Raj Persaud in conversation - the podcasts ((3) extraordinary experiences of severe emotional turmoil)
Electro-Convulsive or 'Shock' Therapy - what is it like to revceive it?

Dr Raj Persaud talks to a lady who received ECT or shock treatment after a prolonged and severe bout of depression. What is it like to be treated with this therapy? What kind of problems lead doctors to consider using it? Are there side-effects? In the long-run is it worth it? Does this treatment work? Is the reality of such a treatment anything like it's portrayal in Hollywood films? All these questions and more are tackled in this rare interview with someone who has actually received ECT. 


Follow Dr Raj Persaud on Twitterwww.twitter.com/(link is external)@DrRajPersaud

Raj Persaud and Peter Bruggen are joint podcast editors for the Royal College of Psychiatrists and also now have a free app on iTunes and Google Play store entitled ‘Raj Persaud in conversation’, which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world.

Download it free from these links:

https://play.google.com/store/apps/details?id=com.rajpersaud.android.raj...(link is external)


Direct download: ect_and_raj.mp3
Category:(3) EXTRAORDINARY EXPERIENCES of severe emotional turmoil -- posted at: 10:26pm UTC

Obsessional Compulsions over Order - what can Helen teach us about OCD?

What can Helen teach us about Obsessive Compulsive Disorder? Interview with Helen Barbour by  Dr Raj Persaud


In the new novel ‘The A To Z of Normal’ by Helen Barbour - Clare Thorpe's need for order and symmetry governs everything she owns - from tins and toiletries, to cushions and clothes. Yet she has always managed to hide the compulsions dominating her world. Until now. When long-distance boyfriend Tom proposes, her secret life begins to unravel. How can she share a future with the man she loves, if she can't even share her space? And when the only way forward brings a threat greater than any compulsive behaviour, do they have a future together at all? A poignant and humorous story of love, family, secrets...and military precision.


The book is available to order here:




Helen's blog 'The Reluctant Perfectionist' is available here:






'Clare loves her boyfriend, Tom. So why is she panic-stricken when he asks her to marry him? Because marriage means living together. And that means he will find out what she’s really like...


In The A-Z of Normal, Clare inhabits a world in which extreme order and ritual rule. She arranges her belongings with military precision. The simplest of acts have to be done in a particular manner with dizzying attention to detail. It’s no wonder that keeping her compulsive behaviour secret from those closest to her proves exhausting. She wants to change. She tries to change. As she searches for a ‘cure’, however, her life becomes ever more complicated and, at times, she appears bent on throwing away her happiness. The way she is going it seems less and less likely she will ever make things work with Tom.


Helen Barbour understands the nature of obsessive behaviour and writes about it brilliantly. She explores a tricky subject with sharpness and humour. I found myself willing Clare on, wishing she could free herself from the stranglehold of her destructive compulsions. The A-Z of Normal is a funny and poignant story. If ever anyone deserves their happy ending, it’s Clare.'


Maria Malone, Author and Ghostwriter (Cheryl Cole, Tony Hadley, Eamonn Holmes, Mica Paris), www.mariamalonebooks.com


‘I loved The A-Z of Normal, by Helen Barbour. The author uses an intelligent blend of both humour and poignancy to journey with the protagonist through something inherently challenging. It's an intriguing exploration and clever observation of a challenging and touching personal struggle that leaves the reader satisfied...and yet hungry for more by the end of the book. I hope there will be a sequel!’


Tina Cadwallader


‘The A to Z of Normal is a well-paced book which I found difficult to put down.


Clare is finding it difficult to overcome her Obsessive Compulsive Disorder (OCD) behaviour before she marries Tom. Her family, each occupied with issues in their own lives, know nothing of her struggle so are unable to offer her any help. She joins a group in the hope that others suffering from OCD can offer support and there she meets Michael who creates additional problems in her life.


This captivating story explores the difficulties faced by OCD sufferers in a sensitive and humorous way.’


Carol Sampson

You can listen to the interview with Helen Barbour via a free app on iTunes and google play store entitled 'Raj Persaud in conversation', which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world. Download it free from these links








Committed to an Asylum. Claire explains what it's like to be committed to a psychiatric hospital against your will

What is it like to be committed to a psychiatric hospital against your will? This is surely one of the most frightening experiences anyone could endure? Claire was placed under a variety of sections of the Mental Health Act and as a result found herself committed on several occasions to various psychiatric institutions. Raj Persaud talks to her to get her story out to the world on what it's like to be 'sectioned'. The interview was organised thanks to assistance from Mind - the mental health charity. Many thanks to Aimee Gee of Mind for assisting in making this interview possible.

A related article which may be of interest first published in The Huffington Post by Raj Persaud and David James


How Having, or Not Having, an NHS Psychiatric Bed Can Kill You

An investigation by BBC News and Community Care magazine into 53 of England's Mental Health Trusts reveals that 1,711 mental health beds have been closed since April 2011, including 277 between April and August 2013, representing a 9% reduction in the total number of mental health beds available in 2011/12.



