Social stigma and Discrimination

Discrimination_wordcloud2

Monitoring and tackling discrimination is an important issue for Irish society” Frances McGinnity

“Discrimination takes place when one person or a group of persons are treated less favourably than others because of their gender, marital status, family status, age, disability, ‘race’ – skin colour or ethnic group, sexual orientation, religious belief, and/or membership of the Traveller community” [1]

Disability is “an impairment that may be cognitive, developmental, intellectual, mental, physical, sensory, or some combination of these. It substantially affects a person’s life activities” Wikipedia.

About 4 years ago I was sitting in a pub with a friend and the barman sat down close to us and said “You are Bipolar, you are on medication and the whole town knows about it!”. While I was aware of social stigma and discrimination and had experienced it, this was the first blatant “in your face” experience of it that I remember. By the way the barman had a lot of inaccuracies in what he said but it still affected me deeply. The “Bipolar” he mentioned (or Manic Depression to give the condition its correct name) is in fact an adverse reaction to antidepressants I took for anxiety, I am not on prescribed psychoactive drugs (since 2011) and I don’t know the “whole town”.

When researching this area I came across a lot of interesting books and resources. Erving Goffman’s book Stigma “is an illuminating excursion into the situation of persons who are unable to conform to standards that society calls normal. Disqualified from full social acceptance, they are stigmatised individuals. Physically deformed people, ex-mental patients, drug addicts, prostitutes, or those ostracised for other reasons must constantly strive to adjust to their precarious social identities. Their image of themselves must daily confront and be affronted by the image which others reflect back to them” [2]. This often happens in subtle ways.

“New research entitled Who experiences discrimination in Ireland? Evidence from the QNHS Equality Modules published jointly by the ESRI and the Irish Human Rights and Equality Commission (IHREC) examines people’s experiences of discrimination at work, in recruitment and in accessing public services (education, transport, health, other public services) and private services (housing, banks/insurance companies, shops/pubs/restaurants)” [3].

“Discrimination can be damaging to the individuals who experience it, in terms of their self-esteem, well-being and for their material outcomes, such as their income and access to valued positions and services. There are also costs at a societal level. Discrimination in the labour market may be economically inefficient, as the skills of individuals are not effectively used. Discrimination can also undermine social cohesion. Monitoring and tackling discrimination is therefore an important issue for Irish society.” lead author Frances McGinnity in study for the Economic and Social Research Institute (ESRI) [3].

Approaches to overcoming Social Stigma and Discrimination

One of the key ways of overcoming social stigma and discrimination is Education. But people also need to be more supportive of each other in families, our social circle and communities. I sometimes find empathy is lacking and people can be very judgemental about others. Listening non-judgementally, while keeping certain boundaries, is an important part of supporting people going through emotional distress.

The following quotes are taken from a report ~ Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change (2016). Chapter 4 ~ Approaches to reducing Stigma [4].

Educational anti-stigma interventions present factual information about the stigmatized condition with the goal of correcting misinformation or contradicting negative attitudes and beliefs. They counter inaccurate stereotypes or myths by replacing them with factual information”.

“In contact-based behavioral health anti-stigma interventions, people with lived experience of mental illness or substance use disorders interact with the public describing their challenges and stories of success”.

Peer support is where “people with lived experience who work as health care team members and foster the provision of nonjudgmental, nondiscriminatory services while openly identifying their own experiences. When integrated into service-provision teams, peers can help others to identify problems and suggest effective coping strategies”.

Protest and Advocacy is another method. “Protest strategies are rooted in advancing civil rights agendas. In the context of this report, protest is formal objection to negative representations of people with mental illness or the nature of these illnesses. Protests are often carried out at the grassroots level by those who have experienced discrimination and by advocates on their behalf”.

A review by Dr. Eleanor Longden and Dr. John Read evaluates the effects of mental health anti-stigma campaigns. They “found that although biomedical explanations of mental illness predominate in current anti-stigma discourse, not only are they ineffective but they also tend to increase stigma. Conversely, evidence indicates that psycho-social explanations of psychosis are effective in reducing stigma and humanizing those who live with the condition” [5].

Referring to the same study “There is a reasonably substantial evidence base supporting the hypothesis that anti-stigma campaigns which frame psychosis as a meaningful response to adversity are effective. They are a more promising approach to ‘humanizing’ people with complex mental health problems than strategies based on models of disease and disability” [6].

Relating this to my own personal experiences of adversity I’ve have a number of traumas over the past year. It’s taken a lot of resilience to get through. I sometimes underestimate my own coping ability, even if I have some coping strategies that aren’t perfect.

Employment

Discrimination when it comes to employment is another area of importance. “People seen as ‘mentally ill’ are often avoided, treated harshly and subject to discrimination. For example, although having a job can be very important in people’s recovery, employers are less likely to offer work to someone if they know that they have a psychiatric diagnosis and unemployment rates for people with a ‘psychotic’ diagnosis are very high” [7]. This report by the British Psychological Society has a lot of information on stigma and discrimination, including the effect of racial discrimination on mental health.

As an example of what can happen in employment I came across an article on a website called Sprudge. After Sharon “revealed to her employer that she had … been successfully treated for Bipolar disorder, she says the cafe owner became very withdrawn and Sharon was later let go via a phone call” [8].

In Ireland there is an organisation called Employability that does help people with disabilities get back into the workforce. It’s an employment support service that provides the person with a job coach.

Being Supportive

This is a world full of social stigma and discrimination. But also some good, supportive people. Social stigma can be a trigger for the person and can seriously impact their recovery. Due to the subtle nature of social stigma I notice people may initially seem nice but then use information you gave them against you. Some of the things we say can be thrown back at us in dis-empowering ways. These days people are asked to talk and share their story around any mental health struggles. But the reality is we need to be careful who we share with. At the same time if someone is in deep distress or about to take their own life they should reach out to others who care or ring a helpline (e.g. The Samaritans 116 123).

I find it a bit frustrating that people seem more comfortable complaining about symptoms of mental health issues than they are at supporting the person in overcoming or managing their condition. For example a person with Manic Depression/Bipolar who seems to be developing hypomanic or manic symptoms may need help in identifying some habits that are not helping them (e.g. over spending or drinking to try to cope with the symptoms). There are certain ways to help or even to phrase feedback to the person that is more effective than others. See my blogs on:

  • Tips on dealing with symptoms of Bipolar and

  • Family, Friends and Community (in section Strategies to enable family and friends to help someone through mania and/or Psychosis).

Recovery and Healing
The following quote is from a document by Mental Health Reform ~
“From the perspective of people with lived experience of a mental health condition, recovery is an individual process of discovering one’s own strengths, values, meaning and aspiration; a self-determined journey that can take place inside or outside the mental health system, through personal development, through partnership relationships with professionals, through peer support or through community support. It is a process of reconnecting with life that can happen for some with the continuation of symptoms while for others, a reduction in symptoms is important” [9].

As someone that went through the mental health system, found it harmful overall and ran away from it in January 2012 I think there is a misconception that its the responsibility of doctors and this system to fix people. There is a danger when we hand over responsibility to others to “fix” us, instead of doing our best to take personal responsibility for our own healing journey. I learned this the hard way! I’m not recommending running away from the system, as you need supports in place and everyone’s journey is unique. There are parts of the system that I found helpful e.g. Occupational therapy and I had a very good Occupational therapist called Orla.

Seeing as none of us live in a vacuum and we are all very much interconnected families, communities and society in general can benefit from helping people on their healing journey. People who have lived through difficult symptoms and experiences may need some ongoing support in their community. This would also take some of the pressure off the already stretched mental health service. At the same time this system should be able to provide timely psychological support, especially to children. At the moment it seems to be still very biomedical based, with a focus on drugs and blaming faulty genes!

