a partner.”

• Old people increasingly find walking to be difficult, not as a natural consequence of the aging process but because “their understanding has been warped, and they often feel there is no place to go.”

• Strokes are caused by “negative thinking”; miscarriages by “fear of the future.”

• Animal bites are caused by “anger turned inward. A need for punishment”; bug bites by contrast happen when you have “guilt over small things.”

• “Accidents are no accident. Like everything else in our lives, we create them.”

These deranged ramblings would be funny if they didn’t inflict so much pain on vulnerable people who are already suffering. Blaming the victim is an insult to anyone who has ever got sick; to the memory of any family member, friend or colleague who has died of anything other than natural causes. As someone who has struggled with chronic illness I find Hay’s philosophies to be at best highly presumptuous and at worst deeply offensive.

Such irresponsible quackery should come with a health warning.

BE A MAN

Help is a four-letter word: men and suicide

News comes this week that the suicide rate for middle-age men with mental health issues has risen by 73 percent since 2006. “The problem is not simply that they don’t seek help – they are already under mental health care – so we have to understand better the stresses men in this age group face,” says Louis Appleby, formerly the government’s mental health tsar and who leads the national suicide prevention strategy.

This is in keeping with a general significant rise in male suicide over the past decade—although curiously not in Scotland, which has seen a decline—while the incidence for women has remained constant. The male suicide rate is the highest since 2001. The suicide rate among men aged 45-59, 25.1 per 100,000, is the highest for this group since 1981.

So the question is why? There are plenty of economic reasons: the recession, falling income, “zero-hour” contracting, debt, unemployment.

But there is another reason. Judging by the way he tends to be represented in our culture, a “real man” is supposed to be: strong, logical, heterosexual, attractive, virile, successful, young, deep, powerful, wealthy, rugged, hard, active, white, decisive, potent, funny, brave, knowledgeable, determined, ambitious, autonomous, rational, unemotional (though anger is desirable in certain circumstances). And under no circumstances is he to ask for directions. Ever.

“Eros” dominates the female psyche, while males are governed by “Logos.” From an early age, little boys learn they must “repudiate all that is soft, vulnerable, playful, maternal and ‘feminine’ ” writes Andrew Samuels.

Many grow up to remain as little boys sequestered in grown-up bodies, destined to labour under the limitations of what Moore and Gillette call “Boy psychology.”

“Boy psychology is everywhere around us, and its marks are easy to see,” they write in King, Warrior, Magician, Lover. “Among them are abusive and violent acting-out behaviors against others, both men and women; passivity and weakness, the inability to act effectively and creatively in one’s own life and to engender life and creativity in others (both men and women).”

Men learn to keep their relationships with other men on a superficial level. Acceptable topics: sports, cars, humour, women (as sex objects); unacceptable ones: sadness, loneliness, confusion, despair, love, joy, beauty, wonder. And men’s relationships with women stereotypically revolve around conquest and control. Writes Meg Barker: “This can mean that they don’t have a close, supportive relationship with anyone.”

To be whole, we must learn to embrace all aspects of our selves, and for men that means the female archetype within, what Jung called the anima, while at the same time not diminishing the strength of our true malehood, which some of the more extreme branches of feminist philosophy would like to completely eradicate or, perhaps we might say, emasculate.

Part of being human is acknowledging your vulnerability, your suffering, your sadness, your despair. Admitting your weakness—and asking for help—paradoxically requires great strength.

The consequences of not doing so are dire: Men are more than three times as likely than women in the U.K. to commit suicide, or be alcohol-dependent. Men are 20 times more likely to be sent to prison.

Increasingly, there seems to be less of a stigma about seeking help. Almost one person in five in the U.K. has consulted a counsellor or psychotherapist. Maybe you’ve considered it but are not sure. Watch this short film written and narrated by Alain de Botton. And try it. Sometimes in life you have to take a risk.

Most of my counselling clients are men. They are all different, but they all want a richer, fuller, more meaningful, more colourful life. They want to love and be loved. It’s not always easy. But they fight for it, every day. I think of each of them as incredibly courageous.