The BBC News website reports possible consequences including the tragic case of 39-year-old Mandy Peck who told clinicians she was feeling suicidal, but her local mental health service centre initially claimed no beds were vacant. She jumped to her death from a multi-storey car park shortly afterwards.



As psychiatrists who have worked in the NHS, we have both experienced the chaos of trying to find a bed for a patient who needs one urgently.



The enormous pressure on the staff to find a bed means that the modern NHS becomes a constant fight for beds, creating stressful conflict with other clinicians. Even if you (eventually) secure an admission for your patient, this is at the expense of the patient who was previously in that bed, who, in order to accommodate the new admission, gets moved to another part of the country, or is discharged, or sent on leave prematurely.



Providing any kind of therapy in this frenzied environment is not possible. Admitting someone in a fragile mental state into this siege atmosphere means you are only arranging an admittance to prevent suicide or harm to others, rather than offering help to the mentally ill in need of care. You have become a form of warder, not a clinician.



The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness at the University of Manchester, published in July 1013, reports that during 2001-2011, in England, 13,469 deaths (28% of general population suicides) were patient suicides. These are persons who had been in contact with mental health services in the 12 months prior to death.



There has been a projected rise in 2011 (the last year for which data is available). In 2001 there were 1261 suicides by people in contact with mental health services and this figure had risen to a projected number of 1333 by 2011, during a period when it now looks like more beds were being lost.



Patrick Keown, Gavin Mercer and Jan Scott published a recent analysis in the British Medical Journal, finding that between 1996 and 2006 in England the number of NHS psychiatric beds decreased by 29%. Entitled Retrospective analysis of hospital episode statistics, involuntary admissions under the Mental Health Act 1983, and number of psychiatric beds in England 1996-2006, their investigation found involuntary patients occupied 23% of NHS psychiatric beds in 1996, but 36% in 2006.



The authors conclude that inpatient care transformed considerably in the decade from 1996 to 2006; more involuntary admissions to fewer NHS beds. The case mix shifted further towards psychotic and substance misuse disorders, altering the atmosphere of inpatient wards.



One interpretation of this data, and our personal experience supports this, is that the ambience on wards has changed, and for the worse, in terms of providing a therapeutic environment. Psychiatric in-patient units are now much more likely to be precarious containment areas for the extremely seriously mentally ill, not a haven, nor asylum from stress for those who need help.



For these reasons, being admitted to a psychiatric ward today may in fact be an added source of stress - not a therapeutic experience at all.



Some evidence for this comes from a recent investigation of a consecutive series of individuals aged 18 to 65 who died by suicide between the 1 January 2001 and 31 December 2006 in England, the date of death being within seven days of the date of admission to a psychiatric ward.



The study entitled, Suicide in recently admitted psychiatric in-patients: A case-control study, found around a quarter of all in-patient suicides occurred within the first week of admission to psychiatric in-patient care. 46% of cases died on the ward itself; the majority by hanging. 40% of suicide cases died within the first three days of admission. A fifth of all suicides were on authorised leave at the time of death, but 34% were off the ward without staff agreement, compared to only 1% of controls.



The authors, Isabelle Hunt, Harriet Bickley, Kirsten Windfuhr, Jenny Shaw, Louis Appleby and Nav Kapur, conclude that contrary to previous relevant research, this investigation examining wards in England found a short length of illness (less than 12 months duration) was independently predictive of suicide in the immediate admission period.



The study, published in the 'Journal of Affective Disorders' in 2013, contends that it may be that receiving a psychiatric diagnosis requiring in-patient treatment is particularly stressful, plus the experience of entering an environment that patients have described as ''frightening'' and ''intimidating' probably increases, rather than diminishes, suicidal feelings.



The authors considered there could also be an association between being admitted to a psychiatric ward and a heightened sense of being stigmatised.



Given that those on authorised and unauthorised leave account for such a large proportion of in-patient suicides from their data, the authors of this study point to two recent court cases in England after the suicide of a detained patient who absconded (Savage v. South Essex Partnership NHS Foundation Trust, 2008) and a voluntary patient who died by suicide whilst on leave (Rabone v. Pennine Care NHS Trust, 2012).



The authors of the study point out that these cases were viewed as a breach of Article 2 of the European Convention on Human Rights (which safeguards the right to life), resulting in a new obligation for health authorities and hospital staff to protect patients where there is a ''real and immediate'' risk of suicide.



The danger of the current headlines over fewer beds is that it's not just the numbers that are important - the quality of the bed, as it were, is vital. What is the point of offering a bed if the quality of the experience is so poor, aspects of it contribute to feeling worse?



The NHS neglects quality of care, which has been sacrificed on the altar of numbers, because numbers are so political.



Numbers of beds dominates the debate - and numbers are important because we have had too few beds for the system to be safe for some time now. And the decline in bed numbers appears to continue inexorably. But we should be looking beyond numbers to human beings, focusing as well on the quality of what patients get, when they actually get anything at all.





