Raj Persaud in conversation - the podcasts
Funeral Mania explained. Is there such a thing as 'Funeral Mania'?

It is said some go high at funerals - is this a real phenomenon?

Raj Persaud in Conversation with Katherine Keyes. 

Katherine Keyes is Associate Professor of Epidemiology Columbia University and with serveral colleagues had published a study in the 'American Journal of Psychiatry' investigating what happens when people suffer one of the worst stresses of all - the unexpected death of a loved one. She talks to Consultant Psychiatrist Raj Persaud about her study which with colleagues appears to have verified there really is such a thing as 'Funeral Mania'.

The Burden of Loss: Unexpected Death of a Loved One and Psychiatric Disorders Across the Life Course in a National Study

Katherine M. Keyes, Ph.D.; Charissa Pratt, M.P.H.; Sandro Galea, M.D., Dr.P.H.; Katie A. McLaughlin, Ph.D.; Karestan C. Koenen, Ph.D.; M. Katherine Shear, M.D.

Am J Psychiatry 2014;171:864-871. doi:10.1176/appi.ajp.2014.13081132

Abstract

Objective  Unexpected death of a loved one is common and associated with subsequent elevations in symptoms of multiple forms of psychopathology. Determining whether this experience predicts novel onset of psychiatric disorders and whether these associations vary across the life course has important clinical implications. The authors examined associations of a loved one’s unexpected death with first onset of common anxiety, mood, and substance use disorders in a population-based sample.

http://www.amazon.co.uk/Dr-Raj-Persaud-Latest-Users/dp/B0082XNF40

 

A related article from The Huffington Post which may be of interest:

 

 

Do Near Death Experiences Finally Confirm the After-life?

RAJ PERSAUD AND PETER BRUGGEN

A new near death experience study, widely reported in the media this week, found high levels of brainwaves at the point of death in rats. Published in the journalProceedings of the National Academy of Sciences, the University of Michigan research discovered in the 30-second period after the rodent's hearts stopped beating, there was a sharp increase in high-frequency brainwaves.

'Near death experience' or NDE research remains a key divide between religion and science - can consciousness function independently of the human body, and therefore, survive bodily death? Could this then prove the existence of a 'soul', and confirm ghosts, plus other paranormal or spiritual phenomena?

A near death experience is defined as unusual recollections associated with a period of unconsciousness during either serious illness or injury, or resuscitation from a cardiac or respiratory arrest. Some people who might have been technically dead, seem to report experiences 'near or beyond death'.

Dean Mobbs from the Medical Research Council Cognition and Brain Sciences Unit, Cambridge and Caroline Watt from the University of Edinburgh Department of Psychology, recently published a paper entitled, There is nothing paranormal about near-death experiences: how neuroscience can explain seeing bright lights, meeting the dead, or being convinced you are one of them, which vigorously rejects any spiritual account.

Published in the journal 'Trends in Cognitive Sciences', Dean Mobbs and Caroline Watt explain that while 3% of Americans declare near-death experiences, such as feeling the soul leaving the body, approaching a bright light and entering another reality, where love and bliss are all encompassing, there are other scientific accounts for all these phenomena.

They report over 50% of those who recount near-death experiences were not in fact in that much mortal danger, so a serious problem for the spiritual account is that, for many experiencers, NDE's aren't revealing what happens near death, but merely what happens when one believes one is in danger of dying.

The lead author of the rat study so widely reported this week, Dr Jimo Borjigin, suggested that the dying brain was also not shutting down as might be expected, but instead, "If anything, it is much more active during the dying process than even the waking state."

Dean Mobbs and Caroline Watt also point out that psychiatric phenomena such as 'Cotard' or 'walking corpse' syndrome, named after the French neurologist Jules Cotard, which results in the feeling and conviction of being dead, could explain some of the peculiar sensations reported in Near Death Experiences.

Mobbs and Watt report that in NDEs, 50% experience being dead, 24% said that they had had an out-of-body experience, 31% remembered moving through a tunnel, and 32% reported meeting with deceased people. Mobbs and Watt contend that electrical stimulation of brain regions can result in a sense of presence (i.e. someone is standing behind us). Meeting deceased people could therefore be hallucinations due to compensatory over-activation in brain structures near areas damaged by whatever is causing death.

But other academics vigorously disagree with Mobbs and Watts attempts to explain Near Death Experiences invoking a purely scientific or non-spiritual account.

For example, in a paper entitled Seeing Dead People Not Known to Have Died: "Peak in Darien" Experiences, Bruce Greyson from the Division of Perceptual Studies, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, argues that in his collection of 665 NDEs, 138 (21%) included a purported meeting with a deceased person, whereas only 25 (4%) included an encounter with a living human.

While this discrepancy might be viewed as evidence of post-mortem survival of the persons seen, it might also be no more than an expression of the dying person's expectations of imminent death.

But Bruce Greyson points out that more troubling for the scientific account of Near Death Experiences is where those on their deathbeds see, and often express surprise at meeting, a recently deceased person, of whose death neither they nor anyone around them had any knowledge. This excludes the possibility that the vision was a hallucination related to the experiencer's expectations.

Such NDEs are termed "Peak in Darien" cases, after a book by that name published in 1882 by Frances Power Cobbe. The title is taken from a John Keats poem describing the shock of the Spaniards, who, after scaling a peak in Darien (in what is now Panama), expect to see a continent, but are confronted instead with another ocean.

Bruce Greyson reports in his paper, published in the academic journal 'Anthropology and Humanism', many examples, including that of Physician K. M. Dale who related the case of 9-year-old Eddie Cuomo, whose fever finally broke after nearly 36 hours of anxious vigil on the part of his parents and hospital personnel. As soon as he opened his eyes, at 3:00 in the morning, Eddie related that he had been to heaven, where he saw his deceased Grandpa Cuomo, Auntie Rosa, and Uncle Lorenzo. Then Eddie added that he also saw his 19-year-old sister Teresa, who told him he had to go back. His father became agitated, because he had spoken with Teresa, who was attending college in Vermont, just two nights ago. Later that morning, Eddie's parents learned that Teresa had been killed in an automobile accident just after midnight, and that college officials had tried unsuccessfully to reach the Cuomos at their home.