Conclusion

In the area of mental health there are various ways we can support each other on our life journeys including tolerance and listening non-judgmentally when someone is in distress. To quote from Ivor Browne, now in his 90th year, “the only real, lasting change comes when we help a person to bring about the painful work of change within themselves”. This needs to happen within a supportive environment and community. A community that strives to tackle social stigma and discrimination. As we are all interconnected this will mean a healthier, more content and more productive community for those who live in it.

References

[1] Experience of Discrimination in Ireland: Analysis of the QNHS Equality Module ~
http://eprints.maynoothuniversity.ie/2873/1/RKOR_Discrimination.pdf

[2] Stigma: Notes on the Management of Spoiled Identity by Erving Goffman, 1986 ~

https://www.amazon.com/Stigma-Notes-Management-Spoiled-Identity/dp/0671622447

[3] Who experiences discrimination in Ireland?

https://www.esri.ie/news/who-experiences-discrimination-in-ireland/

Who experiences discrimination in Ireland? Evidence from the QNHS Equality Modules ~
https://www.ihrec.ie/app/uploads/2017/11/Who-experiences-discrimination-in-Ireland-Report.pdf

[4] Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change (2016). Chapter 4 ~ Approaches to reducing Stigma ~ https://www.nap.edu/read/23442/chapter/6

Study produced by the National Academies of Sciences Engineering Medicine in Washington DC ~
http://www.national-academies.org/

Patrick Corrigan ~ https://humansciences.iit.edu/faculty/patrick-corrigan

[5] Psychosocial Explanations of Psychosis Reduce Stigma, Study Finds ~

https://www.madinamerica.com/2018/03/psychosocial-explanations-psychosis-reduce-stigma-study-finds/

[6] ‘People with Problems, Not Patients with Illnesses’: Using Psychosocial Frameworks to Reduce the Stigma of Psychosis (Eleanor Longden & John Read, 2017) ~
https://www.ncbi.nlm.nih.gov/pubmed/28857755

[7] Understanding Psychosis and Schizophrenia. A report by the British Psychological Society from 2014. Updated in 2017 ~
https://www1.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/CAT-1657.pdf

[8] Mental Health in the Service Industry: Confronting the Stigma ~
http://sprudge.com/health-series-part-iii-118876.html

[9] “Recovery … what you should expect from a good quality mental health service” by Mental Health Reform (2013) ~
https://www.mentalhealthreform.ie/wp-content/uploads/2013/03/MHR-Recovery-paper-final-April-2013.pdf

Other relevant links

* Bar staff should get anti-racism training, says Traveller activist ~
https://www.irishtimes.com/news/social-affairs/bar-staff-should-get-anti-racism-training-says-traveller-activist-1.3330696

* Blind nun wins discrimination case against pub ~
https://www.irishtimes.com/news/blind-nun-wins-discrimination-case-against-pub-1.1185227

* Convention on the Rights of Persons with Disabilities ~

http://www.ohchr.org/EN/Issues/Disability/Pages/DisabilityIndex.aspx

* UN convention on disability rights passed by Dáil (after 10 years) ~
https://www.rte.ie/news/ireland/2018/0307/945705-disability-rights/

* Irish Human Rights and Equality Commission ~ https://www.ihrec.ie/

* Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies ~

https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.201100529

* Pull Yourself Together! A survey on the stigma and discrimination faced by people who experience mental distress ~ by the Mental Health Foundation (2000) ~

https://www.mentalhealth.org.uk/publications/pull-yourself-together-update

* Psychiatry in Context : Experience, Meaning & Communities by Dr Philip Thomas 2015 ~

https://www.pccs-books.co.uk/products/psychiatry-in-context/

My review of this book ~ www.goodreads.com/user/show/46943899-anne

“It’s necessary to engage with people in emotional distress within the social and cultural contexts of the communities they come from. The author explores the impact racism has on the mental health of people in Black and Minority Ethnic communities.”

* “The Secret Life of a Manic Depressive” presented by Stephen Fry ~

www.topdocumentaryfilms.com/stephen-fry-the-secret-life-of-the-manic-depressive/

* Mental Health and the Service Industry: How to Get Help (from US) ~ https://talesofthecocktail.com/wellness/substance-abuse-addiction-insurance

* A physical hearing problem that causes me a lot of distress.
What is hyperacusis ? http://www.hyperacusis.net/what-is-it/ 

Some of my efforts at tackling social stigma head on (2015)

* One woman’s account of suffering from ‘Psychosis’ (which was an adverse reaction to antidepressants and fuelled by other prescribed psychoactive substances!) ~

www.todayfm.com/One-womans-account-of-sufferinbg-from-psychosis

* More on my experience ~ ‘I was unaware of potential adverse effects to my prescribed antidepressants’

https://www.independent.ie/life/health-wellbeing/mental-health/aines-story-i-was-unaware-of-potential-adverse-effects-to-my-prescribed-antidepressants-31218347.html

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Family, friends and community

Empathy

“If you can’t get rid of the family skeleton, you may as well make it dance” George Bernard Shaw

When it comes to healing from emotional distress, support from others and within the community is vital for successful recovery. Despite all the talk in the media about mental health, sadly people can find themselves without support or understanding. Lack of support can inhibit and delay the healing journey.

Families need accurate information on what can help a person in distress. “In the field of mental health people need to be as informed as possible as some day, without much warning, we can find ourselves, a relative or a friend coming in contact with the current system … Giving someone a Psychiatric diagnosis is an immensely powerful act which has profound implications for their identity, relationships, place in the community, employment, health and future.” ~ clinical Psychologist Lucy Johnstone [1]. Dr Johnstone highlights that the process of recovery has to start with the most accurate description of what is going on for the person. Listening non-judgmentally with empathy is something to aim for, hard as that might be. Find out what is going on in the person’s life. It can sometimes be more convenient to slap on labels and blame genetics than address issues and struggles within the individual and their family or within society itself.

We have been conditioned in the biomedical view, which benefits the pharmaceutical industry but doesn’t necessarily help the person to heal to the best of their potential. It is possible to get people through recovery and back to being a productive member of their community. This could mean paid work but there are also ways a person can voluntarily contribute to their community and this requires some recognition. It is not always possible if the person is on high doses of strong tranquilizers which can affect their ability to get motivated and function e.g. in a work environment. While no one should stop or change prescribed drugs without expert advice, long term exposure to these drugs can cause brain damage.

Critical Psychiatrist Dr Philip Thomas in his book Psychiatry in Context explains that it can be hard to measure non-specific factors that aid recovery e.g. trusting human relationships [2]. He points out that it is necessary to engage with people in emotional distress within the social and cultural contexts of the communities they come from. It may be possible to find out from communities what helps people in that community regain a sense of well being, so that people can be productive and have purpose and meaning in their lives.

Forces in society that damage family relationships

“Sometimes you got to accept the fact that certain things will never go back to how they used to be”

I recently re-watched the great classic movie One Flew Over the Cuckoo’s Nest and wish I had seen this movie at 18. While it is now over 40 years old and has cult status, there is a lot to be learned from this awesome movie. I do believe that mainstream Psychiatry is a powerful and controlling group that has the potential to cause a lot of damage to family relationships intergenerationally. As my father had an emotional crisis when I was about three years old, a lot of what I was led to believe about “mental illness” for the first few decades of my life is based on fiction and not fact. I had been indoctrinated from an early age into my families and societies way of viewing and dealing with mental health issues.

