Sunday, 22 January 2017

pons asinorum: donkey bridge; facing the Real Other #HistoryBeyondTrauma

from New World Encyclopedia
back cover


Bus to Glenrothes for shopping, reading History Beyond Trauma, there and back, following on from First Crisis, Nth Crisis; (helper reduced to) A Minor Character, 20 January 2017, on bus to Dundee.

From readings today and Friday, what struck me again were the feelings of homecoming regarding the psychoanalytic engagement, working with mad people, in psychosis.  It makes sense.













people without capacity don't require advocacy: said psychiatrist Stratheden IPCU 9Feb12

Stratheden Hospital blog started July 2012
or words to that effect, from Dr Bill Dickson, Consultant Forensic Psychiatrist, RMO, Stratheden Hospital IPCU, at the first meeting I had with him over a week after my son was transferred in his underpants and bare feet, broken hand and bruising, from Lomond Ward, Stratheden, by porters in a minibus.  I witnessed this from car park at approximately 4pm.  Didn't know about the broken hand or Midazolam injection.  Or that he had been assaulted by a nurse prior to face-down restraint.

I also didn't know about the locked seclusion room, no toilet, no water, in the dark, for hours on end, unobserved.  Yet I'd been engaging with Stratheden Hospital since 1995 when my first son was an inpatient of Lomond Ward, had a critical incident with ECT.  Then was an inpatient myself in Lomond, 2002.  

The locked seclusion room in Ward 4/IPCU.  Naughty step.  Dirty secret.

I set Dr Dickson straight about the need for advocacy for mental patients, particularly those deemed to be "without capacity" and proceeded to advocate for my son whenever he asked me to.  At clinical meetings headed up by Dickson in the IPCU.  On one occasion Dickson lost the head after my son sat on his chair, had his jacket on back of it.  Dickson said to my son: did you not notice my jacket?  Of course he did.  That's why he sat on the doctor's chair.

Dr Dickson retired end of March 2012 then got supply work at Carseview Dundee psychiatric unit.  
  
front page Scottish Sunday Express 5Oct14
Psychiatric Patient's Treatment Slammed; Express Sunday 5Oct14

back door IPCU/Ward 4 2012, where I had to enter ward, other folk got in front door






 
19 July 2012 Courier article

photo taken by me Jul12 Stratheden grounds
cigarette ends left by Stratheden staff on pavement outside back of IPCU 2012



























Friday, 20 January 2017

#HistoryBeyondTrauma First Crisis, Nth Crisis; (helper reduced to) A Minor Character

"Gilda was looking for someone who could sustain the shock of her experience" p169 

"It is better to conceive of all crises of madness as beginnings" p168

"The crises of the patient, which are always the first crises, are answered by the analyst's critical moments, which are, each time, initial moments." p172 

"Interpretations by themselves do not determine meaning" Wittengenstein, footnote 8. p170


















Monday, 9 January 2017

Psychological approaches to understanding & promoting recovery in psychosis and bipolar disorder

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Southampton (UK): NIHR Journals Library;

Abstract

Background:

Recovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.

Objectives:

To facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.

Method:

There were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.

Results:

Measurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total; p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78; p < 0.006).

Conclusions:

This research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.

Funding:

The National Institute for Health Research Programme Grants for Applied Research programme.  

Plain English summary

Psychosis (including disorders such as schizophrenia, which are characterised by hearing voices or paranoid beliefs) and bipolar disorder (BD) (characterised by mood swings) are common forms of serious mental health problems. Clinical services typically define recovery in terms of absence of symptoms. In contrast, service users conceptualise recovery as a unique process rather an end point, with key themes including hope, rebuilding self and rebuilding life. Our research aimed to understand and promote recovery in psychosis and BD, in a manner that is acceptable to and empowering of service users. Six linked projects were conducted using a variety of methods to develop new ways of measuring recovery; to understand what recovery means to service users and what factors promote recovery; to understand how recovery, symptoms and psychological well-being are related; to examine what sort of factors predict recovery; and to test three new interventions. All projects were conducted in collaboration with service users and the research team included two service user researchers. Our research has made significant additions to our understanding and promotion of recovery, including the development of two new measures which were shown to be valid and acceptable to service users. We have shown that we can measure recovery, that factors such as reduced negative emotions, increased self-esteem and hope are predictive of recovery judgements and that the new interventions tested showed promising benefits to people with psychosis and suicidal thinking and people with BD. These findings have important implications for future research and for clinical practice.