Raj Persaud is a Consultant Psychiatrist in Private Practice in Harley Street, London UK and author of several best-selling books including ‘The Mind: A Users Guide’ published by Bantam Press. Dr David James is an eminent Forensic Psychiatrist.



Raj Persaud is joint podcast editor for the Royal College of Psychiatrists and also now has a free app on iTunes and google play store entitled ‘Raj Persaud in conversation’, which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world.






His books are available on amazon.co.uk here:



Hospitalized against your will. Margaret was committed to a Psychiatric Institution against her will

Margaret talks to Raj Persaud about her frightening experience of being admitted to a psychiatric hospital against her will with no idea as to why this was happening. This interview was made possible by 'Mind' - the mental health charity and particular thanks go to Aimee Gee of 'Mind', for her assistance in making it possible.


A related article which may be of interest:


Should Anorexics Be Force-Fed?


By Raj Persaud and Peter Bruggen


first published in The Huffington Post: http://www.huffingtonpost.co.uk/dr-raj-persaud/should-anorexics-be-force_b_1608531.html


Should Anorexics be force fed? The latest legal ruling could kill the patient - but doing nothing might also condemn her to death.


The Daily Telegraph has reported that a leading judge who sits in the Court of Protection, Mr Justice Peter Jackson, has ruled that a former medical student suffering from severe anorexia nervosa, and who is at a life-threatening low weight, should be force-fed against her wishes by doctors.


Dr Evan Harris, the former Liberal Democrat MP and member of the British Medical Association's ethics committee, is quoted by the Daily Telegraph to have responded: "The implications of force-feeding are really significant because she would need restraining or sedation and the treatment would last a year... It might not succeed and is itself life-threatening. To impose that on a patient who might be competent in refusing treatment is a very major step."


The 32-year-old woman is described as not having eaten solid food for a year and her parents are reported by the Daily Telegraph to have told the court: "It upsets us greatly to advocate for our daughter's right to die... We feel she has suffered enough..."


Mr Justice Jackson is reported by the newspaper to have conceded the woman stood only a 20% chance of recovery even if she was put on an invasive force-feeding programme that would last at least a year.


Is it really true that medical intervention can be as dangerous as leaving people with an eating disorder to starve themselves to death? And is it also true that it's pretty pointless anyway?


In a 2010 study by Dr Marie Vignaud from the University Hospital of Clermont-Ferrand, France, all patients with Anorexia Nervosa admitted to 11 Intensive Care Units in France between 2006-2008 were investigated, and of 68 admissions, seven died during the admission.


The study published in the academic medical journal Critical Care, found the commonest cause of death was 'Refeeding Syndrome'. This is a potentially fatal shift in fluid and electrolyte levels (minerals such as sodium, potassium and calcium which are distributed around the body where the delicate balance across cell membranes is vital for life) that may occur in the malnourished receiving artificial nutrition.


Precisely because of the dangers of re-feeding, Dr Vignaud and colleagues contend oral re-feeding is the best approach to weight restoration. But faced with absolute refusal to eat, or in cases with extreme malnutrition, feeding via a nasogastric tube may be life-saving, the authors argue. In even more extreme cases, or when the digestive tract itself is no longer functioning, intravenous feeding should be used despite the risks, they believe.



Vignaud and colleagues point out the dangers of medical re-feeding have to be balanced against the fact that Anorexia Nervosa is in itself one of the most fatal psychiatric disorders, with a mortality rate of almost 6% for every 10 years of having the illness; 12 times the rate expected for similar age- and gender-matched groups.



It's perhaps sobering to realise in the light of these statistics that rates of anorexia appear to have been going up since the 1930's. A 2007 study published in the American Journal of Psychiatry by a group lead by Anna Keski-Rahkonen at the University of Helsinki, Finland, found that up to 50% of Anorexia Nervosa cases remain undetected by healthcare systems. Current estimates are that lifetime prevalence rates for Anorexia Nervosa in 20-40-year-old women are estimated between 1.2% and 2.2%. The rates for other milder eating disorders would be much higher.



In a study yet to be officially published, Daniel Rigaud and colleagues from the Service d'Endocrinologie-Nutrition, in Dijon France, followed up 41 severely malnourished anorexia nervosa patients and compared them with 443 less malnourished Anorexia Nervosa patients. The severely malnourished group of 41 had reached an average seriously low weight of 26 kilograms (four stones 1.3 pounds) with an average height of 160 cm (5.2 feet) which translates to an average Body Mass Index of 10 (bear in mind the normal healthy range is roughly 20-25).



Body Mass Index is the measure nutritionists use to calculate whether your weight is healthy as it takes into account your height. The formula is your weight in kilograms divided by your height in metres squared. A BMI lower than 10 kg/m2 in adults is widely considered incompatible with life.


Rigaud's study, due to be published in the academic journal 'Clinical Nutrition', found that all of the 41 severely malnourished anorexia patients received tube-refeeding: but during the in-patient stay, one patient died, two others suffered from myocardial infarction, two others from acute pancreatitis, and five from mental confusion.