When I had my own crisis and direct experience a decade ago, instead of using an Open Dialogue approach to engage with me [3], family members were questioned and this information was then used as “collateral”. This made it feel like everyone was working against me instead of with me. The terminology is something I became aware of when I got my notes under Freedom of Information! Reading such notes can be very traumatic and I do not recommend it unless you have a good support person to go through this process with you. I was left with Post Traumatic Stress, feeling fearful, unsafe and hyper-vigilant. While the feelings are starting to ease, this has lasted almost a decade so far! When I went through Regression therapy with Ivor Browne, it turns out the Post Traumatic experience I carry is very much intertwined with memories of my father been locked away on several occasions throughout my childhood.

In my experience, starting with how the person can be forced into an “Acute Unit” without use of a mental health advocate or Open Dialogue, I found the overall approach taken by the system to be highly traumatic and damaging. It destroys trust between family members. Sometimes the family is already struggling with past issues, trauma and dysfunction and this adds another layer of damage to the situation. What is needed is family therapy.

If friends/relatives spy and gossip about the person in distress, this is very unhelpful. If the person becomes aware of this, it can lead to a breakdown of trust and relationships. When trust is gone sometimes it’s gone for good! Sadly I am not talking about “paranoia” but evidence based fact. But a certain amount of paranoia can easily become a survival mechanism. While some people have been occasionally good to me financially to help me through the destruction caused e.g. loss of career, on an emotional level I went from feeling I was part of a family to feeling very much alienated and disconnected from them. An outsider. I am still close to some cousins in my extended family and have started to build back some trust with relatives in the previous generation. People that have been very good to me, especially in my younger days. But the approach of Psychiatry can cause lots of damage.

We are advised to talk about our mental health struggles but in general we also need to be careful when doing so and to protect ourselves e.g. career wise. Some people in our communities are not so understanding about struggles with emotional distress. At the same time there are good people, therapists and organisations out there e.g. Samaritans (116 123). 

R D Laing

Sometimes the dysfunction within families can trigger mental health issues. Scottish Psychiatrist R D Laing did studies on this using game theory (based on the work of mathematician John Nash) [4].

Family members may not be the best people to try to re-engage the person or motivate them. Occupational therapists and other support people should be involved. If I had a family member or friend with mental health issues I would acknowledge any true progress they are making and wouldn’t compare them to others. Everyone’s journey is unique.

Impact of mental health struggles of a parent on their children

“it is essential to try to open up the hidden area and collusion going on within the family” Ivor Browne

When a parent experiences mental health difficulties this also will affect the family unit and children, including the stability of the environment the person grows up in. Family therapy may be needed to help families through difficult times.

If the parent is / was on medication, the sedative nature of the drugs can impact on the parents ability to function and motivate themselves e.g. work, cook meals, get the children out to school or engage with their children. Watching a parent experience depression, mania or ‘psychosis’ can affect the child.

By being aware of intergenerational trauma and what can be done to support each generation, it is possible to help families to function better. My goal would be that the next generation in my family will have an accurate picture of what mainstream Psychiatry is about and a more accurate picture of what Manic Depression is and what can trigger it. This would help them of avoid pitfalls of what has become an intergenerational trap. They need to be armed with the correct knowledge that will protect them, so that they do not become a victim of what I see as a damaging system.

As the oldest of four siblings, I grew up in an environment where my father was on up to 14 pills a day and given Electric shock treatment which had a huge impact on him, his relationship with my mother, my childhood and family life. I was unaware of the risks of getting involved with the Psychiatric industry and allowed myself to be referred by my GP for help with severe anxiety / panic. While I’m not discouraging people from getting psychological help when they need it, allowing myself to be referred to a Psychiatrist and into the public system was a big mistake that has cost me dearly on many levels.

Mainstream Psychiatrists are medical doctors that mainly prescribe drugs and get people onto cocktails of drugs. Only a relatively small percentage of them are trained therapists. Despite all their power and control in society e.g. in the courts, they can’t help a person in distress without the correct skill set! When I eventually got to see Prof Ivor Browne, who is a Psychiatrist and trained therapist, while I’m not trying to say he is perfect, the difference between seeing him and the other amateurs was huge. Even when I read back on my notes now from being in the system between mid 2008 and early 2012, the “help” I received was inadequate on many levels. With the exception of the help I received from Orla the Occupational therapist. More investment is needed in Occupational therapy.

In my blog on Genetics I explore the fact that some people can’t process drugs like anti-depressants and there is a genetic aspect to that. I have a 1st cousin that took a similar SSRI to the one I did (Citalopram & Escitalopram respectively). We both ended up with the same diagnosis. So I would recommend that people related to me, particularly on my paternal side, to steer away from these mind altering psychotropic drugs and to find alternative ways of managing their distress.

True_Friends

Strategies to enable family and friends to help someone through mania and/or Psychosis

  • While I don’t agree with all the information in this link some of it may be helpful. How to avoid a manic episode [5].

  • Start with the most accurate description of what may have triggered the Psychosis (loss of touch with so called reality) and anything that may be fueling it e.g. Severe lack of sleep, drugs (prescribed or street), alcohol. Address any of these issues appropriately.

  • An Open Dialogue approach is needed, if possible, which has been known to have very good recovery rates. See separate blog.

  • Address the stigma within families from the start. Not all families are supportive of each other. R D Laing believed that ‘psychosis’ and ‘Schizophrenia’ is incubated within family environments. Sometimes there may be other causes e.g. Drug use, including prescribed psychoactive substances.

  • Minor or major tranquilizers are not a “cure”. Short term they can help a person who is in mania and/or psychosis to relax and get some sleep. Depending on the person and the drug, as each person reacts differently to each drug. For example, I found 5 mg of Olanzapine used short term to be helpful.

  • Relevant courses, including online ones, can provide knowledge but are sometimes funded by or influenced by the pharma world e.g. Free online courses on FutureLearn.

  • Charities like Grow and Shine provide some support

  • Support is also needed for kids whose parents experience mental health difficulties e.g. play therapy and counseling, to reduce inter generational trauma [6]

  • Work on a sense of Self. Both the person in distress and their supporters can do this. There is a good book called Selfhood with exercises by Dr Terry Lynch [7].

  • Coming off medication should be an option for most people but that requires specialised, expert advice and close monitoring. It would need to be done slowly under the supervision of someone who has the expertise. Usually a GP or other doctor but the question is do they have the most accurate information and knowledge ? [8, 9]

  • If a person hears voices there are organisations out there that can help e.g. Hearing Voices Network and Intervoice [10, 11]

  • When the person is in a good place learn about WRAP (Wellness Recovery Action Plan) and help them develop a WRAP plan [12]. There are some organisations in Ireland that provide training in WRAP e.g. Suicide or Survive.

Social stigma and discrimination

Research by the Mental Health Foundation (Pull Yourself Together report) found that 56% of people suffering from mental distress had experienced discrimination by family and 51% said they had experienced discrimination by friends. Many of the respondents reported that relatives and friends had distanced themselves, sometimes to the extent that people felt ostracised and socially isolated. Many people also reported being on the receiving end of name calling, labelling, and unhelpful instructions such as “Pull yourself together”. [13]

If you don’t feel accepted or feel unwanted, stigmatised or excluded, healing from emotional health issues can be seriously affected. Your sense of belonging within your family of origin can diminish or become non-existent.

Many of us have persevered in the face of discrimination and social stigma. We have witnessed the death of our old self and the “reemergence of a new self out of the ashes of the old” [2]. This can be quite a painful process. You experience a sense of loss. Sometimes it can be hard to let go of what was to embrace the new reality. But this is sometimes a necessary part of the healing process, including stepping away from relationships that increase distress. Either temporarily or more long term. Life is short. Sometimes we really only appreciate people when they have passed away. As someone who lost a close friend recently in tragic circumstances, we need to learn to appreciate people more while they are still around and to be as supportive as possible.