Bruce Greyson relates many other examples, including cases in which the deceased person seen was someone whom the experiencer had never known. For example, Greyson reports cardiologist Maurice Rawlings describing the case of a 48-year-old man who had a cardiac arrest. In a NDE he perceived a gorge full of beautiful colours, where he met both his stepmother and his biological mother, who had died when he was 15 months old. His father had remarried soon after his biological mother's death, and this person had never even seen a photo of her. A few weeks after this episode, his aunt, having heard about this vision, brought a picture of his mother with a number of other people. The man picked his mother out of the group, to the astonishment of his father.

In response to Bruce Greyson's critique that the non-spiritual account of near death experiences ignores difficult to explain phenomena as above, Dean Mobbs points out that such cases Greyson has marshalled are all anecdotal reports, and therefore difficult to rigorously verify.

The spiritual understanding of what happens to us differs from the scientific view because it places greater faith in human experience, and these death-bed stories. Science demands proof that comes from brain scanners, replication and precise measurement.

But because these extraordinary accounts will always exist, does that mean religion will forever survive the onslaught of science?

Or could it be that our first proper glimpse of heaven will instead shortly arrive from a brain scan?

 

 

 

 

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


Are delusions that irrational?

How do you know when you are being irrational?

 

Raj Persaud in conversation with Lisa Bortolotti a Professor of Philosophy interested in delusions and irrationality. Are delusions really that different from other commonly held beliefs? If this is the case then this is a fundamental challenge to psychiatry, as delusions lie at the very heart of the psychiatric understanding of mental illness.

 

Professor Lisa Bortolotti MA (London), BPhil (Oxon), PhD (ANU)


Professor of Philosophy University of Birmingham

A philosopher of the cognitive sciences, focusing on the

philosophy of psychology and psychiatry.

 

Description

Delusions and Other Irrational Beliefs is a contribution to the debate about the nature of delusions and to the literature on the conditions for belief ascription. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
This monograph was published by Oxford University Press 
(International Perspectives in Philosophy and Psychiatry series)
in November 2009. It was awarded the American Philosophical Association
 
A symposium on the book appeared in a special issue of Neuroethics (2012).
 
The book was also included in the Current World Literature published by 
Current Opinion in Psychiatry, 24 (6), 2011, and rated as "of outstanding interest"
(category History & Philosophy > Recent developments in naturalizing the mind).
 
From 'Reading about Philosophy of Psychiatry' by Matthew Broome, The Psychiatrist Online, August 2013
"One of the most important works on delusions is Bortolotti’s Delusions and Other Irrational Beliefs, a book that examines the core features of delusions in relation to other mental states, demonstrating that many non-delusional beliefs are not so rational and delusions often differ in degree, rather than kind, from other, non-pathological, beliefs."
 
http://www.amazon.co.uk/Irrational-International-Perspectives-Philosophy-Psychiatry/dp/0199206163/ref=sr_1_1?s=books&ie=UTF8&qid=1411245974&sr=1-1&keywords=delusions+irrational

http://www.amazon.co.uk/Dr-Raj-Persaud-Latest-Users/dp/B0082XNF40

 

Why Is the Ancient Mayan Prophecy That Today Is the End of the World So Popular?

DR RAJ PERSAUD AND PROFESSOR ADRIAN FURNHAM

According to ancient Mayan Prophecy, today is meant to herald the end of the world. But just in case there is still a world to read this, why are such apocalyptic visions all the rage?

Whether the Mayans actually prophesied the end of the world on this date is indeed controversial - Hollywood and the media appear to have distorted the ancient forecast and, apparently, constructed a fantasy which grips public imagination.

Just a few years ago - in 1999 - the 'Y2K' computer problem was predicted to create such chaos - planes would fall from the sky and populations would be trapped in elevators - that the end of civilisation as we know it - would arrive.

Before that, the nuclear stand-off between superpowers was supposed to herald imminent Armageddon. The thesis that 'mutually assured destruction' is just around the corner is so perennial, psychologists even coined a term 'The Armageddon Complex' - capturing the conviction many harbour, the end of time is nigh.

It seems that every civilisation appears to believe it, uniquely in history, sways on the precipice, and peers over the edge into the abyss.

In the past it may have been world war and nuclear holocaust, viral epidemics, computer malfunction, nanotechnology gone wild, and today it is global warming, which has stepped into the breach of why it's all about to end. If there is a recurrent pattern through history of believing in imminent apocalypse, does this begin to reveal more about our psychology? Or did these convictions mean we backed away from the edge - saving ourselves?

'Apocalypticism' appears linked to certain religious and personality outlooks.

Maurice Farber, a Professor of Psychology at the University of Connecticut published one of the first studies into 'The Armageddon Complex' in the academic journal Public Opinion Quarterly as far back as 1951. Farber explained that the Armageddon Complex is the disposition to believe total war is inevitable. 312 students were asked if they favoured a 'show-down' war with Russia. Desire for nuclear war was positively related to unsatisfactory future outlook for their personal lives.

During World War II, Farber had served in intelligence and psychological warfare units of the US Army in Europe. Possibly the authorities have long had an interest in our obsession with apocalypse, using this to manipulate us. Wars are sold to the public on the basis that they are needed to avoid imminent Armageddon. Remember the '45 minute' weapons of mass destruction invocation that cajoled the public into supporting a war on Iraq?

Stephen Kierulff, a Californian clinical psychologist published a study in 1991 entitled 'Belief in Armageddon Theology and Willingness to Risk Nuclear War', where he refers to 'Armageddonists', who believe that Bible or other religious prophecies about the 'End Time' must be taken literally, and seem to expect nuclear war to fulfil these prophecies.

