Two tribes

There seems to be a dramatic gap between "front line" health staff and the administrators of the HSE, and an even more dramatic one between doctors' perception of the problems of the health service and politicians'. This not just the case in Ireland. There are lots of reasons why this might be so. One however relates to a more general issue about how scientists and experts communicate with politicians and "policy makers" (a wonderfully vague term that seems to mean anyone of influence) about scientific and medical issues. We have lots of training now in how to communicate with patients, but communicating with politicians/policy makers seems to be nearly as important a skill. One set of suggestions I found online, from the world of palliative care, can be read here (you have to scroll down a bit to get to the part about politicians)

An exercise for readers of the blog - if were given half an hour to present to the Minister for Health and a random selection of influential TDs (or MPs, or Senators, or whoever) about suicide, or psychiatric stigma, how would you go about it? What would you like to get through to them?

Reporting suicides

One of tomorrow's lecturers is Joe Little, RTE's Religious and Social Affairs Correspondent. You've probably seen him on the news! He'll be talking about psychiatry and the media. One of the most pressing issues in this regard is how suicides are reported. The way suicides are reported has been shown to affect suicide rates. You can look at some guidelines here. Reporting of suicide methods also can affect which methods are used. For instance, in Singapore some high profile deaths by suicide involved charcoal burning, and subsequently the proportion of suicides by this method increased (you can read about this here.

Has psychiatry turned normal sadness into depression?

This article is a lengthy review of a book published earlier this year arguing that psychiatry has turned "normal sadness" into depression. The review is balanced and well argued, and gives an interesting if somewhat jaundiced overview of the process whereby DSM diagnostic criteria are created.

A qualitative study about stigma worth reading

This study about stigma a few years ago from the British Journal of Psychiatry is worth reading. It goods a give overview of many of the issues involved. It also gives you some sense of how qualitative research is carried out.

The Environment, Climate Change, and Mental Health

A few months ago this article in the magazine WIRED attracted some attention. It deals with the topic of "solastalgia", a word coined by the Australian environmental philosopher to describe the distress experienced by those whose environment is changing around them.

Albrecht had worked for many years as an environmental activist and advocate in the Hunter Region of New South Wales. Open cut coal mining and the construction of new power stations had transformed this formerly agricultural landscape. Local residents who were concerned about specific environmental issues contacted Albrecht to discuss these. In the course of these interactions he began to notice that a wider distress at the extent of local environmental change was evident. Influenced by various environmental thinkers, who argued man-made environmental stress lead to “land-sickness” (which, unlike other "natural" environmental stresses, did not lead to an environmental recovery) and caused psychic stress among the population of the particular environment, he developed the concept of solastalgia.

Albrecht described how "nostalgia" was traditionally defined as sadness at absence from a particular place, and wrote in his original paper on solastaliga “People who are still in their home environs can also experience place-based distress in the face of the lived experience of profound environmental change. The people of concern are still ‘at home’, but experience a ‘homesickness’ similar to that caused by nostalgia. What these people lack is solace or comfort derived from their present relationship to ‘home’, and so, a new form of psychoterratic illness needs to be defined. The word ‘solace’ relates to both psychological and physical contexts.”

Clive Thompson, who wrote the WIRED article, described "solastalgia" as "a fascinating new concept in mental health." Do you think that "solastalgia" can be described as a "mental illness?"

The Economics of Mental Health

Health economics is a topic of increasing interest to practising doctors, as the realisation grows that our practice is affected both positively and negatively by economic conditions. As recent economic changes will no doubt affect this even more, we are increasingly obliged to have at least some knowledge of the economic effects of the conditions we treat, and the relationship between economic change and these conditions. The website of the (London) Institute of Psychiatry's Centre For The Economics of Mental Health is a good place to look around and get some idea of how interventions and treatments are evaluated from an economic point of view.

An interesting way of fighting stigma

This is an interesting way of fighting stigma.

Is faith delusion?

Hello everyone,

Welcome back and I hope your summers went well. I am hoping that this blog will be more active both from the posting and commenting end. I'd like to reiterate that anyone who is interested in posting on it should simply email me at seamus.macsuibhne@ucd.ie . If you have a gmail account, signing up takes seconds (if you don't, it only takes a few more seconds)

As the exam approaches, I will be posting more on this myself to get you all thinking. One event that is coming up which may be of interest (if you weren't cramming yourselves full of paediatric, obstetric and gynaecological knowledge I guess) is a talk by Professor Andrew Sims to the Psychiatry Section of the Royal Academy of Medicine in Ireland on September 25th at 7 pm. Prof Sims is the retired Professor of Psychiatry at Leeds University and is the author of "Symptoms in the Mind" which is the key text in phenomenology (and comes very highly recommended). The talk will take place in the Royal College of Physicians on Kildare Street. A paper he has previously presented on the topic can be readhere

Obviously the topic "Is Faith Delusion?" is influenced by the title at least of Richard Dawkins' book "The God Delusion." As you all know, by definition a delusion can't be a cultural or subcultural belief, so by the basic definition of dleusion a religious belief can't be a delusion. However this rather circular argument begs the question, why shouldn't we class religious beliefs as delusional? They are after all held in the absence of evidence, can be unshakeable, and as there is a diversity of religious beliefs some at least must be false. Andrew Sims' paper perhaps is a good argument why we don't.