References

[1] A Straight Talking Introduction to Psychiatric Diagnosis by Lucy Johnstone
www.amazon.co.uk/Straight-Introduction-Psychiatric-Diagnosis-Introductions/dp/1906254664

My review of this book ~
https://www.amazon.co.uk/gp/aw/cr/rRZTSBCCI1MGDN/ref=aw_cr_i_1

[2] Psychiatry in Context : Experience, Meaning & Communities by Dr Philip Thomas 2015

https://www.pccs-books.co.uk/products/psychiatry-in-context/

My review of this book ~ www.goodreads.com/user/show/46943899-anne

[3] A collection of resources on Open Dialogue practices ~ http://willhall.net/opendialogue/

[4] R D Laing used work of Nash and Game theory to study human relationships (18 & 25 mins)

www.ruthenians.net/kArpatia/portfolio/the-trap-episode-1-fk-you-buddy/

[5] How to Avoid a Manic Episode ~ www.bpso.org/nomania.htm

[6] The Efficacy of Play Therapy With Children: A Meta-Analytic Review of Treatment Outcomes

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.472.68&rep=rep1&type=pdf

[7] SELFHOOD: A Key to the Recovery of Emotional Wellbeing, Mental Health and the Prevention of Mental Health Problems, 2011 ~

www.amazon.com/SELFHOOD-Emotional-Wellbeing-Prevention-Psychology/dp/1908561009

[8] Psychiatric Drug Withdrawal A Guide for Prescribers, Therapists, Patients and their Families by Dr Peter Breggin, 2012 ~

www.breggin.com/index.php?option=com_content&task=view&id=296

[9] Guide for stopping anti-depressants (under supervision of medical professional) ~

https://rxisk.org/guide-stopping-antidepressants/

[10] Hearing Voices Network ~ www.hearing-voices.org

[11] Intervoice (International Hearing Voices Projects) ~ www.intervoiceonline.org

[12] WRAP (Wellness Recovery Action Plan) ~ www.mentalhealthrecovery.com

[13] Pull Yourself Together! A survey on the stigma and discrimination faced by people who experience mental distress ~ by the Mental Health Foundation (2000) ~

https://www.mentalhealth.org.uk/publications/pull-yourself-together-update


Other information that may be useful

* The 7 Habits of Highly Effective Families by Stephen Covey ~

www.amazon.com/Habits-Highly-Effective-Families/dp/0307440850

* The Writings of Ivor Browne: Steps Along the Road, the Evolution of a Slow Learner ~ www.amazon.co.uk/Writings-Ivor-Browne-Evolution-Learner/dp/1855942194

Some of the papers in this book covers family & family therapy “it is essential to try to open up the hidden area and collusion going on within the family where it is often seen as necessary to hold the patient in his or her sick and painful state as scapegoat and guardian of the secret” pg. 239

* Ivor Browne interview with Pat Kenny from 2013 ~ www.rte.ie/radio1/podcast/podcast_patkenny.xml

* Sanity, Madness and the Family by R D Laing ~
https://www.amazon.com/Sanity-Madness-Family-Schizophrenics-psychology/dp/0140134662


Definitions

Family therapy “is a type of psychological counseling (psychotherapy) that helps family members improve communication and resolve conflicts” www.mayoclinic.org

Family systems therapy draws on systems thinking in its view of the family as an emotional unit. When systems thinking—which evaluates the parts of a system in relation to the whole—is applied to families, it suggests behavior is both often informed by and inseparable from the functioning of one’s family of origin”

https://www.goodtherapy.org/learn-about-therapy/types/family-systems-therapy

Pharmacogenetics “is the study of inherited genetic differences in drug metabolic pathways which can affect individual responses to drugs, both in terms of therapeutic effect as well as adverse effects” (Wikipedia)

Play therapy “a form of counseling or psychotherapy in which play is used as a means of helping children express or communicate their feelings”. For more information see www.playtherapy.ie

Mental health and violence

Despite all the anti-stigma campaigns, when tragedy strikes, through sensational headlines, society is led to believe that the “mentally ill” are some type of sub-class of potentially dangerous people when in reality anyone can develop mental health difficulties.

People with mental health difficulties are generally no more dangerous than the rest of society. Street drugs and/or alcohol can disinhibit the person and increase the risk of violence or the risk of being a victim of violence. For some this also includes prescribed psychoactive substances or withdrawal from these drugs.

While I use this quote I do not use the word “disorder” myself. “It’s time that, as a society, we begin to knock down stereotypes and start breaking down the stigma associated with mental disorders. The first stereotype to go down – permanently, we hope – is that people who suffer from depression, anxiety, schizophrenia, an eating disorder, or any other type of mental disorder, are somehow more violent than others. This simply isn’t true, unless they are involved in substance abuse. Use and abuse of substances such as drugs or alcohol is often correlated with an increase in violence anyway (e.g. due to impaired judgment)” [1].

Mental disorders are neither necessary, nor sufficient causes of violence …It is far more likely that people with a serious mental illness will be the victim of violence” [2].

Although the drug manufacturers are quick to downplay this connection as anecdotal or coincidental mounting scientific evidence points to a strong correlation between the use of psychiatric drugs in general, and SSRIs in particular, and violent behavior” [3].

In 2012 Harry Kennedy, head of the Central Mental Hospital, said that since they stopped prescribing benzo / tranquilizer medication in their prison clinics the suicide rates there had fallen [4].

Some people have carried out violent acts and it has been blamed in the media on “paranoid Schizophrenia” but when you look a little closer into it the person may have been abusing drugs and alcohol e.g. a certain high profile case where friend’s of the perpetrator told police “he regularly smoked skunk cannabis, took cocaine and had been known to drink whole bottles of spirits each day” (case involving Nicholas Salvador ~ quote from the Guardian newspaper). That is enough to poison anyone’s brain / body and make some act out of character or carry out unimaginable acts.

Akathisia

If a person does not take prescribed drugs correctly e.g. stops the drugs ‘cold turkey’, this can lead to a drug withdrawal state and even akathisia (a severe inner restlessness) which can sometimes lead to serious problems.

Akathisia has two sides, or faces: outer, objective restlessness and inner, subjective agitation. The outer, visible restlessness caused by akathisia particularly affects the legs and may be mild, moderate, or severe. In mild cases, patients find it difficult to sit or stand comfortably. They may adjust their posture frequently, shifting their weight from one foot to the other while standing, or crossing and uncrossing their legs white sitting. In moderate cases, patients are more visibly jittery and fidgety, tapping their feet on the floor or pacing. In severe cases, patients are visibly agitated, find it difficult to sit still, and are driven to pace back and forth… Akathisia can be extremely dangerous, especially in patients who have not been warned about the side effect and mistake it for a worsening of their psychiatric condition. Akathisia can trigger panic reactions in patients, increase paranoia, and drive patients to suicide and violence.” [5].

I once stopped Olanzapine (an expensive major tranquilizer) cold turkey as I had not been given correct advice or warning by a particular private hospital on the dangers of withdrawal. 2 weeks later I ended up in what I now know to be akathisia and would not wish it on anyone! The severe inner restlessness is hard to describe in words. I had pins and needles going down my arms. I thought I was having a “nervous breakdown” but when I met Prof Ivor Browne 3.5 years later he explained that these are the symptoms of drug withdrawal.