Compared with the other 443 less severe Anorexia Nervosa patients (average weight in this less severe group was 40 kg or six stone 4.2 pounds), the 40 remaining patients (one died shortly after admission) had a worse six year outcome: a further two died (7% versus 1.2% in the 443 less ill group), and only 41% recovered (versus 62% in the less ill group).



Rigaud and colleagues conclude that in Anorexia Nervosa patients with a Body Mass Index of less than 11 kg/m2, prudent tube-refeeding could avoid short-term mortality, but long-term, the prognosis remains ominous.



Perhaps part of the problem lies in the very battle against the fervent desire of the anorexic; perhaps something is being missed. Jill Holm-Denoma and colleagues at the University of Vermont, USA, in 2008 proposed a theory that the high death rate in anorexia nervosa may be linked also to an especially high suicide motivation, which may have been previously missed by clinicians and relatives. Their study is based on previous research which finds the risk of death by suicide among anorexic women is approximately 57 times the expected rate.



The study, published in the 'Journal of Affective Disorders', considered the suicides of nine women with Anorexia Nervosa. They were found to be more likely to use highly lethal methods, with low rescue potential, that would likely kill anyone. Three died by throwing themselves in front of a train, and two more died by hanging.



Another reason courts may have to intervene against the wishes of severely anorexic patients, doctors argue, is their brains are likely to be incapable of reasoning rationally because the mind itself begins to be affected by the malnutrition. Brain imaging studies find reduced cerebral volume and the greater and faster the weight loss, the smaller the total brain volume. Refeeding, if it leads to weight gain, can largely reverse this brain shrinkage.



The latest study to report this kind of finding was conducted by a group lead by Boris Suchana from the Institute of Cognitive Neuroscience, Ruhr-University Bochum, Germany, in a study published in the journal 'Behavioural Brain Research' in 2010. This intriguing brain imaging study found a particular reduction in gray matter density with anorexia sufferers in a specific part of the brain associated with body size misjudgement. This raises the possibility that sufferers from anorexia get caught in a vicious cycle whereby losing weight might produce brain changes which in turn alter perception, and thus encourage more weight loss.



Anorexia Nervosa is a serious and complex disorder for which treatment must be tailored to the needs of the individual, but where 'the system' seldom allows this. Life saving intervention is required more than in most other psychiatric disorders.



Patrick Keown from Queen Elizabeth Hospital, Gateshead, and colleagues, published in the British Medical Journal in July 2011 an analysis on the impact of the dramatic reduction in UK NHS psychiatric hospital beds between 1988-2008 - a period when alternatives to hospital admission in the form of community care was supposed to be provided.



Keown and colleagues found the rate of involuntary admissions (being 'sectioned' under the Mental Health Act) per year in the NHS increased by more than 60%, while the provision of mental illness beds decreased by more than 60% over the same period. The authors calculated the closure of two mental illness beds contributes to an additional involuntary admission in the subsequent year. This data referred to all of psychiatry - not just eating disorders - but it might also contribute to our understanding of why anorexia has ended up in the courts, and in the news now.



A dramatic rise in the use of compulsory admissions over the last two decades does not mean that psychiatric disorders have in their nature got worse, but that the prospects for those who have them seem more bleak.



This is because a progressively starved, more disorganised NHS is less effectively caring.



Those desperately trying to look after patients who've reached the end of this road, are therefore forced to seek help from sources outside the health service.


So now we dispense with the doctors, and retain the lawyers.



Raj Persaud is a Consultant Psychiatrist in Private Practice in Harley Street, London UK and author of several best-selling books including ‘The Mind: A Users Guide’ published by Bantam Press. 

Raj Persaud is joint podcast editor for the Royal College of Psychiatrists and also now has a free app on iTunes and google play store entitled ‘Raj Persaud in conversation’, which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world.



His books are available on amazon.co.uk here:




Unparalleled Trauma. One of the most traumatic events of all?

A young woman who suffered one of the most traumatic experiences of all for anybody talks to Dr Raj Persaud.


Raj Persaud in conversation with Victoria, who suffered bipolar illness, sexual assault, self-harm and suicide attempts.

Victoria (not her real name) was a victim of a serious sexual assault who developed mental health problems, yet has made a good recovery. She has been successfully treated for bipolar illness, but her problems may be linked to a difficult childhood and strained relationship with her father.​



Do Offenders, as in the Rolf Harris Case, Sentence Their Own Families, and Their Victims, for Life?



Recent high-profile cases of sex crime convictions, as in Rolf Harris and Max Clifford, reveal outwardly puzzling and strange reactions from their own families. Some relatives show solidarity, appearing each day in court, loyally at the side of the accused. 

What goes on inside a household when someone at their centre is guilty of child, and other, sex crimes, could explain how these particular criminals lead such an incredible double-life. This might account for these astoundingly long criminal careers, in what is widely regarded as one of the worse crimes of all, because children are the most innocent of victims.