They seem to be more in favour of a nuclear war and their pro-nuclear sentiment stems (among other sources) from fundamentalist Christianity which affirms Jesus will return to Earth in order to save the human race after a cataclysmic war. Many such 'premillennialists', Kierulff argues in his paper, published in the Journal for the Scientific Study of Religion, believe that the 'Last Days' are already upon us, considering that the final war will be global and nuclear.

Kierulff found from his research that the more 'Armageddonist' people's religious beliefs are, the more willing they are to risk a nuclear confrontation with the Soviets, and the more likely they are to believe that they would survive the subsequent nuclear war. As predictors of convictions that the US will attack Russia and that nuclear war is personally survivable, 'Armageddonist' views outperformed any of the indicators used in his study, including political conservatism, suggesting religious, or other certainties about the imminent end of the world has been neglected by pollsters.

Today it is possible 'Armageddonists' no longer consider the apocalypse will arrive following a war between the US and Russia, but now perhaps between Christian and Islamic fundamentalists.

Dr Simon Dein and Professor Roland Littlewood from the Departments of Psychiatry and Anthropology, University College London, wonder about the significance of what might appear to be an increasing number of reports of mass suicide over the last few decades.

In their paper entitled 'Apocalyptic Suicide: From a Pathological to an Eschatological Interpretation' they remind us of the 1978 mass suicide of 914 (including 200 children) by drinking cyanide, amongst Jim Jones's Peoples Temple in Jonestown, Guyana. In 1993, Waco, Texas, seventy-six men, women and children Branch Davidians, led by David Koresh, died after their compound was set alight - though by who remains controversial.

Dein and Littlewood also remind us of the Solar Temple episode of 1994, where over 50 killed themselves simultaneously in Canada and Switzerland, thus apparently 'transiting' to the star Sirius. 16 colleagues died in a related incident in France some months later, while five more committed 'ritual suicide' at the moment of the spring equinox in 1995. In the Heaven's Gate suicide in 1997, 39 followers died from auto-asphyxiation, apparently assuming in the after-life they would join a space ship lurking behind the Hale-Bopp comet.

Among Dien and Littlewood's possible speculations, appears to be that in ancient times we indeed constantly lived on the edge of survival, where bad weather and other environmental hazards could destroy crops, and wipe out communities. So we naturally developed superstitions and rituals which gave us a sense of control over capricious 'gods', hence the development of religion, and possibly, the close link psychologically between religious belief and apocalypse.

The problem is that 'Armageddonism' or 'Apocalypticism' beliefs include strongly self-fulfilling prophetic elements. These convictions appear to drive most political as well as religious extremism, including suicide terrorism.

If you believe the end is neigh, you seem more willing to consider extraordinary or ultimate devices, which in turn, actually hasten your demise.

 

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: Delusions_interview_2_1.mp3
Category:(2) General Podcasts -- posted at: 5:04pm UTC

Psychology of Alan Turing. Was Code-breaker Alan Turing Assassinated?

Controversy continues over how Alan Turing died and why it matters

 

Raj Persaud in conversation with Michael Ferguson discussing the death of Alan Turing

Michael Ferguson lives in San Francisco and is on the editorial board of the Journal of Homosexuality and he does book reviews on a variety of topics having to do with sexuality and cultural history.

 

Michael Ferguson has written a fascinating book review of two recent biographies of the famous mathematician and cryptographer Alan Turing - who recently received a royal pardon following his prosecution for homosexuality in the 1950's. Did Turing kill himself with an apple poisoned with cyanide or was it a disguised assassination by the British Secret Security Services who might have become concerned that Turing was a security risk given his homosexuality? MichaelFerguson discusses these issues and others with psychiatrist Raj Persaud. More information is available here: 

http://rajpersaud.wordpress.com/2013/12/25/does-his-psychology-reveal-whether-alan-turing-killed-himself-raj-persaud-and-peter-bruggen

Does His Psychology Reveal whether Alan Turing Killed Himself?

Michael Ferguson's book review reference: Journal of Homosexuality Volume 56, Issue 8, 2009. The Man Who Knew Too Much: Alan Turing and the Invention of the Computer, by David Leavitt and Alan Turing, the Enigma, by Alan Hodges

 

 

Does His Psychology Reveal Whether Alan Turing Killed Himself

RAJ PERSAUD AND PETER BRUGGEN

Alan Turing has been granted a posthumous Royal Pardon 59 years after his death.

Turing used advanced mathematics to break the Enigma code, revealing the positions of German U-boats during World War II. This ensured the country's survival; Eisenhower is even quoted as declaring that Turing's personal contribution shortened the War by two years.

Following his prosecution for homosexuality and forced chemical castration treatment, controversy dogged his apparent suicide. Did he kill himself, or was he in fact murdered by the secret service? Such agencies are notorious for assassinations disguised as suicides. Turing might have been considered a threat or a security risk, some argue. But even today, homosexual men are found to have significantly higher suicide rates than heterosexual males.

For example in a study of 1,382 Austrian adults, published in 'Archives of Sexual Behaviour', entitled 'The relation between sexual orientation and suicide attempts in Austria', suicide attempts were more frequently reported by those with homosexual or bisexual fantasies, partner preference, behaviour, and self-identification, compared to their heterosexually classified counterparts.

Another recent study, published in the 'Journal of Affective Disorders', and entitled 'Suicidal ideation among young French adults: Association with occupation, family, sexual activity, personal background and drug use', found in a sample of 4075 French adults, that among men, homosexual intercourse was more strongly linked with suicidal thinking than living alone or being unemployed.

Michael Ferguson, in reviewing two recent biographies of Alan Turing's life, concludes that to answer the enigma at the heart of Alan Turing's death, you have to get inside the complex head of the great mathematician.