Wednesday, 28 December 2016

swimming exploits in Scotland & London; keeping fit, action research, testing the water

After my health scare summer of 2015 when I had reached the end of my tether, no justice after the psychiatric abuse Feb12 and many years of being excluded for speaking out with a survivor voice, I got back to swimming.  And joined Fife Sports and Leisure Trust, when I still had a car, visiting a number of their swimming pools.  It wasn't a positive experience on the whole, at times very negative, so I began to try out other pools in different Scottish areas and in London Nov15 and Jul16 when down there.  Action research, mystery shopper sort of a thing, testing out the waters.

The pools I swam at in Fife, from September to December 2015 were in: Cupar, St Andrews, Glenrothes, Kirkcaldy, Dunfermline and Burntisland; Bowhill was closed at the time and I didn't get to Cowdenbeath or Levenmouth pools although I'd used them back in the 1990's when a student at Fife College, found them OK for leisure swimming not for doing lengths.  

Cupar was closest but had slippy old tiled flooring and psychiatric nurses from Stratheden using the facilities, one of whom had assaulted my son 1Feb12.  St Andrews East Sands leisure centre changing rooms were in need of refurbishment, broken lockers and hairdryers, pool didn't have enough room for proper length swimming.  Kirkcaldy and Glenrothes were new pools funded by Sport Scotland.

The Kirkcaldy pool I found to be risky, safety wise, and males swimming aggressively.  There weren't enough lifeguards on duty one Saturday, electric sockets at toddler height near hairdryer tables with no safety plugs, mixed gender changing rooms unsupervised, teenagers running wild.  I reported my concerns at the time to NE Fife MSP Roderick Campbell who acted on my behalf, writing to the Fife Trust. Glenrothes pool seemed to have been taken over by swimming clubs, especially at weekends and through the week public swimming wasn't always available.  On speaking to local folk they didn't seem happy about this.

at Burntisland Beacon Centre Dec15

I enjoyed swimming at the Burntisland and Dunfermline Carnegie centre pools.  The former had helpful staff, nice views out large windows surrounding the pool, the latter also had friendly staff, many different facilities on offer.  But both centres were difficult to access by public transport from where I live.  A bus then two trains or two buses and a distance to walk.  In addition there weren't fitness options available to suit.

at Tollcross pool Glasgow Dec15
By December 2015 I had ceased using the Fife leisure centres and started travelling to the Olympia in Dundee, getting an over-60's offer, just £15/month, including free swim and some classes Mon-Frid daytime, free gym anytime including weekends.  At the same time I tried out other pools when visiting Edinburgh, Glasgow and Perth, to see what they were like, compared to the Fife swimming experience.  I'd often swam in Perth Leisure Centre pool, Glasgow Rd, 2000-2 when working with PKAVS at the Gateway, NMethven Street, and did fitness at the Rodney Centre, Bridgend.  It was still a positive swimming experience.


London Olympic pool Nov15
In Glasgow Dec15 I swam in the Commonwealth pool at Tolcross International Swimming Centre and the Whitehill pool at Dennistoun.  Both had very helpful staff although the Tolcross pool had much newer facilities, larger pool geared towards length swimming.  In Edinburgh I visited the Leith Victoria with changing rooms around the side of the pool in a lovely setting, the Portobello Swim Centre which also had a Victorian pool, and the Royal Commonwealth Pool.  Again very helpful staff and a pleasant experience.

after swim London Fields Lido Jul16
I was in London November 2015 for the Carers UK Summit and visited the Olympic pool at Stratford, deep water, large changing areas, helpful fellow swimmers and staff.  Similar positive experiences in July this year when in London and swimming at the London Fields Lido outdoor pool and the Kensington Leisure Centre pool, only about a year old.  Had no complaints about the way I was
at Kensington pool London Nov16
treated at these facilities.  Didn't see any risky situations or behaviour.


I've been a member now at the Olympia Dundee for over a year, travelling via two buses, and have found swimming there to be very therapeutic, relaxing and safe.  Lane swimming and hot showers, useful when recovering from a hamstring injury after a bike fall in September.  Having taken up cycling early in the year, on and off road, I don't use the gym as much, do dumbbell exercises at home.  There's only so much gear I can carry in my rucksack at the one time!

Summing up, it was useful to try out other swimming pools and I will continue to do so when visiting new areas, if possible.  It was like a mini action research project, testing out the waters, building up confidence while getting fitter.   All grist to the mill for a psychiatric survivor, adventurer and PhD student.

after swimming at The Olympia Dundee 5 December 2016