Lectures for Autumn Term

It's a while away, but for what it's worth these are the Autumn Lectures

September 18th

2 pm - a lecture by Professor Kevin Malone and Seamus McGuinness on Suicide.

3 pm - a presentation by Dr Marie Naughton on confidentiality (please note this topic may be examined in the final examination) followed by a lecture by Dr Seamus Mac Suibhne on stigma

October 10th

2 pm a lecture by Dr Liam Delaney, UCD Geary Institute, on Mental Health, Economic Wellbeing, and the Celtic Tiger

3 pm a lecture by Joe Little, Social and Religious Affairs Correspondent, RTE, on Psychiatry and the Media

The role of work in psychological health and well being

There's an interesting post on the blog of the UCD Geary Institute on the role of work in psychological health and well being. The post links to various other articles.

Sigmund Freud once wrote somewhere or other that the role of therapy was to enable the patient to, once again, "love and work." (he wrote elsewhere that psychoanalysis replaces the presenting symptom with more ordinary neurosis)

Dr Caragh Behan's lecture

Hello,

I hope those who attended enjoyed Dr Caragh Behan's lecture on health economics. I've just put the actual lecture up on Blackboard. I know this covered ground you've already done in epidemiology. However it is very much within the remit of the course to cover the interaction between psychiatry and economics. There will be a follow up lecture in September by Dr Liam Delaney of the UCD Geary Institute (you can read about the Geary Institute in the blogroll to the right) which will focus more directly on economic change and mental health.

When I was a medical student at the turn of the century (how old that makes me sound...) I remember finding all these lectures on what, for want of a better term, public health type stuff very very boring. Most medical students don't go into medicine to learn about p values and cost effectiveness studies and the rest of it, but to learn how to diagnose and treat illnesses. And most of us switch off whenever we hear some combination of words like "service delivery", "stakeholder" and the like. However as your clinical career progresses (again I'm sounding an ancient fuddy duddy) you realise how important it all is. Even if it always remains less than fascinating, how the health system is structured and funded is directly relevant to your daily lives and what you can do for your patients.

Sermon over.

Lecture May 15th

2 pm, C005 - Dr Caragh Behan - "Pricing the priceless - whose business is
Health anyway?"

Upcoming lectures

Hi all,

This Thursday at 2 in C005 there will be a lecture on the DETECT Early Detection of Psychosis project.

On Thursday 15th May Dr Caragh Behan will be giving the lecture - title to be announced.

We won't be having lectures on Thursday 24th April due to proximity to end of rotation exams.

Today.

Hello,

I've put my presentation on blackboard. I'll put Niall's up in due course. Thanks for filling out the questionnaires!

I'll post more in due course. As I said, have a look around, you might get a feel for last years course and how it panned out. If anyone is keen to get involved, just drop me a line at seamus.macsuibhne@ucd.ie . Its very simple to sign up, especially if you have gmail (which most of you seem to have)

Seamus

Your Brain On Music

This isn't strictly (or, to be honest, at all) relevant to the course, but I've just been reading Daniel Levitin's "This Is Your Brain On Music which is a fascinating look at why we spend so much time and energy on music, and invest so much emotionally and intellectually in it, from a psychology/neuroscience point of view. It's a fun, accessible read, and I'd recommend looking through the site. Levitin had quite an interesting life as a musician and music producer before going back to university later in life (in fact, looking at his wikipedia entry, he's almost nauseatingly accomplished)

On the website this is particularly enjoyable (though I've never heard of "Parthenon Huxley" myself) - a list of pop and rock songs which refer to neuroanatomy in some way:

* "Now I guess I'll have to tell 'em/ That I ain't got no cerebellum ."
The Ramones, "Teenage Lobotomy."