Real men ask for help.
—John Barton

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TRUE NATURE

This week I took a short work-related trip to Scotland. When I got out of the car, something was different. Immediately I felt the crisp, perfumed caress of something strange, something that city-dwellers have long had to live without: fresh air. I filled my lungs with this exotic elixir and instantly felt stronger, happier, fitter. I slept better in Scotland. I became more alive, more human.

If only you could bottle this extraordinary intoxicant, you could make a fortune. (Actually someone did that already, in China, whose cities bring pollution to a whole new level.)

Even though we may not understand all the reasons, it makes intuitive sense that metropolitan living can be detrimental not only to our physical health, but to our very psyches, too. The research findings are not a huge surprise: Urbanites have higher rates of anxiety and depression. We’re more frazzled, more sensitive to criticism. Schizophrenia, too, is much more common in cities. And since 2009, more than half the world’s population lives in cities, according to the United Nations. That’s almost 4 billion souls potentially denied the oxygen of a healthy environment, one free of pollution, car alarms, and armies of sharp-elbowed impatient people rushing to the next meeting—or away from themselves. The Hopi call it Koyaanisqatsi or “life out of balance" (and if you haven't seen the mind-blowing 1982 film of that name, please stop reading this or whatever else you are doing and order it now). 

• Relieve stress. Whatever works for you. Mindfulness. Music. Exercise. Take up golf—a way of being among greenery and it might make you live five years longer (or, depending on how you play and who you play with, it might just make you feel five years older). If the stress of city life gets really bad, or even if it doesn’t, get some help.

• Join or get involved with local wildlife organisations like the London Wildlife Trust, or global ones like Friends of the Earth, the World Wildlife Fund, or Greenpeace.

• Take regular daytrips beyond the city limits (and beyond your comfort zone). Hopefully this will be more successful and uplifting than the legendary, foul-mouthed scene from “Trainspotting” when “Tommy” drags his sceptical city pals to the beautiful, desolate Rannoch Moor (“This is not natural man,” says one.) 

• Use your vacations, too, to get back to basics. Head for the hills: camp in the Lake District for instance, and “walk in blessedness” there as Wordsworth did all those years ago.

As the wandering, wondering wordsmith said: “Nature never did betray the heart that loved her.”
—John Barton


U.K. NEWS

Large UK trial to ask if mindfulness boosts teenage mental health
From Reuters:

Nearly 6,000 British school children are to take part in a major trial designed to assess whether mindfulness training for teenagers can improve their mental health.

Mindfulness is based on the idea of being more aware of the present by intentionally focusing on emotions, thoughts and sensations and viewing them with acceptance. Advocates say this understanding helps people to respond in ways that are more purposeful, rather than reacting on "automatic pilot".

The three-part study will include the first large randomized control trial of mindfulness training compared with teaching as usual in 76 schools.

Further parts of the study include experimental research to establish whether and how mindfulness improves mental resilience of teenagers, and an assessment of the most effective way to train teachers to deliver mindfulness classes to pupils.

Brain scientists know that teenage years are a crucially vulnerable time for mental health, particular in brain regions responsible for decision-making, emotion regulation and social understanding. More than three-quarters of all mental disorders begin before the age of 24, and half by the age of 15.


U.S.A. NEWS

Even mild mental health problems in children can cause trouble later
From NPR:

It's not easy for a child who has had mental health issues to make a successful transition into adulthood. But even children who have symptoms that are mild enough that they wouldn't be diagnosed are more likely to struggle with life as adults, a study finds.

Children and teenagers with a psychiatric disorder had six times higher odds of having at health, legal, financial and social problems as adults, according to a study published Wednesday in JAMA Psychiatry. Those with milder symptoms were three times more likely to have problems as adults.

We already know from previous studies that most adults with mental health issues had a previous psychiatric disorder during childhood – it doesn't have to be the same exact condition. But this study shows mental health problems that occurred during childhood can make it more likely that someone will struggle as an adult, making it more likely that they won't graduate from high school or commit a felony, for instance.


Judge orders counseling for Obama critic Dinesh D'Souza
From India West:

A New York judge has ordered Dinesh D'Souza, an Indian American conservative scribe and Obama critic filmmaker, to do community service for four more years for breaking campaign-finance laws and undergo further counseling.