Laurence Miller, a Florida psychologist, has published an investigation in 2013 into the different types of paedophile; 'Sexual Offenses against children: Patterns and Motives'. His categorisation could suggest families or relatives are sometimes even colluding in some way, or possibly are victims themselves. At the very least, they can appear in severe denial over the perpetrator in their midst.

He points out, in his study published in the academic journal, 'Aggression and Violent Behaviour', that the 'situational' child molester abuses children as targets of opportunity, particularly if other sexual prospects are unavailable. They therefore tend to also target the elderly, disabled and any other kind of available victim, provided by circumstance.

This is in contrast to the 'preferential' child molester, who in the seductive sub-type, grooms young victims with gifts and attention. He rationalises a 'special relationship'. The 'fixated' sub-type, within the 'preferential' category, is a bit of a child himself - emotionally immature and socially inept.

The most violent and dangerous type is the 'sadistic' paedophile, who enjoys inflicting pain, fear and horror. To heighten the torment, they may even tell the child victim that their parents hate them, and ordered this retribution.

Laurence Miller contends that many child molesters seem to deploy primitive child-like 'defence mechanisms' such as dissociation - 'I didn't know what I was doing' - or denial - 'they're not really hurt, they seemed fine at the time'. Another classic psychological inner defence is 'projective identification', in which one's own unacceptable feelings are projected onto the victim; so it's the child who was viewed as acting seductively.

It's possible that some families also deploy such defence mechanisms in order to reconcile themselves to the paedophile in their midst. Some paedophiles either manipulatively encourage this process, or it spreads naturally through a close-knit group, as people under stress often need such defences in order to cope.

These powerful psychological mechanisms may explain why some paedophiles don't get caught for so long.

Laurence Miller comments that few family members will actively collude with blatant criminal sexual behavior on the part of their husband, brother, father, or son who may now be facing prosecution. However families will rationalize the perpetrator's behavior partly because they have a lot to lose if the perpetrator is convicted (home, finances, family reputation, etc.).

Sometimes, Laurence Miller observes, an interesting "flip" occurs when families, who have been rallying on the side of their loved one for some time, are now faced with mounting evidence against him, and abruptly switch to loathing and rejection, partly against the perpetrator, but also partly out of self-denigration for "letting myself be fooled for all these years."

Nevertheless, Laurence Miller points out, many family members continue to support long after the nature and scope of the offenses has been made clear. Parents are more likely to remain supportive than spouses or children.

Laurence Miller quotes an example of a news story in 2009 of New York's then oldest registered sex offender, who had his 100th birthday in a correctional facility, while serving a ten year sentence for sexually assaulting two sisters aged 4 and 7. This perpetrator appeared to have used his grandfatherly charm to entrap young victims for over 60 years.

Garry Walter and Saby Pridmore, psychiatrists from the University of Sydney and University of Tasmania, have published in 2012 a study of suicides across the world in publicly exposed paedophiles, entitled 'Suicide and the Publicly Exposed Pedophile'. 

Their examples, published in 'The Malaysian Journal of Medical Science', include former Liberal MP and Secretary of State to the Colonies, a 1st Viscount, who killed himself aged 59 in 1922, following publicity over the raping of a 12 year-old boy. But he had been a sexual predator for years previously.

Another example they report is of a famous US paediatrician who shot himself in 2011 aged 71, one day after a class action sexual abuse and malpractice law suit was filed against him, charging that he had performed unnecessary genital examinations on 40 boys. He was also a number one New York Times Bestselling Book author. 

Other illustrations they quote include a 56 year old man who had been Texas District Attorney for more than 20 years, who shot himself as a SWAT team entered his home following an investigation by an anti-paedophile group, which had arranged for actors to pretend to be under-aged children making contact with him.

Twenty incidents of suicide in publicly exposed paedophiles were identified from eight countries, with the average age of offenders being Fifty-Three years. These also include a United States Prosecutor, as well as a UK author and academic emigrant to Canada with a PhD in neuroscience.

Of course we never really know why a person who commits suicide does it. But these cases illustrate how really serious family wrecking criminals, often have built socially very respectable careers, just as the 'successful' Rolf Harris.

In four of these cases, Garry Walter and Saby Pridmore explain, the evidence suggests they had been perpetrating sex abuse on children in the order of 30 years, and in another four cases for at least 15 years; some were married with families.

Donald Campbell, a psychoanalyst based in London, recently published a paper entitled 'Doubt in the psychoanalysis of a paedophile', where he argues that issues of disbelief, particularly the ability of such perpetrators to create doubt in the minds of those around them, might be a fundamental modus operandi.

Donald Campbell, Past President of the British Psychoanalytical Society, refers to a kind of 'sadistic' doubt, in his paper published in the June 2014 issue of 'The International Journal of Psychoanalysis', where the sex abuser appears to derive sexual gratification from the sewing of seeds of incredulity all around him.

Perhaps uniquely more than in any other crime, at the heart of sex offences, is doubt. This renders the crime particularly psychologically damaging. Uncertainty is planted in the minds of the victim, and of those close to the victim, and the perpetrator, over exactly what happened.