Actually, the cerebellum (which is in the back of the head at the base of the skull) would not be directly affected by a lobotomy (which disconnects the frontal lobe from the rest of the brain). But you can't blame The Ramones, one of my favorite bands; after all, they went to a "rock and roll high school" and spend their leisure time not reading books about brain anatomy, but " Hangin' out in 100B, watchin' Get Smart on TV, thinkin' about you and me." But looking at it another way, they may be right. As we are just beginning to learn, there are massive connections between the frontal lobe and the cerebellum, so it is true that anyone with a frontal lobe lobotomy is going to suffer impairments in cerebellar connectivity. [Chapter 6]



* "When a rattle of rats had awoken,
The sinews, the nerves, and the veins.
My piano was boldly outspoken, in attempts to repeat its refrain."
Paul McCartney, "Monkberry Moon Delight"


Sudden noises can launch a startle response in the brain that tenses our muscles (a sinew is a tendon), put our nerves on alert, and dilate our arteries as a means of increasing our blood pressure and preparing for a fight or flight. Nerves are part of the peripheral nervous system. Afferent nerves convey sensory signals to the central nervous system, for example from skin or organs, while efferent nerves conduct stimulatory signals from the central nervous system to the muscles and glands. Afferent and efferent fibers are often arranged together, forming mixed nerves.



* "Something in my heart stopped when you walked by. . .
Cerebellum breakdown when you said 'hi'
San Francisco Bay went completely dry "
Parthenon Huxley "Something in my heart"


A sudden emotional experience, such as seeing that special someone you're in love, especially unrequited love, puts all our senses on alert. The cerebellum is responsible for motor responses, and yes, the lyric is accurate in that a breakdown of normal function there is what happens when faced with an exciting or emotional experience. Parthenon couldn't have known this in 1987 when he wrote the song, but the recent discovery of mirror neurons" in the brain has shown how prescient this lyric was; seeing someone walking activates neurons that help us coordinate and implement our own walking. [Chapter 6] Parthenon Huxley is one of my favorite, and most inspiring, songwriters. You can get his music here: parthenonhuxley.com



* "The lunatic is in my head
The lunatic is in my head
you raise the blade, you make the change
you rearrange me ' till I'm sane
you lock the door
and throw away the key
there's someone in my head but it's not me"
Pink Floyd, "Brain Damage"


For most of us, the seat of our feelings of "me-ness" is in the brain; we identify that which makes us "us" with something inside our heads, and that is the brain. Perhaps a reference to lobotomy, the lyric accurately portrays the 20th century resolution to the mind/body problem. [Chapter 3]



* "Fame, it's not your brain, it's just the flame that burns the change to keep you insane Fame"
David Bowie, "Fame"


The space oddity is right, the brains of famous people are not fundamentally different from anyone else's, and the brains of musicians -- although they do undergo some changes as a result of practice -- are not architecturally different from other's as far as we know. Experience shapes a brain, but musical experience doesn't do this any more than experience with chess, driving a taxi in London, or listening to the Animaniacs. [Chapter 7]

UCD/St John Of God's Research Project

From "socialisationproject@ucd.ie"
Sent Wednesday, February 27, 2008 10:17 am
To All Staff
Cc
Bcc
Subject Volunteeers for Socialisation Project
Dear Colleague,

I am writing to ask for your help with a research project being carried out in UCD School of Nursing, Midwifery and Health Systems, University College Dublin in conjunction with St. John of God Mental Health Services. The purpose of the research project is to establish and evaluate a programme which will enable people living in the community who are experiencing mental health problems to socialise. As part of the research project we are hoping to recruit a group of volunteers who are willing to commit to spending a couple of hours a week undertaking social activities with a person who has an enduring mental illness.

The research project will last approximately nine months and if you are willing to participate as a volunteer or require further information on the study please contact a member of the research team on socialisationproject@ucd.ie or telephone 01-716672

An expression of interest does not commit you to taking part.

Thank you for your time and consideration of this important study.

Kind regards,

Dr. Ann Sheridan
Principal Investigator
UCD School of Nursing, Midwifery & Health Systems
Health Sciences Centre
University College Dublin
Belfield,
Dublin 4.

Welcome incoming final years!

Hello

Welcome the incoming final years who have followed this link on Blackboard! First of all, look around, feel free to comment, and if anyone would be interested in posting themselves, drop me a line (Seamus.macsuibhne@ucd.ie) and we can set you up. Secondly, the lectures will kick off March 13th in Belfield, in C005. Niall Crumlish, who as you can see posts here already, will be holding forth to you all.

Seamus

Hi

A link to an article in the Irish Independent from Saturday 9th Feb.

http://www.independent.ie/opinion/analysis/personal-tragedies-used-to-support-a-flawed-hypothesis-1285818.html

It was in response to this from 1st February. (Probably better to read this first).

http://www.independent.ie/opinion/columnists/kevin-myers/sisterhood-triumphs-again-in-our-twotier-penal-system-1278505.html

These touch on the relationship of psychiatry to the legal system and the media; the expectations that people have, and the need to be clear about what we do as psychiatrists, and doctors.

Oh dear

Movie Reviews

I think I'll try and, um, refine things for next year.