Judge Richard Berman clarified July 13 that under the sentence he handed down after D'Souza pleaded guilty last year, he has to do eight hours each week for the entire five years he is on probation and not just the eight months he was confined to a halfway house.

The Manhattan federal court judge also read aloud a report from a court-appointed psychologist who called D'Souza "arrogant" and "intolerant of others' feelings," according to the New York Post.

"In my mind it was never contemplated that the eight hours only applied to the period of home confinement," Berman was quoted as telling defense attorney Ben Brafman.

He later read out a report from a psychologist who saw D'Souza, the maker of the anti- Obama film "2016: Obama's America,” and then ordered him to continue attending weekly sessions, the Post said.

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DYING WITH DIGNITY

In America in 2009, there was a proposal for Medicare, the government’s health insurance program for the elderly and the disabled, to provide end-of-life counselling. There was an outcry—Republican vice presidential candidate Sarah Palin for instance screeched about  the spectre of government-sponsored “death panels” deciding when the game was over for hordes of frail and befuddled elders. It became a divisive issue that threatened to derail President Barack Obama's health care law.

This week, Medicare finally announced that it intends after all to proceed with end-of-life counselling. There were only a few murmurs of dissent. If the proposal is accepted, the elderly and their families will be able to have conversations with doctors and nurses in advance about what kind of care and interventions they want as they face the final curtain—and what they don’t want.

Giving people greater control over their death seems like an eminently sensible idea. Just because we have the technology to extend life with with a roomful of machines, tubes and drugs doesn’t always mean that’s the right thing to do, especially when the person involved has clearly expressed their desire not to “live” in this way.

A civilized society should help people to die with dignity. In some countries that means not just withholding excessive though potentally life-saving treatments but actively allowing doctor-administered death, especially when the person is suffering or in great pain from a terminal illness. Switzerland has allowed doctor-assisted suicide since 1942. Voluntary euthanasia—where the doctor actually administers the fatal dose at the patient’s request rather than merely prescribing it or handing it over to the patient—was made legal in the Netherlands in 2002, but only under strict criteria. The patient's request, awareness and level of suffering must be clear and sustained, suitable information and consultation must be provided, there must be absence of reasonable alternatives, doctors must consult with other doctors and they must report euthanasia to a review committee. Belgium followed the Netherlands later in the year, followed by Luxembourg in 2009 and, this year, Canada and Colombia.

The practices of assisted suicide and voluntary euthanasia are both illegal in the U.K., but that may change. According to a 2007 survey, 80 percent of Brits are in favour of giving terminally ill patients the right to die with a doctor's help.

In the U.S., a Supreme Court decision left rulings about assisted suicide to the discretion of individual states. Oregon swiftly passed a law allowing doctors to prescribe lethal drugs for people who have been given less than six months to live. Washington, Montana and Vermont now have similar laws in place.

Opponents of such laws are concerned that they could be abused. A compliant or confused parent for instance might be coerced into literally signing their life away by uncaring offspring who are eager to get their hands on an inheritance as soon as possible.

“I don’t want to be a burden,” the elderly often say.
“Ok, well sign here then,” the heartless son or daughter might reply.

But the problems, the violations, the abuses, do not alter the principle. Just because some people might exceed the speed limit, jump a red light or drive without a license does not mean that all driving should be banned.

We have some choices in how we live. Perhaps an enlightened government can offer some choices in how we die, too.

Medicare plans to pay for end-of-life counseling
From the Boston Globe:

Medicare, the federal program that insures 55 million older and disabled Americans, revealed plans Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.

The proposal will be open for public comment for 60 days, but it is expected to be approved and take effect in January. If adopted, it would settle a debate that raged before the passage of the Affordable Care Act, when Sarah Palin labeled a similar plan as tantamount to setting up “death panels” that could cut off care for the sick.

Medicare’s plan comes as many patients, families, and health providers are pushing to give people greater say about how they die — whether that means trying every possible medical option to stay alive or discontinuing life support for those who do not want to be sustained by ventilators and feeding tubes.