It may be the ability to make people distrust even themselves, is a uniquely manipulative skill of abusers. Grasping this strategy could halt these immoral careers much earlier, as they seem to be some of the longest in criminal history.

A court conviction, followed by sentencing, normally ends the ambiguity for the public, over what happened, in a sex crime.

But for the families of perpetrators, as well as the victims, the hesitation and uncertainty over who someone like Rolf Harris really is, can be a life sentence.



This podcast has been made on behalf of the Royal College of Psychiatrists (UK) by Raj Persaud and Peter Bruggen

If you are interested in further information on CPD Online or wish to earn CPD credit points, please visit the Royal College of Psychiatrists CPD Online website for further information at www.psychiatrycpd.co.uk


For more general podcasts visit: www.rcpsych.ac.uk/discoverpsychiatry/podcasts.aspx

Direct download: DR-100_0055_1.mp3
Category:(3) EXTRAORDINARY EXPERIENCES of severe emotional turmoil -- posted at: 4:46am UTC

What is it like to feel suicidal?

Dr Raj Persaud in conversation with Kenny Johnstone about the extraordinary experiences that led to Kenny setting up CLASP




Kenny Johnston, Founder of the Counselling, Life Advice and Suicide Prevention charity, CLASP, talks to Dr Raj Persaud about how he set up the organisation after he twice tried, but failed, to take his own life.

Kenny Johnston is 43 and from west London. Having witness domestic abuse, racism, mental illness and a variety of stress-related experiences in his life, many could assume his suicide attempt in October 2010 was due to a build-up of tragic life experiences.

Kenny studied to become a CBT and Suicide Intervention Counsellor in order to help those living with their life traumas and daily trying to overcome the stigma which surrounds mental and stress related illness as well as suicidal thoughts to seek help and feel able and empowered to discuss their emotions and thoughts openly in order to resolve them, see a positive future and save a life.


"I truly believe that, if 50-60 years ago there was a stigma over black and white couples and now there's mixed races children including me; 20-30 years ago we had a stigma about Gay and Lesbians because of HIV and Aids, now there's same sex marriages; then isn’t it time to end the stigma about mental and stress related illness as well as suicide, because the longer it’s there the more lives will be lost"

Kenny Johnston

Founder and CEO, CLASP Charity


After the Robin William’s tragedy – will there be copycats?


Raj Persaud and Professor Sir Simon Wessely (President of the Royal College of Psychiatrists)



Robert Enke, a very famous German football goal keeper, killed himself on the railway on 10th November 2009.




The number of railway suicidal acts, in the following two weeks, more than doubled in Germany.




The study which uncovered this is entitled ‘One followed by many?—Long-term effects of a celebrity suicide on the number of suicidal acts on the German railway net’, and is recently published in the ‘Journal of Affective Disorders’. There was also an increase of railway suicides of 19% in the following two years, as compared to the two years before this tragic event.




The authors of the study,Ulrich Hegerl, Nicole Koburger, Christine Rummel-Kluge, Christian Gravert, Martin Walden and Roland Mergl, found the 25% increase of fatal railway suicides between 2007 and 2010 was significantly greater than the 6% increase in the total number of suicides in Germany over the same period.




The authors based at the University of Leipzig, and Deutsche Bahn AG (the German Railway Company), conclude that Enke’s suicide probably led to copycat suicidal behaviour on the railways.






The authors point out that the media attention of the footballer’s suicide was exceptional and enduring, and this may have had an impact. For example, television broadcasts of a public mourning ceremony, held in the team’s stadium, were viewed by almost 7 million German viewers.




30 railway suicidal acts occurred in the two-week interval before Encke’s suicide, 71 railway suicidal acts in the two week interval following this event; an increase of 137%.




But what is more ominous is that this research found an elevated long-term ‘attractiveness’ of railway suicidal acts after Enke’s suicide.




The authors conclude that their findings are a strong argument for improving media coverage of suicides, and community suicide preventive programs.




A study entitled ‘To What Extent Does the Reporting Behavior of the Media Regarding a Celebrity Suicide Influence Subsequent Suicides in South Korea?’, just published in the journal ‘Suicide and Life-Threatening Behavior’, investigated the world record copycat effect thus far. This was the suicide of the Asian star actress Choi Jin-shil; starring in 18 films, she has been described as South Korea’s equivalent of Julia Roberts .




The authors, Jesuk Lee, Weon-Young Lee, Jang-Sun Hwang and Steve Stack, found her death on 2 October 2008 was subsequently associated with 429 additional suicides in South Korea, which is a record copycat effect.




Another recent investigation entitled, ‘Changes in suicide rates following media reports on celebrity suicide: a meta-analysis’, examined 10 studies from around the world, probing for similar copycat effects, examining 98 suicides by celebrities.




The team of authors, led by Thomas Niederkrotenthaler,  King-wa Fu, Paul Yip, Daniel Fong, Steven Stack, Qijin Cheng and Jane Pirkis, report a change in suicide rates of on average roughly almost three suicides per 1000 000 population, in the month after a celebrity suicide across the world.