It shouldn’t have taken 3.5 years to learn from a man in his eighties this vital, important information! The mental “health” system never informed me that this was the problem which would have helped me a lot. They also never informed me that anti-depressants can cause mania/psychosis ! I ended up back in hospital for 1 whole month and the following year is a blur. A lost year! I had been broken down by what I see as a dysfunctional system.

My self-confidence and general mental/physical health was left in tatters by my “care”. I ended up pumped with 9 foolscap pages of damaging drugs. Pharma did well out of my suffering but I was left damaged and struggling! I still feel the damage a decade on. Luckily I did not become violent because of these mind altering drugs but can see how this could happen.

Note: Samaritans ~ 116 123

Do not stop or change prescribed psychoactive drugs without advice, due to the dangers of withdrawal. The vast majority of people do not become violent on prescribed psychoactive drugs but a significant number of people do. There is a need for more awareness about this serious problem and what can be done to avoid incidents or tragedies as much as possible.

There is another aspect to some cases of violence. Psychiatrist Dr Bob Johnson has worked in Parkhurst prison with violent prisoners. I have met Dr Johnson a few times and heard him speak in Dublin a few years ago. When working therapeutically with prisoners, who were doing time for serious crimes, he discovered a lot of these prisoners were survivors of childhood abuse and sometimes childhood sexual abuse. There is an old Panorama documentary about his work. Here is a link to more information on his work [6].

References

[1] Dispelling the Myth of Violence and Mental Illness ~ www.psychcentral.com/archives/violence.htm

[2] Violence and mental illness: an overview ~ www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/

[3] Medicated to Death: SSRIs and Mass Killings ~
www.corbettreport.com/medicated-to-death-ssris-and-mass-killings/

[4] Cutting jail benzo use reduces violence (2012) ~

www.irishexaminer.com/ireland/cutting-jail-benzo-use-reduces-violence-215716.html

[5] The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and “Addiction” by Dr Joseph Glenmullen (2006) ~

https://www.amazon.com/Antidepressant-Solution-Step-Step-Overcoming/dp/074326973X

[6] The James Nayler Foundation (Psychiatrist Dr Bob Johnson worked in Parkhurst Prison) ~
http://www.quakersintheworld.org/quakers-in-action/178/The-James-Nayler-Foundation

Other relevant information

Trigger warning some may find a few of the links below distressing or triggering.

* “Prescription Drugs Associated with Reports of Violence Towards Others” ~ Thomas Moore and Dr Joseph Glenmullen (2010) ~

www.journals.plos.org/plosone/article?id=10.1371/journal.pone.0015337

* “A lecture by Prof David Healy from the Institute of Psychological Medicine and Clinical

Neurosciences at Cardiff University on the over 100 drugs that can cause violence” (2013)

www.vimeo.com/67245935 (Prof Healy is a Psychiatrist and Psychopharmacologist)

* Are prescription drugs to blame for school shootings? Dr. Healy explains how prescription drugs can lead to school shootings ~

www.rxisk.org/rxisk-asks-are-prescription-drugs-to-blame-for-school-shootings/

* Dr. Peter Breggin’s Testimony at Veterans Affairs Committee On

Antidepressant-Induced Suicide, Violence and Mania: Implications for the Military”:

http://breggin.com/dr-breggin-testifies-before-congressional-committee/

* Suicidality, violence and mania caused by SSRIs: A review and analysis ~

http://breggin.com/wp-content/uploads/2005/01/31-49.pdf

* Recording from The International Society for Ethical Psychology & Psychiatry (ISEPP) Conference. A mother (nurse) speaks of how difficult it was for her son to come off Paxil (Seroxat) ~ 2011 ~

www.youtube.com/watch?v=R8ReARNiAHI

* Forensic Psychiatist Yolande Lucire ~ Adverse reactions to Psychiatric drugs (2013) ~

www.youtube.com/watch?v=IEoSs6Yo0DA&feature=youtu.be

* Paxil (Seroxat) Maker Held Liable in Murder / Suicide ~ Donal Schell case ~

www.baumhedlundlaw.com/drug-injury-press-releases/paxil-maker-held-liable-in-murder-suicide.php

* Pysch drug link to violent episodes analysed ~ Article that discusses the Shane Clancy case. His mother Leonie Fennell works hard at raising awareness about the dangers of anti-depressants ~
http://www.irishexaminer.com/ireland/pysch-drug-link-to-violent-episodes-analysed-400571.html

* BBC Panorama ~ A Prescription for Murder?
Reporter Shelley Jofre investigates the mass killings at the 2012 midnight premiere of a Batman movie in Aurora, Colorado ~ http://www.dailymotion.com/video/x5v0dgt

* “I killed my 11 year-old son” – BBC Stories ~ David Carmichael ~
https://www.youtube.com/watch?v=dwJ1TJSa7Ao

* Woman fighting for prescription warnings after husband kills twins. Kim Crespi “believed from the second he confessed that her husband committed the crimes in a ‘medication induced psychosis’ brought on by a cocktail of medications he’d recently been prescribed”. This also includes the David Carmichael tragedy ~
http://www.wbtv.com/story/25443655/uncommon-killers-david-crespi-and-david-carmichael

* David & Kim Crespi – Oprah Full Interview (Note ~ David Crespi is still heavily medicated during this interview, which would affect how he responds to questions. Mainstream media have a tendency to play down the effect of prescribed psychotropic drugs on people’s mental state) ~

https://www.youtube.com/watch?v=7PtmjIOROrE

* http://www.crespifamilyhope.org/

* Case where Akathisia came up as factor ~ Man on murder charge pleads guilty to manslaughter ~
https://www.irishexaminer.com/ireland/man-on-murder-charge-pleads-guilty-to-manslaughter-276030.html (Cavan hospital, Ireland)

* The Pill That Steals Lives, A Family’s Nightmare on Mental Health Street (Katinka Newman) ~
https://www.youtube.com/watch?v=M1rAAPklkGQ

* The Pill That Steals Lives: One Woman’s Terrifying Journey to Discover the Truth about Antidepressants, Katinka Blackford Newman, 2016 ~

https://www.amazon.com/Pill-That-Steals-Lives-Antidepressants/dp/1786061333

* A blog by Bob Fiddaman, covering the dangers of antidepressant medication, the pharmaceutical industry and medicine regulators ~
https://fiddaman.blogspot.ie/

* This site by Brian, who lost his son to Citalopram, promotes awareness of the dangers of antidepressants ~ http://antidepaware.co.uk/

* Many People Taking Antidepressants Discover They Cannot Quit ~
https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html

* Document on how to stop anti-depressants ~

https://rxisk.org/guide-stopping-antidepressants/

Hope of Recovery and Healing

“And so I wait. I wait for time to heal the pain and raise me to my feet again. So that I can start a new path, my own path, the one that will make me whole again.” Jessie Braun

To quote from Vision for Change (an Irish mental health policy framework document), recovery involves the individual “living a productive and meaningful life despite vulnerabilities that may persist, equipped with the necessary self-understanding and resources to minimise relapse” [1]. I believe that gets to the crux of the matter. If the person can understand what is going on in their life, become self-aware, recognise early warning signs, identify triggers, have a plan if problems escalate and make the necessary changes to get back on track, that will give them more control over their life.

Recovery and healing can mean different things to each individual. For me Recovery involves ~

  • no longer having serious symptoms or knowing how to manage them when they do arise

  • having a WRAP plan in place (Wellness Recovery Action Plan)

  • having daily and weekly routine but also learning to adapt to unexpected events

  • daily work on physical / mental health

  • spending time shopping for healthy food, cooking and healthy eating

  • self-discipline

  • feeling I have meaning and purpose in life. Something worthwhile to do.