“We think that today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team,” said Dr. Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid, also known as CMS, which administers Medicare. “We think those discussions are an important part of patient- and family-centered care.”


U.K. NEWS

Will George Osborne's budget give our children Hikikomori - Japan's new mental health problem?
Mirror.co.uk:

George Osborne's budget will create a generation of young people too scared to leave their bedrooms and rendered mute by fear of the future, according to a British expert.

They will be suffering from Hikikomori a condition believed to affect as many as ONE MILLION Japanese.

Symptoms include hiding away from society and only interacting with the world to surf the Internet and reading fantasy literature.

The Chancellor's plans to limit the living wage to those aged 25 and older, along with scrapping grants to university students, increasing fees in line with inflation and cancelling housing benefit for 18-21 year olds are all likely to make matters worse.

Hikikomori is a huge problem among Japanese youth and can lead to people locking themselves away from the outside world for months and sometimes years on end.


Children's mental health must be cared for. Or the consequences will be dire
From former minister for mental health Paul Burstow, in The Guardian:
 
The chancellor tells us that he is putting into law the obligation to generate budget surpluses in the “interests of our children”. But the axing of funding for children’s mental health in the service of economic dogma will condemn a generation of young people to a life of misery for want of the right mental health support in their early years.

Half of life-long mental illness has its first signs and symptoms in the teenage years. Poor maternal mental health can have profound consequences for them, for their children and their children’s children. The LSE put a figure on this of £8.1bn.

Yet while one in 10 children and young people has a treatable mental illness just one in four receives treatment. It is a shocking indictment of our mental health services.

• School accountability triggering pupil mental health problems, research warns (The TES)

• Exam focus damaging pupils' mental health, says NUT (BBC News)

 
More provision needed for mothers during pregnancy and after birth
Medical Xpress:
 
More research is needed to improve the identification and treatment of women with perinatal mental health issues, according to a new editorial co-authored by Professor Susan Ayers, the lead of the Centre for Maternal and Child Health Research at City University London.

Along with co-author Judy Shakespeare, from the Royal College of General Practitioners, Professor Ayers' article highlights how between 10 and 20 per cent of women suffer from mental health problems during this period, costing the NHS £1.2 billion a year. The editorial is published in the journal of Primary Health Care Research & Development.

Mental health problems can arise in pregnancy or after birth and most commonly consist of anxiety, depression, post-traumatic stress disorder (PTSD) following a difficult birth and stress-related conditions such as adjustment disorder. Severe postnatal mental illness, such as puerperal psychosis, is less common, but is one of the leading indirect causes of maternal death.

U.S. NEWS

Researchers: Vampires are people, too, and need as much psychotherapy as the rest of us
From the Washington Post:

Vampires are real. No, not the impossibly perfect Cullens in the "Twilight" movies or tortured but well-dressed souls in CW shows. But human beings who self-identify as vampires and may drink blood or sleep in coffins. And these people need as much psychotherapy and medical help as the rest of us.

That's the conclusion of a study by D.J. Williams, director of social work at Idaho State University, and published in the July issue of the peer-reviewed journal Critical Social Work.

Williams and his co-author, Emily E. Prior, a researcher at the College of the Canyons, interviewed 11 vampires from across the United States and South Africa and found that they were reluctant to come out to clinicians because they were fearful about being labeled as being psychopathological or "perhaps wicked, and not competent to perform in typical social roles, such a parenting."

However, he noted that the people he interviewed "seem to function normally, based on demographic questions concerning their psychiatric histories, in their social and occupational roles, and some have achieved considerable success in their chosen careers."


WORLD NEWS

India: counselling reveals anger, helplessness
From The Hindu:

Counselling sessions of the victims of the child prostitution case revealed their anger and helplessness at their precarious plight.

The victims are believed to have told counsellors arranged by the Child Welfare Committee that they were angry with themselves and with those who had pushed them into prostitution.

They reported feeling guilty and disoriented, and having haunting memories and an inability to remain calm according to information from the sessions overseen by the CWC.

Apart from the anxiety about the future, there was also fear about being recognised in public.