Extrapolating from these figures, the worse case scenario would be an additional almost 200 suicides over the next month, in the UK, with approaching 1000 in the USA. Whether or not that happens remains to be seen, but these non-celebrity suicides are unlikely to make the headlines.






The study, published in the ‘Journal of Epidemiology and Community Health’, report suicides by an ‘entertainment celebrity’, across the planet, had the greatest impact of all in Europe, in terms of copycat incidents, followed by a slightly smaller impact in the USA.




The authors based at the Universities of Vienna, Hong Kong, Melbourne and Wayne State, found a particular celebrity impact on copycat behaviour by entertainment celebrities, as opposed to other prominent people, such as politicians.




Thomas Niederkrotenthaler and co-authors argue the suicide of an entertainment celebrity is so influential perhaps because of audience identification.




Celebrities are revered and may therefore act as particularly strong role models even when it comes to taking their own lives.




Guidelines for media reporting of suicide include that detailed discussion of the particular method should be avoided, and as images of the death scene are highly influential, these should not be broadcast. For details see http://www.samaritans.org/sites/default/files/kcfinder/files/press/Samaritans%20Media%20Guidelines%202013%20UK.pdf. These and similar links may be of special interest for journalists reporting about suicides




But by writing this article are we ourselves violating the media guidelines? Not so, we contend, because the recommendations do not say there should be no media reporting, but that it should be sober and responsible.




Thomas Niederkrotenthaler points out that not all celebrity suicide reporting is associated with increases in suicides subsequently. This is exemplified by the suicide of Rock Star Kurt Cobain. His suicide was widely reported, but there was no copycat phenomenon afterwards, Dr Thomas Niederkrotenthaler maintains.




This may be due to Cobain’s widow, Courtney Love, expressing both her sadness and anger about her far too early loss, in the media, and contacts to support services were published, along with her statements, immediately after his suicide. Indeed, research showed that these mental health services experienced an increase in clients, but there was no upsurge in suicides.




Perhaps the celebrity obsession of the media is in fact a reflection of a deeper problem with journalism, of which suicide reporting is merely a symptom. Reporting of celebrities lives in general tends to remain somewhat naïve. Being rich and famous, according to the classic simplistic media analysis, inoculates against any serious psychological problems.




In a study entitled ‘Psychological strains found in the suicides of 72 celebrities’, the tensions experienced throughout the lives of 72 celebrities were systematically investigated.




The authors, Jie Zhang, Jiandan Tan and David Lester found of 72 ‘celebrity’ suicides, only one had no ‘strains’ at all.






The authors, from Shandong University School of Public Health and Central University of Finance and Economics, China, and The Richard Stockton College of New Jersey, USA, found the most common pressure was ‘aspiration strain’ – found in 97% of the lives of celebrities who kill themselves.




‘Aspiration strain’ was defined in this study, published in the ‘Journal  of Affective Disorders’, as a gap between an individual’s aspiration and the reality of their life. For example, wishing to be much richer than you actually are.




The study found 30 celebrities who killed themselves suffered at least two contrasting life strains, while 36 had endured three different ‘strains’.




Perhaps the take home message should be that despairing sadness may happen to anyone, irrespective of fame or wealth.




But what many people still do not know is that depression, and also other mental health problems, including personal crises, can be treated, and that there is help available.




That should be the headline story.




If you have been affected by any of the issues raised in this article you may find the following of help: Samaritans Helpline: 08457 90 90 90 http://www.samaritans.org






Manic-Depression or Bipolar Illness. What is it like to experience a bipolar illness?

Raj Persaud in conversation with a lady who experienced a bipolar illness

What is it like to suffer from a Bipolar Illness? This lady talks frankly to Dr Raj Persaud about the reality as opposed to what is widely believed.



A related article which may be of interest first published in The Huffington Post: 




Does Fame Make You More Suicidal?

Raj Persaud and Peter Bruggen



Stephen Fry has revealed that he recently made a serious suicide attempt. He has gone public with the shocking disclosure, apparently in an attempt to de-stigmatise mental illness. 


Fry is a patron and supporter of mental health charities and has previously disclosed suffering from manic-depression, or mood swings, now termed bipolar disorder. 


He is extremely successful in many different areas of life; a 'national treasure'. How can someone popular, wealthy, busy and successful, end up feeling hopeless and despairing?


Yet it's well established from psychological research that there is a link between fame and suicide. 


David Lester, a professor of psychology at the Richard Stockton College of New Jersey, has conducted much research establishing this link. In the journal 'Perceptual and Motor Skills' he published a review of research entitled 'Suicide in Eminent Persons'. He cited various surveys establishing an average suicide rate in the well-known of around 3%, considerably higher than in the general population. One study focusing on eminent people from the 20th Century found a suicide rate of 5%, hundreds of times higher than the suicide rate in the UK's general population.


Why are the famous so prone to suicide?



Perhaps being famous, or becoming well-known, might be stressful.



However, psychological thinking is swinging towards a new idea - there could be an aspect of personality which drives particular people to become eminent, which is the very same factor that also elevates chances of suicide.



