Posts Tagged ‘mental health’

Our current system of understanding mental health is typically based around psychiatric diagnosis. You go to your doctor and your doctor gives you a label like “social anxiety disorder” or “borderline personality disorder”. These labels are, on the whole, stigmatising and unhelpful.

Worse, they are not grounded in evidence-based medicine. After a hundred years of lookng, we cannot find the biomarkers for mental illness. Depressed people do not have lower serotonin, for example. Nor are there genetic markers. As far as we can tell (and research has been well-funded and plentiful), mental health issues are not an “illness” in the traditional medical sense.

So then we say “okay but they are functional”. Something happens to someone which activates underlying vulnerabilities and they develop social anxiety. But this does not hold up, either. There are no clear pathways of things that trigger specific labels (the everything causes everything problem) and the majority of service users meet the criteria for multiple labels (the everyone suffers from everything problem).

As a result, we don’t know what causes any of these labels (no biomarkers or pathways), what they look like (people’s symptoms transcend multiple labels) or what to do about it: most first line treatments like anti-depressants or single-diagnostic CBT seems to make things worse.

Much of psychology already recognises this problem and has suggested dropping the word “disorder” and changing the question from “what is wrong with you?” to “what has happened to you?” Trauma-informed approaches are opening up a much greater scope for what counts as trauma.

The Power Threat Meaning Framework goes beyond that. It asks how power been used in someone’s life (think oppression), what threat that created, what meaning the person made of it and what threat responses were activated. It suggests that all troubling experiences and behaviour, from mild anxiety and depression, to hearing voices, self-harm and eating disorders, can be understood from this perspective.

It also suggests that all behaviour is on a continuum, from “normal” to “clinical”. This is important because while some critics might agree mild anxiety is part of normal human experience, they often bawk at the idea that hearing voices or dissociation is typical. Even though most people regularly “zone out” (dissociate) on a regular basis.

The PTM Framework offers what it calls a general foundational pattern and seven provisional general patterns. These allow us to explore useful patterns without detracting from an individual’s personal narrative.

• Identities
• Surviving rejection, entrapment, and invalidation
• Surviving disrupted attachments and adversities in care
• Surviving separation and identity confusion
• Surviving defeat, entrapment, disconnection and loss
• Surviving social exclusion, shame, and coercive power
• Surviving single threats

The PTM Framework is a contribution to the movement away from psychiatric diagnosis which still has much work to do, and the document acknowledges this.

But we are already seeing improvements. Many services, such as educational support and some NHS mental health services, look at individual need rather than labels and many have switched away from using disorder-specific measures to general outcome measures.

I don’t claim to have done justice to this document in any way in this blog post. You should go read it; it’s fantastic, if quite a technical read.

One of the main reasons there is nothing on my blog this month is that I have my head burried in writing a research paper. Even though I’m not at the writing stage yet. The paper is on mental health in ultra-endurance athletes and I’m currently on the data analysis stage. Watch this space. But not too closely because it’s a slow process.

The Body Keeps the Score is a book on trauma by Bessel van der Kolk. van der Kolk makes the case that trauma is the most pressing public health crisis. It is everywhere, affects a huge number of people and is the number one treatable condition that can improve people’s mental health, give millions of people a chance to live a better life and reduce intergenerational abuse.

He discusses both PTSD, which occurs when someone experiences a traumatic event or events as adults, and childhood trauma, which affects the individual’s development, attachment style and ability to form relationships. Memories of the event(s) are often frozen in time with the individual unable to process it. By process, we’re talking about our ability to form a coherent narrative, with closure, that allows the memory to fade into the background and allow us to move on with our lives even if the scars remain.

He discusses the limitations of talking therapy, though somewhat focusing on CBT over more humanistic approaches, and explores what other evidence-based approaches may work. Notably EMDR, but given the need to physically rewrite the body, also the possibility of using yoga, theatre and other lived-out approaches.

The Coddling of the American Mind is a book by Greg Lukianoff and Jonathan Haidt. It makes the case that people are “anti-fragile” and that by protecting people from ideas they disagree with, we are actually doing them harm.