His book review entitled ''The Man Who Knew Too Much: Alan Turing and the Invention of the Computer', by David Leavitt and 'Alan Turing, the Enigma', by Alan Hodges'', recently published in the, 'Journal of Homosexuality', considers the circumstances of Turing's death on June 7, 1954.

An apple was found near Turing's deathbed, out of which several bites had been taken. Froth around his mouth was consistent with cyanide poisoning, but according to sources cited by Michael Ferguson, the apple was never analysed. It has therefore never been definitively confirmed that it had been laced with poison, although there was both potassium cyanide and cyanide solution in Alan Turing's house.

Turing did discuss the advantages of various methods of committing suicide on a number of occasions with associates, yet Ferguson believes one of the most telling arguments for suicide was Turing's fascination with the Snow White story. Turing saw the Disney film version and was apparently particularly taken with the scene where the Wicked Witch dangled an apple into a boiling brew of poison as she repeated to herself, "Dip the apple in the brew/Let the Sleeping Death seep through."

Turing reportedly liked to chant the couplet over and over again. This personal signature to the act, Ferguson contends, makes it unlikely to have been accidental, contrary to what his mother long maintained.

Crucial pieces of evidence also derive from his psychoanalytic treatment with Franz Greenbaum; Turing kept three dream notebooks. Greenbaum destroyed them after Turing's death, but allowed Turing's brother, John, to look at them first. Hodges' biography indicates that John Turing apparently read through two of the dream books, where it is said he found various disturbing revelations.

Ferguson also points out that Hodges' biography also relates an intriguing incident - a few weeks before he died he went on a Sunday outing with his psychoanalyst, Franz Greenbaum and his family. They walked along a seaside tourist area and came upon a gypsy fortune teller. Alan Turing went in while the Greenbaum family waited for him outside. When Turing emerged, half an hour later, they reported that he was "white as a sheet, and would not speak another word as they went back to Manchester on the bus"--an interesting superstitious volte face, Ferguson suggests, for a genius with such an advanced understanding of mathematical logic and computer science.

People often go to a fortune teller or clairvoyant when they are troubled about something.

Alan Turing's tendency to be severely logical - beyond the point of social survival - may in the end be what killed him. This can appear as a symptom of Asperger's Syndrome - a form of autism claimed to be associated with mathematicians and computer scientists. Henry O'Connell and Michael Fitzgerald suggest this might be the diagnosis warranted for Turing, in a paper published in the 'Irish Journal of Psychological Medicine'.

The investigation entitled 'Did Alan Turing have Asperger's syndrome?' includes various criteria for Asperger's which Turing met - one being 'Impositions of routines and interests' including the fact he always ate an apple before bed. 

Turing was in fact initially arrested when he reported one of his lovers to the police for breaking into his house and burgling it. The police in turn found out about the sexual affair, and instead of prosecuting the thief, arrested Turing for gross indecency with another male.

Turing played his violin for the detectives and served them wine. His statement left no doubt about his guilt.

He eventually pleaded guilty to "gross indecency" and was placed on probation on condition that he undergo medical treatment. His enforced hormone treatments lasted one year, and caused him to grow breasts. The prosecutor remarked on his unrepentant attitude.

Ferguson doesn't agree with the assessment that these various life events conspired to ensure Turing became overly psychiatrically disturbed towards the end of his life. Ferguson argues Turing's death occurred two years after his trial, and one year after his hormone treatments had ended.

Ferguson points out that as early as 1937, Turing had written a letter to a friend that spoke of feeling depressed and even considering a suicide method involving an apple.

Of course Ferguson agrees that, had Turing not been outed as a homosexual and subjected to public humiliation and the loss of credibility within the country that he was largely responsible for saving, he might not have killed himself.

Ferguson concludes Alan Turing is a compelling example of the high cost of persecuting those who are a bit different, not only to those individuals who suffer its brunt, but also to the society that loses a genius with the creativity and originality of an Alan Turing.

Ironically he saved Britain from an enemy regime which was intolerant of homosexuality and other individual differences, only for Turing himself to suffer at the hands of the bigoted nearer home.

That homosexuality remains linked with higher suicide rates 59 years after Alan Turing's death is an indictment of our society which no Royal Pardon can excuse.

 

 

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


Tolstoy explains Depression. Can Tolstoy help us understand depression?

Did Tolstoy have a special understanding of depression?

 

Raj Persaud in conversation with Professor Jeremy Holmes. Jeremy Holmes is a psychiatrist and Professor of psychotherapy at the University of Exeter.  He is best known for his work in Attachment Theory and its applications to psychotherapy and psychiatry.  He also has written extensively on the relationship between literature and psychiatry,  most recently in his book 'The Therapeutic Imagination: Using literature to deepen psychodynamic understanding and enhance empathy'.

Today we are going to be discussing a paper published by Jeremy entitled ‘Mind reading: Tolstoy’s Oak Tree Metaphor: Depression recovery, and Psychiatric ‘spiritual ecology’ and this paper is being published in the journal ‘Advances in Psychiatric Treatment’

'Tolstoy’s Oak Tree Metaphor: Depression recovery, and Psychiatric ‘spiritual ecology’' - paper published in the journal Advances in Psychiatric Treatment 

Summary

Tolstoy’s life and work illustrate resilience, the transcendence of trauma, and the

enduring impact of childhood loss. I have chosen the famous ‘oak-tree’ passage

from War and Peace to illustrate recovery from the self-preoccupation of

depression and the theme of ‘eco-spirituality’ – the idea that post-depressive

connectedness and love applies not just to significant others but also to nature and

the environment.

 http://www.amazon.co.uk/Dr-Raj-Persaud-Latest-Users/dp/B0082XNF40

 

http://www.amazon.co.uk/The-Therapeutic-Imagination-psychodynamic-understanding/dp/0415819571

 

As Botox Is Found to Treat Clinical Depression, How to Battle Low Mood With Your Face

RAJ PERSAUD AND PETER BRUGGEN

We look upset because we feel distraught. Obvious? 