For example, psychologists Sheri Johnson, Charles Carver and Ian Gotlib have just published a study which has found that people with bipolar disorder (the same diagnosis as reportedly given to Stephen Fry) had higher ambitions for popular fame. Bipolar disorder has been found to be over-represented amongst the creative and the famous, especially those from artistic fields.



These researchers, based at Stanford University, University of California and the University of Miami, used a scale termed 'Willingly Approached Set of Statistically Unlikely Pursuits', which measures desire for extremely ambitious (difficult to achieve) life goals, such as becoming the focus of books and TV shows. Goals of great recognition, such as achieving fame, multi-millionaire rank, or political influence, were much more likely to be found in those with Bipolar Disorder.



This study, 'Elevated Ambitions for Fame Among Persons Diagnosed With Bipolar I Disorder', published in the 'Journal of Abnormal Psychology', suggests the drive to achieve difficult ambitions arises partly from this diagnosis.



But does this also explain propensity to suicide?



Of all the various talents Stephen Fry displays, perhaps the most pertinent to the recent suicide attempt may come as a surprise.



See his recently published The Ode Less Travelled - Unlocking the Poet Within. The attached publicity for the book confirms that he has 'written long poems, for his own private pleasure'. The book 'invites you to discover the incomparable delights of metre, rhyme and verse forms'.



Particularly high rates of suicide and bipolar illness have been found in poets. Some psychologists even contend that writing poetry may not be good for your mental health, particularly if you suffer certain predisposing mental vulnerabilities.



In a study entitled 'Word Use in the Poetry of Suicidal and Non-suicidal Poets', psychologists Shannon Stirman and James Pennebaker, from the University of Pennsylvania and University of Texas, point out some psychologists believe Sylvia Plath's poetry may have undermined her coping skills, which in the face of highly stressful life events, possibly contributed to her death through suicide.



Yet writing, particularly poetry, is seen in some circles as a 'release' and therefore therapeutic.


Stirman and Pennebaker probed further. They analysed the words in the poems of suicidal poets, investigating a theory that it might be possible to predict which poet is going to kill themselves, from the word choice in their poetry.



These psychologists analysed a total of 156 poems by eminent poets who committed suicide, and compared them with equally famous poets who did not.



Overall, the suicidal group of poets used more first-person singular (I, me, my) words in their poetry than did the control group. Suicidal poets also used the words 'we', 'us', and 'our' more in the early and middle phases of their career, than did the non-suicidal group. The percentage of use dropped sharply below that of the non-suicide group, during the late periods of their career (ie just before the suicide).



The authors of this study, published in the journal 'Psychosomatic Medicine', suggest that the finding of more first-person singular self-references ('I', 'me', 'my') in their poetry throughout their careers, means that self-references do not increase over time in the suicidal poets. Stirman and Pennebaker contend this means that the suicidal poets' level of preoccupation with self is not due to increasing levels of fame or recognition of their work over time.



Self-reference could be a measure of self-obsession. Maybe getting a lot of attention makes you self-obsessed - or could it be that being self-preoccupied leads you to consider becoming famous? Certainly this self-centredness doesn't appear good for you, if it's linked with suicide propensity.



Stirman and Pennebaker further wonder if their pattern of findings suggest there could even be a kind of 'suicide fingerprint', in patterns of word usage by those who are predisposed to suicide, or becoming more suicidal.



It's perhaps even possible such a 'write fingerprint' might show up in non-poets writings, as in text messages and emails.



However, their main finding is that this 'suicide fingerprint', appears present from the beginning of a poet's career. In other words, suicide and fame might be connected through psychological characteristics present in the personality from the beginning.



The latest evidence is psychological disturbance might drive desire for fame, and this could lie behind the high rates of suicide in the illustrious.



Raj Persaud is joint podcast editor for the Royal College of Psychiatrists and also now has a free app on iTunes and google play store entitled 'Raj Persaud in conversation', which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world.




If your son goes psychotic? What do you do if your son develops psychosis?

Raj Persaud talks to a man whose son developed a severe psychotic illness.

Nick describes an all too familiar battle that carers have of getting NHS psychiatry services to take the concerns of carers and relatives seriously. As a result of being ignored when they tried to inform services, the son became seriously unwell and a series of tragic events unfolded. Nick talks frankly and openly about his experiences and speaks for many carers and relatives in his account of what they have to endure.

Post-Natal Depression. Annalin developed severe Post-Natal Depression

Raj Persaud talks to Annalin who developed severe Post-Natal Depression

Annalin describes how it feels to get severe depression despite what is supposed to be one of highlights of any woman's life - the birth of her first child. She discusses with psychiatrist Raj Persaud possible causes of post natal depression and how recovery is possible.

Parenting a psychotic person. The mum of someone with psychosis speaks

Dr Raj Persaud talks to a mother of someone with a psychotic illness

What's it like to be a mother of someone with severe mental health difficulties? Mary speaks about her experiences with Consultant Psychiatrist Dr Raj Persaud