  • a few good friends

  • sleeping well, getting to bed on time and cutting out habits that affect quality of sleep

  • exercising

  • being content with life most of the time

  • learning to weather the ups and downs of modern life and the stresses

  • releasing negative beliefs about myself and replacing them with empowering thoughts and affirmations

  • Being patient and gentle with myself. I can be quite hard on myself

  • Spending time with children ~ nieces, nephews and friend’s kids

Wellness Recovery Action Plan (WRAP)

Having a WRAP plan in place can help a person who is experiencing emotional distress to stay well and to move forward. The 5 key concepts in WRAP are: Hope, Personal Responsibility, Education, Self-advocacy and Support [2, 3, 4].

A WRAP plan has sections on Triggers, a Wellness Toolbox, Daily Maintenance Plans, Early Warning Signs, When things are Breaking down, Crisis Plan and Post Crisis Planning.

WRAP can help the person identify triggers (events and/or reactions to people that can make their symptoms worse) and to list activities that can help the person feel better. It may also be important for the person to write a crisis plan, so that if they find themselves in a crisis it has been outlined what their wishes are [5].

It is vital to establish who is there to support a person in their recovery and to build on this if necessary e.g. family (depending on circumstances), friends, peer support or by attending meetings with mental health support groups (e.g. Grow) [6].

WRAP can even be used to help write an advance directive, where the person can specify such things as acceptable and unacceptable treatments including prescribed psychoactive drugs that work / have worked in the past and ones that don’t. And whether or not a person sees Electric shock treatment (ECT) as an option for them. Psychoactive drugs should be used ethically and short term in my experience. At the same time no one should stop or change prescribed psychoactive substances without talking to their prescriber or an expert in the field, due to the dangers of withdrawal.

Advance Directives

I have an Advance Directive. The following are the headings in the document I wrote:

1) People I do/don’t want involved in my care and treatment (I list the names)

2) Acceptable prescribed psychoactive drugs and why

3) Unacceptable treatment

4) What I want from my supporters when I am feeling badly

5) What I don’t want from my supporters when I am feeling badly

I have signed and dated it. I would like Advance Directives to become legal documents in this country.

In my experience I think that independent mental health advocates should be involved when people may need hospitalization and not family members unless specifically requested by the person. An Advance Directive is very important if a person has experienced mental health difficulties in the past or found themselves detained in a Psychiatric Unit. It could help improve the overall process and reduce trauma resulting in better outcomes and faster recovery.

When a person is been “sectioned” or detained they should have access to a solicitor / legal representation immediately, whether they are classified as “voluntary” or involuntary. Even access by phone. People deserve to be treated with respect and dignity when in a crisis. And to be told the truth about what’s happening to them.

References

[1] Vision for Change document (on HSE website ) ~
www.hse.ie/eng/services/publications/mentalhealth/mental-health—a-vision-for-change.pdf

[2] WRAP (Wellness Recovery Action Plan): www.mentalhealthrecovery.com

[3] WRAP App Demo: www.youtube.com/watch?v=0BK_jLMToeM

[4] WRAP Overview: www.youtube.com/watch?v=TnNmGyv1IHo

[5] WRAP Crisis Plan and Working Through Hard Times (including link to pdf) ~
www.mentalhealthrecovery.com/info-center/crisis-plan/

[6] GROW Peer Support mental health organisation ~ www.grow.ie

Other Resources that may be useful

* “GROWing towards recovery: a re-enchantment with life – Mike Watts” ~

www.youtube.com/watch?v=g08yo4Phwic

* Phil Fennell, Professor of Law at Cardiff University, looks at mental health legislation in Britain and elsewhere, and draws lessons for reform of Ireland’s Mental Health Act 2001. Phil was speaking at an Amnesty International Ireland conference on mental health law reform in March 2013 ~ www.youtube.com/watch?v=rDvah16UtaU

* Soteria ~ a network of people in the UK promoting the development of drug-free and minimum medication therapeutic environments for people experiencing ‘psychosis’ or extreme states ~ www.soterianetwork.org.uk

* Men’s Sheds ~ www.menssheds.ie/

A Perspective on Suicide

Some days you will be the light for others and some days you will need some light from them. As long as there is light, there is hope and there is a way” Jennifer Gayle

Caring_for_myself

I am not sure what the solution is to the tragedy of suicide. People need to feel that are loved and belong, including working on loving themselves. They also need to feel their life has meaning and a purpose. Viktor Frankl, a holocaust survivor, writes about this in his book Man’s Search for Meaning [1, 2].

There are nearly always reasons for living, no matter how bad things feel. It is important that we give encouragement to others in our family and community [3]. Over the last number of years I’ve met some people who saw themselves as well meaning, giving all sorts of judgements and “insights” into my life. As well as criticism. Without any empathy or understanding about my life journey. This led to feelings of frustration and discouragement. Listening non-judgmentally would have been a lot more helpful.

For over 3 years I was prescribed the anti-depressant Citalopram to help with anxiety and panic (until August 2008). I now suffer from a condition called Tardive Dysphoria. What was a mild or moderate Depression is now a more chronic and severe condition. Medical journalist Robert Whitaker has written about this [4]. I am a lot more prone to suicidal ideation since these drugs than before taking them.

While some people may feel they have benefited from anti-depressants, for others they have caused major problems. In the US these drugs have a black box warning due to the increased risk of suicide in younger people, especially when starting, stopping or changing the dosage [5].

In suicidal mode the idea that all the pain will end might feel good at the time, but whatever emotional pain a person is going through will pass. It is important to reach out to someone, even if they don’t feel like doing that at the time. I once heard a man who has been through suicidal thoughts say that he did not want to pass his pain onto other people. When someone takes their own life it is can be devastating for family, friends and the community.

There is probably something causing their distress. Maybe a multitude of things that seem to be going wrong at the same time. It is easy to get overwhelmed and to go into a state of shock/high anxiety when faced with what seem like unsolvable problems e.g. worrying about a mortgage or debt. If a person feels suicidal they shouldn’t be afraid to discuss how they feel with someone they can trust, a helpline, the Samaritans (116 123) or a private therapist. Problems nearly always have a solution. Sometimes the advice of others is necessary, as the person may feel they are in a fog and cannot think clearly or see any solutions.

As a society and community we need to be more supportive of each other. People may need to look at lifestyle e.g. alcohol, nutrition, stress and the various aspects of their life. If doctors were to take a more Psycho-social approach, as opposed to a biomedical one, I do believe we may see some progress. Or maybe those in distress need an alternative to going to a busy GP surgery that is dealing with such a wide range of medical problems.

A number of years ago, in a documentary that covered suicide, I heard a doctor say that if someone takes an overdose of medication, they can end up alive and brain damaged. Probably worse off that before the overdose. Knowing this may deter a person from taking an overdose. While not being judgemental of a person in a very distressed state, drowning in the sea, lakes, canals or rivers is also a bad idea. A person can end up missing for weeks, causing even more distress to their family, friends and those that care about the person in their community. Not forgetting the huge level of dedication, effort and time that can go into searching for the the body, sometimes in very cold, risky, dangerous and difficult conditions. From listening to a friend who volunteers with sub aqua search and rescue/recovery, the body can end up in a bad state.

ASIST (Applied Suicide Intervention Skills Training)

One of the things that has helped me in dealing with suicidal thoughts, while also giving me the skills to be able to help others, is ASIST. Applied Suicide Intervention Skills Training is a

two-day interactive workshop in suicide first-aid. It is suitable for all kinds of caregivers … people responding to family, friends and co-workers. ASIST trains participants to reduce the immediate risk of suicide and increase the support for a person at risk. It helps them seek a shared understanding of reasons for suicide and reasons for living.