VIEWPOINTS

Sex therapy is making its way into couples counseling, and it's about damn time
From Lea Rose Emery, in Bustle:

Some “renegades” in the field of couples therapy are bringing sex into counseling, The New York Times reports. Although couples therapy and sex discussion may seem like obvious bedfellows, discussions of sex have often been, counterintuitively, absent during couples counseling. The reasons for this may be that the two arenas, couples counseling and sexual counseling, developed as completely different strains, meaning that overlap between them was limited. Often relationships counselors often have no sexual training, as there are currently no requirements for sexual education in traditional counseling licensing.  And the opportunities to receive sexual training are limited. According to The New York Times there ”is only one certification program for sex therapists, the American Association of Sexuality Educators and Counselors, which means aspiring sex therapists may find access to courses and supervisors a challenge.” 
But luckily the increased acknowledgement of the importance of sex in relationships may help change this. Some therapists are now “emphasizing the importance of good sex in relationships and sometimes suggesting the radical idea that couples fix the sex before tackling other issues”. This makes me so happy. 

 
Psychiatric drugs are false prophets with big profits. Psychiatry has been hijacked
From Robert Berezin MD, Mad In America:

We have repeated the same mistakes over and over again, and we are doing so today. It doesn’t seem to matter that the chemical imbalance theory has been discredited. It doesn’t seem to matter that the multibillion dollar pharmaceutical industry and its influence peddling in academic psychiatry has been exposed as financially and scientifically corrupted and manipulated. The drug companies have engaged in study suppression, falsification, strategic marketing, and financial incentives. A complete picture of the studies that pretended to validate antidepressants has now emerged which confirms that they do absolutely nothing. (See – “No, it’s not the Neurotransmitters, Depression is not a biological disease cause by an imbalance of serotonin.”) It rakes in a whopping $70 Billion a year for the drug companies. Unfortunately once people embrace a false belief it is so hard to think clearly again. I’m told its irresponsible to be so extreme. A thoughtful psychiatrist would use both drugs and psychotherapy. Apparently this sounds reasonable in today’s climate. Doing harm is never reasonable.
Human struggle is now, and always has been, the real issue. The very idea that drugs can cure what ails is an insult to the human condition.


The magical healing power of caring and hope in psychotherapy
From Allen Frances in the Huffington Post:

There are three consistent research findings that should make a world of difference to therapists and to the people they treat.

First, psychotherapy works at least as well as drugs for most mild to moderate problems and, all things being equal, should be used first.

Second, a good relationship is much more important in promoting good outcome than the specific psychotherapy techniques that are used.

Third, there is a very high placebo response rate for all sorts of milder psychiatric and medical problems.

This is partly a time effect -- people come for help at particularly bad times in there lives and are likely to improve with time even if nothing is done. But placebo response also reflects the magical power of hope and expectation. And the effect is not just psychological -- the body often actually responds to placebo just as it would responded to active medication.

These three findings add up to one crucial conclusion -- the major focus of effective therapy should be to establish a powerfully healing relationship and to inspire hope. Specific techniques help when they enhance the primary focus on the relationship, they hurt when they distract from it.

• psychogram #4
• psychogram #3
• psychogram #2
• psychogram #1
• https://instagram.com/world_of_therapy/

SUMMERTIME

Summer boldly announced itself on Wednesday this week—July 1—with temperatures in London reaching 36.7C (98F). It was the hottest July day in the UK since records began in the 1870s. Hotter than Barcelona, Ibiza and Athens.

Summer is good, right? The living is easy. The sunshine makes us happy because it promotes vitamin D, an antidepressant. We’re nicer, more helpful. We become heightened, more relaxed, more confident and better-looking versions of ourselves at this time of year. We ripen. We are in abundance. Aren’t we?

No, not necessarily. For some, summer is a time of dread. You’re “supposed” to be living la dolce vita, basking with amazing friends in some tropical beach resort, Tuscan villa, or Caribbean yacht or whatever, and you’re not. You’re home, alone, still you, still unhappy. The heat saps your strength. You’ve lost your appetite. All your appetites. The noonday glare is oppressive, exposing you, attacking you. Maybe you have a disability that means you can’t head for the beach, or a poor body image that makes it impossible to wear sandals, shorts or skimpy swimwear. You’re anxious and you can’t sleep. The kids are home from school or college. Everything is expensive. Tempers flare. The pollution is terrible. You can’t breathe. No wonder suicide rates rise in spring and summer.