The book focuses on the limitations of free speech being introduced across university campuses and the idea that everyone should feel safe. This is antithetical to the way CBT works. If a client comes to therapy and says “I don’t feel safe because I think I will be killed by a tiger” we would look for the evidence around how many tigers live in their local area and whether they typically attack humans. But on many university campuses, and wider society, people are using the idea of “feeling unsafe” to try and shut down freedom of speech. This is bad foe society but also for the individual because we amplify their anxiety.

The book also argues that it creates divisions in society. It argues that teaching things like micro-aggressions and consent workshops is currently done on the basis of negatively, encouraging people to give the least charitable rather than most charitable interpretation of ambiguous actions and therefore creating a negative interpretation bias (which again is something we would try to do the opposite of in therapy).

It also touches on the idea of trigger warnings. Again, in therapy, we would typically talk about how avoidance can be a maintaining factor in mental health problems. Removing avoidance in the safety of a therapeutic alliance is somewhat different to randomly doing it in real life, but it should at least give us a moment to stop and pause and consider how many of the strategies we think are helping people are actually making things worse.

The arguments and nuances in this book are complex and it is not possible for me to do it justice in this blog post. But I would encourage you to read the book yourself because it would be fascinating to hear other informed opinions on it.

Anxiety Leeds is closing. Since 2013, we’ve had thousands of people attend our support groups at the Leeds General Infirmary, supporting each other practically and emotionally. We hope that everyone who has come through our doors found some support from doing so.

Since the pandemic, we have been unable to hold face-to-face meetings. With myself and Chris having to step away from the organisation for personal reasons, we now do not have a venue, facilitators, or capacity to train new volunteers, and therefore it makes sense to close the group and allow others to take our place.

In terms of where you should go for support:

If you would like to access resources yourself and find out more about what is available in Leeds, MindWell remains the best place to visit.

In addition, you can access support at Linking Leeds. They provide Wellbeing Coordinators who can review your situation and help you access the most appropriate support.

I would like to extend a personal thank you to everyone who has attended, volunteered with, fundraised for, or otherwise been involved in Anxiety Leeds over the past nine years.

Four years ago I launched Worfolk Anxiety and since then I’ve trained tens of thousands of students via my online mental health courses. Worfolk Anxiety Management is still a key brand but of course, there is much more to mental health and wellbeing than anxiety and my current range of courses reflects that.

To reflect this wider focus on mental wellbeing, I’ve launched a new brand, Online Mindfulness School. The doors are now open with our mindfulness teacher, mental health ambassador and mindfulness for productivity courses and lots more on the way.

Two years ago we opened Leeds Anxiety Clinic and it has been a big success. Depending on your value of success. We have been very busy and are inundated with clients, which is a business success, but perhaps not a success for the state of society’s mental health.

We are now expanding and have opened a second branch in London, the Islington Anxiety Clinic. If you are in the London area and are looking for support in managing your anxiety, we’re here to help.

Anxiety Leeds has been running face-to-face groups since 2013. However, as we are based at the hospital, our meetings have been suspended since the pandemic arrived to ensure we keep both our clients and vulnerable hospital patients safe (from COVID, not from mental health problems, unfortunately).

So far, we have been referring people to other organisations who are better equipped to handle digital events and services. However, due to high demand, we are now trialling on an online community that allows attendees of Anxiety Leeds to interact digitally, hopefully providing the same level of warmth and support we were able to achieve in the group.

The Mindfulness for Anxiety app is now available for both iOS and Android on the Apple App Store and Good Play Store respectively. The app is completely free to use and comes with five guided audio practices, a self-timer mode that allows you to set any time length and a learning section where you can find out more about mindfulness.

They say that the necessity is the mother of all invention. With the impending COVID-19 crisis looming, we decided it was finally time to make virtual appointments part of Leeds Anxiety Clinic’s offerings.

That was easier said than done. Because of the social distancing recommendations already in effect, and Amazon having halted warehouse shipments, the few webcams that were available had all been panic-bought by other people. Luckily, we were able to beg and borrow the equipment we needed until we could get our own.

We’re still playing around with how to produce the best quality experience, both in terms of the technical setup and the differences between delivering therapy face-to-face, where you can easily scribble a diagram or analyse holistic body movements, and delivering it digitally. Early efforts are working well, though.