The workshop provides opportunities to learn what a person at risk may need from others in order to keep safe and get more help. It encourages honest, open and direct talk about suicide as part of preparing people to provide suicide first aid. Participants also consider how personal attitudes and experiences might affect their helping role with a person at risk” [6, 7].


Wellness Recovery Action Plan (WRAP)

A few years ago I got to do WRAP training with the charity Suicide or Survive. This training combined with ASIST has helped build up my resilience which I need to face into each new day and week. Having a WRAP plan in place can help a person who is experiencing emotional distress to stay well and to move forward. The 5 key concepts in WRAP are: Hope, Personal Responsibility, Education, Self-advocacy (standing up for yourself) and Support [8, 9].

A WRAP plan has sections on a Wellness Toolbox, Daily Maintenance Plan, Triggers, Early Warning Signs, When things are Breaking down, Crisis Plan and Post Crisis Planning.

WRAP can help the person identify triggers (events and/or reactions to people that can make their symptoms worse) and also to list activities that can help the person feel better. It may also be important for the person to write a crisis plan, so that if the person finds themselves in a crisis it has been outlined what their wishes are.

It is vital to establish who is there to support a person in their recovery and to build on this if necessary e.g. family, friends, connecting to others in recovery or by attending meetings with mental health support groups (e.g. Grow).

WRAP can even be used to help write an advance directive, where the person can specify acceptable and unacceptable treatments, including prescribed psychoactive drugs that have worked in the past and ones that don’t, and whether or not a person sees Electric shock treatment (ECT) as an option for them.

Reasons to Stay Alive

I’ve just re-read Matt Haig’s very good book “Reasons to Stay Alive” [10]. In severe Depression a person may feel there is no hope or future. Matt highlights how it can feel like you are inside a tunnel that is blocked at both ends. “You are walking around with your head on fire and no one can see the flames”. When he went through a major crisis he didn’t want to be dead. He just didn’t want to be alive.

Drinking and smoking too much can be a big factor. As can diet and not getting enough sleep. Matt suffered from Anxiety, Panic attacks and Depression and compared that to being in a swamp with whirlpools in it. He writes “Minds have their own weather systems. You are in a hurricane. Hurricanes run out of energy eventually. Hold on”.

He compares his symptoms of emotional distress to back pain “It doesn’t really help me, when the pain flares up, that millions of other people suffer from back problems”. He lists some of his “Weapons for the war” ~ writing, reading, talking, traveling, yoga, meditation and running. Some of the things that help him with panic include yoga, slower breathing, meditation, acceptance (“Don’t fight things, feel them”), live in the present and Love.

One person tweeted this message to him about suicide “The hole you’d leave is bigger than the pain you suffer by being”. “The key is in accepting your thoughts, all of them, even the bad ones. Accept thoughts but don’t become them”. Writing about things your enjoy can help. And refer back to that when you don’t feel so good.

Suicides Rise Dramatically with Increasing Psychiatric Care

Danish studies has been done on the link between Psychiatric care and suicide. Extract from this article [11] ~ As the amount of involvement that people have with Psychiatric professionals and Psychiatric care increases, the likelihood that they will commit suicide rises steadily and dramatically, according to a study in Social Psychiatry and Psychiatric Epidemiology. Taking Psychiatric medications makes people nearly 6 times more likely to kill themselves, while having spent time in the previous year in a Psychiatric hospital makes them over 44 times more likely to kill themselves … an accompanying editorial suggested the findings more likely showed that “Psychiatric care might, at least in part, cause suicide.”

I am hoping that coroners will keep an accurate record of what prescribed medication that the person may have been on at the time they died. Whether they had recently started to take Psychoactive medication e.g. anti-depressants or stopped taking such medication. It appears that sometimes this information can be overlooked. As many deaths are not recorded as suicide, we do not have an accurate picture of the number of people in this country that take their own lives every year.

Conclusion

There are no easy answers to suicide. But I do feel, based on the number of suicides I’ve heard of recently, our approach doesn’t seem to be working. I think it is time that we get some honesty from those with the power to influence public opinion. Instead of drug pushing, we need to hear that the “chemical imbalance” theory was an elaborate marketing campaign that sadly is not based on fact or Science. Some doctors, in their rush to push the drugs, forget about the significant number of people that these drugs are not suited to. Some of us don’t metabolize the drugs very well. A pill is not going to mend a broken relationship, bring back a job that is lost or help with the bereavement process.

If someone does decide to go down the biomedical route, they deserve full informed consent about these drugs. Something myself and many others didn’t get. People in distress also need crisis houses to go to, as an alternative to Acute Psychiatric units. An example of this in the UK is The Maytree [12]. Such crisis housing is part of the policy document Vision for Change which is now over 10 years old [13]. We need a new plan and a new vision.

At the moment there seems to be a lot of emphasis on celebrity culture and hearing the stories of celebrities. While that can provide short term inspiration, in a crisis the person in distress needs to have their own set of tools and resilience to battle through a rough patch. There is also a danger when mental health is over talked in the media. Family and communities may feel that the issues are been dealt with and may not realise someone in their own circle is in distress and needs support.

Relationship_with_self


{ Note ~ What I discuss in part of this blog is my own experience and is not medical advice. We all have our own unique journey. Do not stop or change prescribed drugs without advice. Change has to be done slowly under the supervision of an expert, due to the dangers of withdrawal.
Samaritans ~ 116 123 }

References

[1] Man’s Search for Meaning, Viktor Frankl ~
https://www.amazon.com/Mans-Search-Meaning-Viktor-Frankl-ebook/dp/B009U9S6FI

[2] Man’s Search for Meaning ~ Meaning as a Cure for Depression and other ills ~
https://www.psychologytoday.com/blog/hide-and-seek/201205/mans-search-meaning

[3] Viktor Frankl ~ Why Believe in Others ~
https://www.ted.com/talks/viktor_frankl_youth_in_search_of_meaning

[4] Tardive Dysphoria: Anti-depressants can turn mild/moderate Depression into a chronic condition ~
http://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria

[5] Antidepressant Use in Children, Adolescents, and Adults ~

https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273

[6] ASIST leaflet (Applied Suicide Intervention Skills Training) ~
http://www.hse.ie/eng/services/list/4/Mental_Health_Services/NOSP/Training/ASISTleaflet.pdf

[7] Information on ASIST training ~ http://www.yourmentalhealth.ie/get-involved/news-events/

[8] WRAP (Wellness Recovery Action Plan) ~ http://mentalhealthrecovery.com/

[9] WRAP App Demo ~ https://www.youtube.com/watch?v=0BK_jLMToeM

[10] Reasons to Stay Alive, Matt Haig (2015) ~

http://www.matthaig.com/reasons-to-stay-alive/

[11] Suicides Rise Dramatically with Increasing Psychiatric Care ~
https://www.madinamerica.com/2014/09/suicides-rise-increasing-psychiatric-involvement/

[12] Suicide sanctuary ~
www.maytree.org.uk/

[13] Vision for Change ~
http://www.hse.ie/eng/services/publications/Mentalhealth/Mental_Health_-_A_Vision_for_Change.pdf

Other links that may be useful

* The dangers of giving anti-depressants to children. Jake McGill (14) ~
https://www.independent.ie/irish-news/courts/mother-of-boy-14-who-died-of-selfinflicted-gunshot-wound-welcomes-open-verdict-inquest-34115868.html

* Community Action on Suicide Prevention Education and Research (CASPER) ~
Maria Bradshaw, mother of Toran Henry (Maria now lives in New Zealand) ~
https://www.independent.ie/regionals/wicklowpeople/lifestyle/maria-leads-suicide-fight-30596376.html

* Cutting jail benzo use reduces violence ~

www.irishexaminer.com/ireland/cutting-jail-benzo-use-reduces-violence-215716.html

“Harry Kennedy, head of the Central Mental Hospital, said that since they stopped prescribing the medication in their prison clinics, the suicide rates there had fallen”.