There is something called “seasonal affective disorder” or SAD. It is generally a chronic, recurring low mood, but usually in the winter months—a kind of annual psychic hibernation.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) identifies it as a type of “major depressive disorder” with a seasonal pattern: “The essential feature is the onset and remission of major depressive episodes at characteristic times of the year...This pattern of onset and remission of episodes must have occurred during at least a 2-year period, without any non-seasonal episodes occurring during this period.”

SAD was first identified in 1984 by Dr. Norman E. Rosenthal and his associates at America’s National Institute of Mental Health (Rosenthal’s definitive book on the subject is Winter Blues). The estimates of prevalence of SAD range from 1.4 percent in Florida to almost 10 percent in northern, low-light regions such as Alaska and Finland. SAD is thought to have an organic cause, perhaps some delicate bodily unbalance involving circadian rhythms, melatonin and serotonin levels and the pineal gland. It has been found to respond well to bright-light therapy.

The summer variant--sometimes called reverse seasonal affective disorder or “summer SAD”—is more unusual. According to researchers’ estimates, it’s about a tenth as common than the winter kind, although in some countries near the equator like India or Brazil, the summer kind is more prevalent.

• Seasonal depression can accompany summer sun (The New York Times)
• Summer depression: causes, symptoms, and tips to help (www.webmd.com)
• Janis Joplin sings “Summertime” in 1969 (YouTube)
A year later she died from a heroin overdose:
One of these mornings
You're going to rise up singing
Then you'll spread your wings
And you'll take to the sky

U.K. NEWS

Semicolon tattoo trend spreads to raise awareness over mental health
This is an interesting project. Getting a tattoo is a step up from wearing one of those charity bracelets that were popular a few years ago. Project Semicolon was started in America in the spring of 2013 by Amy Bleuel, who lost her father to suicide. Why a semicolon tattoo? Because “A semicolon is used when an author could've chosen to end their sentence, but chose not to. The author is you and the sentence is your life.”
It is a faith-based Christian organisation. “This by no means excludes any other beliefs or religions, as we accept them all,” states the Project Semicolon website. But it is of course by its very nature exclusionary. People of other beliefs or religions are unlikely to want to get involved. Why not unite people with mental health challenges the world over by making it nondenominational? Until or unless that happens, for most Project Semicolon is a Full Stop.
From www.dailymail.co.uk:

Thousands of people across the globe are getting semicolons tattooed on their bodies in a bid to raise awareness about mental health.
The simple punctuation mark - used to divide sentence clauses - has been adopted by the non-profit group 'Semicolon Project' to help raise awareness over depression, anxiety, self-harm and suicide.
The organisation hopes that by persuading people to have semicolon tattoos - permanent or temporary - will help break down the stigma associated with mental illness.

Although the U.S.-based charity was founded in April 2013, it has recently attracted renewed attention. 
Indeed, Emma Richards of Llandudno, Wales, got a semicolon tattooed on her little finger this week after reading about the initiative online.
The 30-year-old started suffering with depression after her young son was diagnosed with cerebral palsy, epilepsy and autism.
Today, she remains on medication to alleviate the symptoms, which include palpitations and panic attacks.
She told Mirror.co.uk that she read about the Semicolon project and completely related to the message.

EastEnders: Lee Carter to battle depression in new mental health storyline
From the Radio Times:

EastEnders is working with mental health charity Mind for an upcoming storyline that will see Lee Carter (Danny-Boy Hatchard) fight depression.

In the coming weeks, viewers will see army recruitment officer Lee begin to struggle with everyday life as he battles with his emotions. After coming under pressure from sister Nancy (Maddy Hill) to reveal what's wrong, Lee finally comes clean.

But Lee will decide to keep his feelings from mum Linda (Kellie Bright) and dad Mick (Danny Dyer) for fear of causing them worry.