Maybe the other way round? Does looking sad contribute to low mood? 

This would have revolutionary implications for understanding the causes of depression, and indeed the treatment of mood disorders.

How often have we intuitively felt that, if someone just tried to look happier, it might have a positive impact on their mood? 

Now a team of researchers lead by Axel Wollmera and Tillmann Krugerb, based at the Psychiatric Hospital of the University of Basel, Switzerland and the Department of Psychiatry, Medical School Hannover, Germany, have indeed turned conventional thinking on its head. Their research, just published in the Journal of Psychiatric Research, has found that injecting botox into the muscles most linked with low mood, produces alleviation of depression.

Injection of botulinum toxin to the glabellar region - just above the nose and between the eyes, is part of one of the most common procedures in aesthetic medicine, as the toxin inhibits the activity of the corrugator and procerus muscles in that region. This effect is used in the cosmetic treatment of 'frown lines'.

The subjects recruited for this clinical trial were suffering from long-standing low mood - on average 16 years of recurrent episodes of depression with the current episode lasting an average of almost 30 months, and they were selected as a group unconcerned with their facial appearance (they would not have picked 'botox' if given a choice).

The study, 'Facing depression with botulinum toxin: A randomised controlled trial, involved patients who had not previously benefited from standard anti-depressant prescription medication.

In Wollmera, Krugerb and colleagues' clinical trial botulinum toxin was injected just once into a specific part of the face in 15 patients, while another 15 were injected with placebo salt water. Remarkable improvements in mood were achieved after just one injection. Six weeks after a single treatment, scores on a standard depression rating scale, for botulinum toxin recipients, were reduced on average by 47.1%, while the placebo treated group experienced only a 9.2% reduction in the measurement of their depression.

This clinical trial involved the very specific choice of two particular small muscles in the face, especially associated with negative expressions, while 'botox' cosmetic treatments may target other muscles as well.

The corrugator supercilii is a narrow muscle at the corner of the eyebrow near the nose, and is responsible for pulling the eyebrows downward and towards the nose, producing vertical wrinkles of the forehead. This 'frowning' muscle and could be regarded as key in expressing distress. 

The other muscle activated when we're upset is the procerus, which extends from the lower part of the nasal bone to the middle area in the forehead between the eyebrows. It pulls the skin between the eyebrows down, so it's associated with transverse forehead lines and is usually targeted during treatment or correction of wrinkles. 

Since the Victorian era 'the omega sign' of depression, or omega melancholicum was well known, being the facial expression where wrinkling of the skin above the nose and between the eyebrows resembles the Greek letter omega. The 'Omega Sign' was even believed to be diagnostic of a depressive disorder.

A skin fold running obliquely from the lower outside to the upper inside on the upper eyelid is specifically named Veraguth's folds and was also assumed historically to be characteristic of depression.

Now it looks like modern medicine is rediscovering an ancient story that depression writes in the face, and, vice versa, how the face might prop up depression.

William James, a famous Professor of Psychology at Harvard University, said in 1890, "Refuse to express a passion, and it dies", referring to a 'facial feedback' hypothesis. Wollmera, Krugerb and colleagues argue this suggests strong historical support for a mutual interaction between emotions and facial muscle activity, rather than just one way traffic. 

The theory here is that expressing an emotion causes you to feel that mood, not just the other way round.

To test this revolutionary idea a number of scientific studies recently aimed to alter facial expression and then investigate whether emotional experience is subsequently affected. These studies, if they are properly scientific, have to carefully manipulate facial displays of emotion in a manner that eliminates the participants' awareness that they are being asked to produce an emotional expression. 

For example, one experiment involved having subjects hold a pen between their teeth (a simulation of smiling but without the subjects realising this was the point of the experiment). They found cartoons funnier. In another experiment two golf tees were attached to either side of subjects' foreheads and the participants were asked to move the two tees together (a simulation of frowning without the subjects realising they were being asked to glower). When the tees were closer together, subjects rated unpleasant photographs more negatively.

One possible implication of all these startling findings is that you may not need 'botox' to get the same anti-depressant benefits: relaxation techniques applied specifically to your facial muscles might have the same effect.

The ''motion creates emotion'' theory is also reflected in the rise of 'laughter therapy'. A recent review by Ramon Mora-Ripoll, of the Laughter Research Network in Barcelona, Spain, surveys nine scientific studies which had found significant health benefits from laughing. For example in one study of eight laughter therapy weekly sessions, a 55% reduction in pain scores; a 12% increase in functional mobility; and a 50% reduction in depression symptoms and 42% in anxiety symptoms were produced by laughter in 107 chronic pain patients, who maintained these gains at 12 month follow-up.

Mora-Ripoll's review, entitled 'Potential health benefits of simulated laughter: A narrative review of the literature and recommendations for future research' published in the Academic Journal Complementary Therapies in Medicine suggests these health benefits are often being produced by 'simulated laughter' willed upon oneself, and not triggered by humour - or fun as in 'spontaneous laughter'.

Exactly why forcing yourself to laugh, just like forcibly removing frowning or a worried expression, should produce health benefits remains mysterious, but Mora-Ripoll points out that laughter itself exercises and relaxes muscles, improves respiration, stimulates circulation, decreases stress hormones, increases immune system defenses, and elevates pain threshold.

Perhaps it improves mental functioning through the release of inhibitions and promotion of sociability, and maybe frowning less and smiling more as in the botox therapy, works in similar ways.

It's possible that the botox treatment for depression was effective because a more positive facial expression improved social interaction, and this may have contributed to improved mood. Maybe looking in the mirror, and seeing they looked more cheerful, could have lead the subjects in this clinical trial to believe they were happier. This in turn, elevated mood.