"This is not a subject that only a handful of people can relate to. It’s something that at some point most people in their lives will experience on different levels," said actor Danny-Boy Hatchard, who plays Lee. 

As to how the depression will affect Lee's relationship with Whitney, Hatchard explained: "This will make them stronger. What Lee wants in a relationship is what his own mum and dad have. And Lee knows that in order to have that, he has to confide in Whitney.


Positive view of NHS marred by fears over dementia and mental health care
From The Guardian:

Public perceptions of local NHS care for people with mental health problems and dementia are stubbornly low despite overall pride in England’s healthcare system rising to its highest level in recent years, a government-commissioned survey reveals.

Just over two-thirds of more than 1,000 adults questioned in their own homes last winter were satisfied with the running of the NHS at a national level – a figure that has seen little change – but satisfaction with local services dropped from 78% in 2013 to 74%.

Well over eight in 10 people who have been to hospital or their GP recently are positive about the experience, according to a report from the Ipsos Mori Social Research Institute.

More negatively, a higher proportion of people think those with mental health conditions are not well cared for (39%) compared with those who think they are (31%). Dissatisfaction has increased by seven percentage points since the last but one survey in spring 2013. Almost three in 10 people say they don’t know about care for this group of patients.


U.S.A. NEWS

Science proves what you suspected: hiking's good for your mental health
From the Los Angeles Times

Do not underestimate the power of a walk in the woods: A new study suggests that even a 90- minute stroll in a natural environment can lead to measurable changes in the brain, and may help combat depression.

Previous research has shown that just a 50-minute walk in nature can improve your mood, decrease your anxiety and even improve your memory. But for the new study, published this week in PNAS, the research team wanted to see if they could understand what the mechanisms for these positive effects might be.

To help them figure it out, they decided to focus specifically on what psychologists call "rumination," which has been shown to predict depressive episodes.

"Ruminative thought means something very specific in psychology," said Gregory Bratman, a PhD candidate in environmental science at Stanford University and the lead author of the study. "It is repetitive thought that is focused on negative aspects of the self."

Examples of rumination include spending a lot of time thinking back over embarrassing or disappointing moments, or rehashing recent things you've said or done.

To see how a walk in nature affects ruminative thought, the researchers randomly assigned 38 volunteers with no history of mental illness to take a 90-minute walk in an urban green space near Palo Alto or a loud, busy street with three to four lanes of traffic in each direction.


Traumatizing impact of family detention on mental health of children and mothers
From the American Immigration Lawyers Association:

The psychological harm caused when mothers and children seeking asylum in the U.S. are detained in jail-like facilities is the subject of a complaint filed today with the Department of Homeland Security's Office of Civil Rights and Civil Liberties (CRCL) by the American Immigration Lawyers Association, the Women's Refugee Commission, and the American Immigration Council. The complaint includes details of the harsh and detrimental impact of detention on ten case examples of mothers and children documented by mental health professionals after in-depth evaluations. CRCL must immediately and thoroughly investigate these cases of trauma in family detention and further request a complete investigation into psychological and physiological impact that family detention is having on children and mothers.


WORLD NEWS

Turkey: Therapy center looks to heal wounds of Syrian children of war
From Daily Sabah:

Two nongovernmental organizations inaugurated a rehabilitation center in Istanbul yesterday for Syrian children and their mothers traumatized by the civil war in their country.

The Psychosocial Support Center in Istanbul's Fatih district, a hub for displaced Syrians who fled to Turkey after war broke out in their country four years ago, will provide therapy to distressed children and their families.

Mevlüt Yurtseven, director of the Alliance of International Doctors, one of the NGOs operating the center, said Syrian children underwent the most severe trauma during the war and they aimed to help them to recover.

The center will serve 240 children and their mothers in six-monthly terms during which they will undergo psychotherapy, art therapy including other forms of therapy. Both mothers and children will be able to attend the lifelong learning courses that aim to help traumatized children forget their past troubles and boost their self-confidence, NGO officials said.

Apart from children, the center will cater to Syrian women in need of legal and social counseling and offer Turkish classes.