However, the Wollmera, Krugerb and colleagues argue, there are many reasons a purely aesthetic benefit can be excluded as the main cause of mood improvement in the botox treatment of depression. Patients in this clinical trial were not concerned about the cosmetic appearance of their frown lines. The improvement in mood did not turn on feeling better about a cosmetic improvement in appearance. For example, one participant's depression remitted with the botox treatment, but that person disliked the facial appearance it produced.

The authors conclude that their clinical trial shows facial expressions associated with depression are not just the consequences of low mood. In fact, they may be integral components of the disorder, and therefore should also be targeted.

Clinical depression is a serious and complex disorder where it's unlikely any one treatment is going to be a magic panacea. Because standard medical treatments work only in a proportion of patients, exploring other possible approaches is warranted. One in 10 of the general population suffer from clinical anxiety and depression at any one time.

So it's good news that learning to smile and laugh more, but frown less, may just be the latest scientifically validated treatment for depression.

 

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: raj_persaud_chats_to_jeremy_holmes.mp3
Category:(2) General Podcasts -- posted at: 6:42am UTC

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?

 

RAJ PERSAUD AND PETER BRUGGEN

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

Sleep problems explained. The psychiatry of sleep problems

How to get a good nights sleep without pills?

Dr Raj Persaud in conversation with Dr Jeremy Beider. Problems sleeping are one of the commonest difficulties that doctors in the UK deal with - possibly leading to massive over-prescribing of hypnotic drugs which can be highly addictive. What are the non-pharmacological ways of achieving a good nights sleep? Raj Persaud in conversation with Jeremy Beider who was presenting on this topic at the Annual International Congress of the Royal College of Psychiatrists at the Barbican.

Jeremy Beider is a consultant in adult psychiatry in West London Mental Health Trust and holds a MSc in Behavioural Sleep Medicine from Glasgow University.

He has Clinical experience at Guy’s and St Thomas’ Sleep Disorders unit and the National Neuropsychopharmacology Clinic UK

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

As a Dream Predicts Lottery Win, and Malaysian Airlines Passenger Posts Eerily Prophetic Picture - Can Dream and Visions Foretell the Future?

 

RAJ PERSAUD AND PETER BRUGGEN

 

http://www.huffingtonpost.co.uk/dr-raj-persaud/lottery-dream_b_5605068.html

 

The UK press has reported that a judge recently ordered a restaurant owner to split half of a million pound lottery prize with his waiter, because of a dream foretelling the future.

The boss of a Turkish restaurant in York, England, bought the winning lottery ticket following a vivid dream experienced by his superstitious employee, predicting the win.

Judge Mark Gosnell's ruling followed a protracted legal dispute between the two men as to whom the prize money belonged to. The Judge's final decision, that the jackpot had to be split by the boss with his waiter, partly turned on a premonition.

It is reported that the waiter dreamt that he was holding a large bundle of cash and standing in front of him was his boss. Being a strong believer in the power of such visions, the dreamer interpreted this to mean that he and his boss would scoop the lottery.

The following day the waiter apparently "pestered" his boss for hours, before the restaurant owner finally agreed to enter the EuroMllions draw.

The judge examined CCTV footage from the restaurant which showed the two men filling in the winning ticket, and ruled in the waiter's favour, accepting the dream explanation was "plausible".

While anecdotal reports of dreams predicting the future abound, Parapsychologists are interested in scientifically testing whether foretelling the future might be possible.

For example, a paper entitled, 'An ostensible precognition of the Arab surprise attack on the Day of Atonement, 1973', published in 1986 by Gilad Livneh, in the 'Journal of the Society for Psychical Research', presented just such a compelling case. A letter to Israeli Prime Minister, Golda Meir, was discussed in which a woman reports her vision about an Arab attack, two weeks before the actual event took place.

While accurate prophecy was a plausible explanation, however, the author also conceded that chance coincidence could not be ruled out, due to the inconsistency of certain details between the dream, and the actual event itself.

Caroline Watt, Natalie Ashley, Jack Gillett, Megan Halewood and Rebecca Hanson from the Department of Psychology, University of Edinburgh, have just published one of the most recent systematic studies on prophetic dreams.

These authors report surveys showing that around one quarter of the population believes in the ability to foretell the future, while about one third report 'precognitive' experiences (precognitive means literally fore-knowing).

The authors also point out the scientific and public importance should some dreams indeed turn out to be reliably prophetic. For example, if such precognitive dreams contain trustworthy information, it might be possible to warn of forthcoming disasters, or even to prevent them from occurring.

This has particular resonance right now given a Dutch passenger feared dead, is recently reported to have posted a photo of the Malaysian Airlines Jet he was boarding, destined to crash in the Ukraine, with the message: "if we disappear, this is what the plane looks like".

Caroline Watt, Rebecca Hanson and colleagues point out that following the Aberfan disaster the British Premonitions Bureau was set up in London, and in the USA the Central Premonitions Registry was established. Both appear to have faltered partly due to an insufficient number of predictions that could be related to specific incidents.

Linking an incident which has now happened with a prior dream could merely be a tendency to see patterns facilitated by the benefit of hindsight.

In another past study reported by the authors of the latest research, participants were asked to document their dreams upon awakening, and then to mail a copy to the researcher. The dreamers were asked to notify the investigator if they noticed any events occurring that corresponded to their dreams. In one series, it was judged that only two out of 265 dreams (over an 8-week period) appeared 'moderately' prophetic.

Caroline Watt, Rebecca Hanson and colleagues' current paper, entitled 'Psychological factors in precognitive dream experiences: The role of paranormal belief, selective recall and propensity to find correspondences', investigated the part of selective recall in prophetic dream experiences. Participants read two diaries, one purporting to be a dream diary, and one claiming to be a diary of incidents in the dreamer's life. The events either confirmed or disconfirmed the reported visions.

A significantly greater number of confirmed than disconfirmed dream-event pairs were recalled by participants taking part in the experiment, possibly indicating a human tendency to see connections over unconnected happenings.