Turkey is home to nearly 1.8 million Syrians and over 260,000 Syrians living in tent camps built by the Turkish government in provinces near the Turkish-Syrian border, while others either reside in their own homes, in rental houses or squat in abandoned buildings and parks. Psychological therapy and social support are provided for Syrians in camps but those not living in camps have no prospect of therapy.


Australia: new concept takes counselling into the great outdoors
From www.dailytelegraph.com.au:

If EXERCISE is just as good as medication in treating depression then Ryde psychologist Jo-Anne Sammons could be on to an absolute lifesaver – counselling in the great outdoors.

It was while completing a course at the Black Dog Institute, which looked at the success of using exercise to treat mild and moderate depression, that Ms Sammons came up with the idea of walking and talking.

“I’d been thinking about it for a couple of years,’’ she said. “I had a client with a newborn baby and she had post-natal depression. I thought, ‘wouldn’t it be great if we could do this outside where she could push the baby in a pram’.

“When you are outside you can practise mindfulness, focusing on the sun on your face, you get the benefit of exercise and some people just feel more comfortable being side-by-side – particularly men.’’

Holland: Dutch study on diabetes reports effectiveness of mindfulness-based psychotherapy
From Diabetes News Journal:

In a recent study published in the Journal of Psychotherapy and Psychosomatic, a team of Dutch researchers led by professor Paul Emmelkamp assessed the long-term clinical outcomes of psychotherapy in patients with diabetes.

Patients with diabetes often report depressive symptoms, a comorbidity that has a negative impact in clinical outcomes and mortality. The burden of depression is increased by the fact that it is a chronic and progressive condition, with high rates of relapse. Recently, evidence has shown that Mindfulness-based cognitive therapy (MBCT) is effective and beneficial as a psychological treatment for patients with depressive symptoms. The method is also beneficial for relapse prevention.


VIEWPOINTS

Equality at work is still a pipedream for people with mental health problems
From Clare Allan in The Guardian:

One of the very few things the last government did to make life easier for people with mental health problems was to introduce legislation preventing employers from asking about the health of an applicant before making a job offer. (There are some exceptions. You cannot apply to MI6 if you’ve ever been diagnosed with either “manic depression” or schizophrenia, for example.)

While this change was long overdue and extremely welcome, that such legislation is needed is indicative of the fact that true equality, equality whereby the full range of human experience is regarded as equally valid and potentially useful, is still pretty much a pipedream for the vast majority of people with mental health problems. The best we can hope for is that nobody will find out.

This seems a pity. It’s a pity for the person forced to try and conceal the gaps in their CV by means of extended periods of “overseas travel”, career breaks and whatever else, like brushing strands of hair across a bald patch. But it’s a pity for employers, too, who must assess candidates without access to information on the full range of skills and experience they may have to offer.


How ketamine is revolutionizing the way we treat depression
From Dr. Keith Ablow in Fox News:

I have now treated approximately one hundred patients with intravenous ketamine. The results mirror those of research trials on the treatment; more than two thirds of my patients have experienced dramatic recoveries. Their profoundly low mood, lack of energy, decreased self-esteem and even suicidal thinking very frequently yields entirely to the ketamine infusions. And while the results from ketamine may last weeks or months, that is often more than enough time to allow other medications and psychotherapy to permanently rid patients of their suffering.


Have your feelings without your feelings having you
Dr. Gary Trosclair in Huffington Post:

I've noticed that most people come in to therapy with some preconception about what to do with their feelings in session: Some believe that venting will help them to heal, others feel that it will be most helpful to remain distanced from their feelings so that they can analyze them. They're both right. And they're both wrong. It's the use of both of these modes in alternation that's most helpful -- though I think that there are better ways to describe them than "venting" and "analyzing."

We need to value our feelings and use them rather than trying to get rid of them through either venting or analyzing. I've found that the best way to do this is to let feelings rise into consciousness, fully experience them, contain them and learn from them, and then decide what to do about them. This means expressing feelings without reacting to them impulsively, and then making conscious decisions about how to live based on what we learn from them.

This whole process could take minutes or years. Some feelings take a long time to fully rise into conscious, and to be fully experienced and fully understood. Others emerge quickly.