The authors argue that their research, published in the 'International Journal of Dream Research' in April 2014, explain the seeming coincidence between dreams and events that can be interpreted as prophetic.

Two possible psychological mechanisms - selective recall and propensity to find correspondences seem to lead us to experience many more dreams apparently foretelling the future, than may genuinely exist.

These explain the discrepancy between the dearth of scientific support for prophetic dreams, compared with the rather frequently reported experience in the general population, of having dreamed about a seemingly unpredictable future event.

Psychologists Gergo Hadlaczky and Joakim Westerlund from Stockholm University have published a study in 2011 which argues that how surprised you are by coincidences could predict how likely you are to end up believing in phenomena such as parapsychology and the supernatural.

The study entitled 'Sensitivity to coincidences and paranormal belief' and published in the journal, 'Perceptual and Motor Skills' exposed participants to artificial coincidences, who were asked to provide remarkability ratings. Those who were more surprised, when experiencing coincidences, tend towards higher paranormal belief (beliefs such as in telepathy etc).

The most obvious explanation for many coincidences is 'just chance'. Tending to be more surprised by coincidence suggests a tendency to reject the 'it's just chance' account. For example, there will be some who put it down to just chance that two Malaysian Airlines Jets should suffer catastrophe in a short space of time. Others will be much more surprised.

It's possible that a tendency to be more shocked by coincidence simply betrays poor probability reasoning. But it could also have positive survival value in an evolutionary sense. Being more paranoid may mean seeing patterns in what others assume are random events.

Being more astonished by coincidence, could have made you more vigilant for threat in our ancestral environment, more paranoid, and therefore more able to detect and defend against predators in our ancestral past. We could be genetically wired up to be surprised by coincidence.

But paranoia and surprise by chance is only helpful if it leads to an actual action that then produces a positive outcome. The passenger reported to have posted the prophetic internet message about the Malaysian Airlines Jet due to be flying over Ukraine, apparently still did board the plane.

The recent lottery-winner case appears an excellent example of a kind of quasi-scientific proof that dreams can foretell the future, because the person who had the dream then engaged in an action the next day as a direct result - persuading his boss to buy a lottery ticket.

Yet if the waiter in the most recent legal judgement ruling was so convinced by his prophetic dream - why did he not take more precautions to safeguard his claim to the win?

Why did he not foresee that sharing the ticket purchase with his boss was going to lead to a protracted legal battle?

Depending on how you interpret it, this could become an example of how dreams or visions don't really predict the future.

 

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


The science of hearing voices

Raj Persaud in conversation with Professor Peter Woodruff. Professor Peter Woodruff from Sheffield University and Raj Persaud discuss the latest neuroscience research on hearing voices or auditory hallucinations with Raj Persaud - the conversation was recorded at the Annual Congress of the Royal College of Psychiatrists at the Barbican. The latest neuroscience developments appear to hold out the prospect of innovative new non-drug related therapies.

 

Professor Peter W R Woodruff MBBS PhD MRCP FRCPsych

Professor and Head of Academic Clinical Psychiatry
Director of the Sheffield Cognition and Neuroimaging Laboratory (SCANLab)
Deputy head of the Section of Neuroscience

  • 1 July 1999 – present: Professor and Head of Academic Clinical Psychiatry, University of Sheffield & Honorary Consultant Psychiatrist, Sheffield Care Trust (from 1 July 1999)
  • 1997- 1999: Senior Lecturer in Psychiatric Neuroimaging University of Manchester
    Honorary Consultant Psychiatrist, Mental Health Services of Salford.
  • 1995 – 1997: British Telecom Research Fellow in Functional MRI, Institute of Psychiatry London
    Senior Lecturer in Psychiatric Neuroimaging/Hon Consultant Psychiatrist in Psychiatric Intensive Care, Maudsley Hospital London
  • 1994 – 1995: Fulbright Fellow in Functional MRI, Harvard Medical School & Massachusetts General Hospital USA
  • 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

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

 

http://www.huffingtonpost.co.uk/dr-raj-persaud/washington-shooting-naval-yard_b_3960983.html

 

 

Could Psychiatrists Have Prevented the Washington Naval Yard Shootings?

 

Raj Persaud and Peter Bruggen

 

As reports began to appear of the disturbed background of Aaron Alexis, the media seems to have universally decided that mass shootings are readily explained by severe mental illness.

 

The assumption is that as psychiatric disorder is so obviously linked to violence, there should be no surprise that the Washington Naval Yard killings involved someone with a mentally troubled history.

 

New research finds that media reporting of mass murder, such as this most recent tragedy, leads to more negative public attitudes to the mentally ill. This in turn may contribute to a pessimistic stereotyped image for psychiatric problems and services. As a result, people who suffer symptoms, as it appears Aaron Alexis could have, may not access treatment which possibly prevents these atrocities.

 

 

A vicious cycle is thus created, ironically perpetuated by media coverage. Is it possible the reporting is part of the cause of such senseless violence? Not because this encourages one sub-type of mass killers - 'infamy seekers' (which it may do) but also as it may discourage early psychiatric intervention?

 

 

Emma McGinty, Daniel Webster and Colleen Barry, from the Johns Hopkins Center for Gun Policy and Research, and the Johns Hopkins Bloomberg School of Public Health, Baltimore recently found that reading a news story about a mass shooting, heightened negative attitudes toward sufferers from mental illness.

 

 

The study entitled 'Effects of News Media Messages About Mass Shootings on Attitudes Toward Persons With Serious Mental Illness and Public Support for Gun Control Policies', involved a national sample of almost two thousand participants. Their findings suggest public perception is that serious mental illness, more than access to guns, accounts for mass shootings.

 

 

The study, recently published in the 'American Journal of Psychiatry', concludes that in the aftermath of mass shootings, the barrage of news stories describing the shooter with psychiatric symptoms, his history, and his actions during the shooting might raise public support for gun control policies. But such coverage also contributes to negative attitudes toward the mentally ill.

 

 

The authors go on to point out that pessimistic public attitudes are linked to poor treatment rates among persons with serious mental health conditions.

 

 

But if there were better psychiatric services, and if the taboo surrounding mental illness was less, so more people accessed better treatment earlier, would it make a difference to these tragic shootings? Could psychiatric interventions prevent these atrocities in the future?

 

 

'The American Journal of Psychiatry' was partly prompted by the Johns Hopkins media effects study, to wrestle with the question of how psychiatrists could make a difference to the apparently rising incidence of mass killing incidents.

 

 

Psychiatrists Richard Friedman and Robert Michels, were in fact responding to the Newtown Connecticut school shooting, at the time of their editorial. Yet their comments anticipate the likelihood that such tragedies would recur soon.

 

 

They did indeed, when Aaron Alexis recently killed 12 people in the Washington Naval Yard.

 

 

The media reports suggested the navy contractor was wrestling with mental illness. He appears to have been hearing voices and complained he was being followed by people using a microwave machine to send vibrations through his body.

 

 

Doctors Friedman and Michels agree that mass killings attract the kind of blanket media coverage which can create misleading impressions. For example, the attention they attract distracts from the fact mass killings are very rare. Friedman and Michels point out that in 2011, mass killings accounted for only 0.13% of all homicides in the United States.

 

 

Friedman and Michels believe the conundrum the public find most difficult to grasp is that although mass murderers probably suffer more mental illness than other killers, the mentally ill as a group actually pose relatively little risk of violence.

 

 

For example, their editorial entitled 'How Should the Psychiatric Profession Respond to the Recent Mass Killings?' quotes that only 4% of violence generally can be attributed to persons with mental illness. The prevalence of violence amongst those with serious mental illness throughout their lifetime is 16%, as compared with 7% among people without.

 

 

Alcohol and drug abuse are far more likely to produce aggression. Those who abuse alcohol or drugs but have no other mental disorder, are nearly seven times as likely as those without substance abuse, to commit violence.

 

 

One possibility is that improving mental health services might make a difference; Aaron Alexis appears to have fallen through the net of treatment.

 

 

But, remarkably, should a psychiatrist have been able to evaluate this man before the shootings, suffering though he appeared to be from hearing voices and delusions, it's not clear he could have been easily detained involuntarily by current mental health legislation. The law, both in the USA and the UK, supports doctors in seeking involuntary admission to hospital, only if they can convince the authorities that a patient is an immediate danger to himself or others.

 

 

Perhaps in the wake of these recent shootings, involuntary mental health legislation and practice should be loosened from 'imminent danger', to a 'reasonable likelihood of violent behaviour'.

 

 

But Friedman and Michels argue that lowering the threshold for involuntary treatment could discourage consulting doctors. People could become more wary of being candid or seeking help voluntarily.

 

Heightened fears of being committed to an institution against their will, might mean some of most unwell patients would be driven further away from the mental health system.

 

 

Mental illness is very treatable, and sufferers can and do return to productive well-being with the right healing, implemented early enough. Yet the fear of being 'locked away' forever in an asylum continues to stigmatise the system.

 

 

As psychiatrists, when we hear these tragic stories of what mental disturbance lay behind a mass shooting, we have a further concern. It is that sufferers from these severe psychiatric symptoms, over and over again, were not receiving adequate treatment.

 

 

The media clouds the key lesson to be learnt, which is that it's neglected and untreated mental illness, not psychiatric disorder alone, which is involved.

 

 

If the truth was more widely understood, about how effective modern treatment of psychiatric problems can be, particularly if dispensed by properly trained professionals, then it is possible that these incidents could indeed become rarer. Clinics might then attract adequate public funding, and even better clinicians, which would all help services become ever more effective.

 

 

Some may possibly argue that even the best mental health system would likely have little impact on deterring mass killings, as some of these killers largely avoid psychiatric treatment - but for the others - and those who might be influenced by friends and relatives observing something amiss, we still believe there could be a worthwhile impact.

 

 

If the USA is not going to embrace tougher gun control, as it appears reluctant to, then it may well be even more imperative they develop absolutely excellent mental health services.

 

In the aftermath of yet another mass shooting tragedy, this might just be our only hope.

 

 

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.

https://play.google.com/store/apps/details?id=com.rajpersaud.android.rajpersaud

 

https://itunes.apple.com/us/app/dr-raj-persaud-in-conversation/id927466223?mt=8


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

 

FROM THE ROYAL COLLEGE OF PSYCHIATRIST'S WEBSITE

http://www.rcpsych.ac.uk/discoverpsychiatry/podcasts/kennyjohnston-suicideand.aspx

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

 

 

http://rajpersaud.wordpress.com/2014/08/22/after-the-robin-williams-tragedy-will-there-by-copycats-raj-persaud-and-professor-sir-simon-wessely-president-of-the-royal-college-of-psychiatrists/

 

http://www.amazon.co.uk/Dr-Raj-Persaud-Latest-Users/dp/B0082XNF40


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: 

 

http://www.huffingtonpost.co.uk/dr-raj-persaud/stephen-fry-attempted-suicide_b_3395012.html

 

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.

https://play.google.com/store/apps/details?id=com.rajpersaud.android.rajpersaud

 

https://itunes.apple.com/us/app/dr-raj-persaud-in-conversation/id927466223?mt=8


Young Shrinks Speak Out. Headstarters Part 4 - young psychiatrists speak

Headstarters Part 4 - Raj Persaud in conversation with young psychiatrists

The research indicates that there are two kinds of medical student - those who know what they are going to specialise in before they start medical school and those who choose afterwards - is psychiatry as a medical speciality different in this regard? Raj Persaud chats to young psychiatrists in training about this issue and others.