* Denmark ~ “Antidepressant regulations tightened following suicide”:
www.cphpost.dk/news/antidepressant-regulations-tightened-following-suicide.8243.html

* Kerry coroner makes emotional plea over suicides ~
www.irishtimes.com/news/crime-and-law/kerry-coroner-makes-emotional-plea-over-suicides-1.1365157

* ‘Suicide remains a taboo subject, something few people are prepared to talk about’ ~
www.youtube.com/watch?v=US-oM-wBBxI

* Life After Suicide BBC Documentary 2014 “Documentary. Angela Samata explores why some people take their own lives and how those who love them come to terms with the loss”.
www.youtube.com/watch?v=HdIxzeA1F2k

When suicide comes in clusters ~ What can we do to prevent copycat suicides ?
www.psychologytoday.com/blog/media-spotlight/201208/when-suicides-come-in-clusters

* Alcohol and suicide, Kendall, 1983 ~
www.ncbi.nlm.nih.gov/pubmed/6648755

* Smoking and Suicide: A Meta-Analysis ~

www.ncbi.nlm.nih.gov/pmc/articles/PMC4938402/

* Suicidal Ideation and Suicide Attempts in Treatment-Seeking Pathological Gamblers ~
www.ncbi.nlm.nih.gov/pmc/articles/PMC3397475/

* Stages of Compulsive Gambling ~
http://www.elementsbehavioralhealth.com/addiction/stages-of-compulsive-gambling/

* Caring for patients with suicidal behaviour: An exploratory study ~
https://www.researchgate.net/publication/5821268_Caring_for_patients_with_suicidal_behaviour_An_exploratory_study

* We’ve become too complacent about the mental wellbeing of others’ –
https://www.independent.ie/irish-news/news/weve-become-too-complacent-about-the-mental-wellbeing-of-others-priests-warning-after-high-number-of-suicides-in-town-36830689.html

 

An Open Dialogue around ‘Psychosis’

“The deepest hunger of the human heart is to be understood” Stephen Covey

Psychosis_hand

Cabiria, 1914 (from a silent movie by Giovanni Pastroni). Trying to capture how terrifying Psychosis sometimes feels like, which is difficult and the clip that goes with this photo reminded me of the experience.

In November 2014 I went to the launch of the lengthy report “Understanding Psychosis and Schizophrenia” by the British Psychological Society (BPS) in London. There I got to meet and hear from some of the top experts and clinical Psychologists in the UK. A revised version was published in 2017 [1].

‘Psychosis’ is a loss of touch with reality, which is usually temporary. Because the general population don’t understand it, they can overreact. The person themselves may feel quite confused & scared. Especially if it’s their 1st experience. It can involve unusual perceptions e.g. the person feels they are under attack from evil and the need to protect themselves. In my experience, how I protected myself was influenced by religious upbringing. I even started to go to Latin mass to try and calm my brain down. While some would have frowned upon that at the time, for me it was a coping mechanism. I only occasionally go to a church these days. Usually to light a candle and to sit in silence for a while.

As an example of one of my “psychotic breaks”, in my last experience I decided that the town I live in, which is prone to flooding as it is built on a river, was going to become immersed in water. I checked into a hotel that was a few stories high & took a bus to a ‘safer’, inland county. At the time I was frightened. It wasn’t based on reality but could have been based on news reports and worries about climate change. Stress and lack of sleep would have been a trigger, plus the fact that I was still going through drug withdrawal. It took at least two years to get the main effects of long term use of prescribed psychotropic drugs out of my system and I was left with long term sleep issues, the effects of which I still feel to this day.

Psychosis can be triggered by anti-depressant use and severe lack of sleep / stress [2]. I had been on anti-depressants for anxiety / panic attacks for 3 years when I had a ‘psychotic break’ in August 2008. Other illicit drugs can also trigger psychosis e.g. skunk cannabis [3].

Trying to make sense of the symptoms can help. In the context of the person’s life. As through making sense of experiences or learning to process them, a person is more likely to recover.

Usually the people around you will not understand and might not be supportive. I went through my last ‘psychotic break’ alone (2012). I would not recommend that but maybe getting through it alone is why I no longer fear it. There was also a Spiritual aspect to the experience and I wish I kept notes at the time to give me more insight into what I was going through. In my terrified state, particularly at night time, with no support around me, I used the online work of Sean Blackwell to help me through. “Bipolar or Waking up?” [4, 5, 6]. I do believe this was more of an awakening and a spiritual journey. A part of my own evolution as a soul on this planet.

A significant percentage of people hear voices and for many this is not a problem. If the person hears voices that are distressing or ask them to harm themselves or others and the person finds this overwhelming, they would need help and support in coping with the voices. There are people who have managed to integrate their voices into their lives, without been affected negatively by them e.g. Eleanor Longden [7] , Jacqui Dillon [8] and Rai Waddingham [9]. Dutch Psychiatrist Dr Marius Romme has also done a lot of great work in the Hearing Voices Movement [10]. Some children also hear voices and may need support.

Others experience hallucinations. If the hallucinations affect a persons quality of life, including ability to work, sleep and relate with others, the person may need help in dealing with their experiences.

Open Dialogue

I’m a believer in the Open Dialogue approach, where the person should be involved as much as feasibly possible in decision making about their care or treatment plan [11, 12].

Open Dialogue includes the gathering of clinicians, family members, friends and other relevant persons for a joint discussion. It was started in Lapland by Jaakko Seikkula et al. It is also used in other countries eg the Parachute project in New York [13]. In West Cork a successful pilot project was implemented [14, 15]. It would be great to see widespread use of this approach. If a more traditional, backward approach is used it can lead to more dysfunction within a family and the fracturing of relationships, sometimes long term, in my experience. It is important to get the approach right at the start. Not everyone will want family involved in their care.

I write more about the trauma of what happened me in 2008 in the blog Anti-depressants are great, until you have an Adverse Drug Reaction, where I outline some of the things that would have helped at that crucial time. Because of the way people in ‘psychosis’ are treated, I ended up with Post Traumatic stress for the past decade, which is only starting to ease recently. It has improved via therapy and hard work on my self, but it is something that will probably always be there are a protective force in my life. A necessary hyper vigilance and a lack of trust in others!

I have learned as much as I can about what is helpful when a person is in distress. I’ve dedicated several years to learning via reading, listening to audio/visual presentations (of experts I respect), courses, conferences and various short training sessions. A summary version of what happened to me can be found under Other Relevant Resources at the end of this blog.

During my first ‘psychotic break’ (where I had not harmed myself or others) I needed:

  • truth and honesty about the anti-depressant drug I was on & its adverse effects (2)

  • An Open Dialogue approach

  • Re-assurance that my stay in the hospital was temporary ( the survival part of my brain was convinced I would be there for a very long time, possibly forever. This left me in a very distressed and agitated state and naturally so)

In places like Finland, where they employ the Open Dialogue approach and where prescribed psychoactive drugs are not the main form of treatment, they have proven that recovery is possible. They use early intervention and involve the person in decision making. In general, instead of the person ending up on disability, they go back to being productive members of society.

Below is now 89 yr old Prof Ivor Browne giving a talk in the National College of Ireland in 2015. As opposed to being “anti-drug”, Prof Ivor Browne believes in using the lowest dosage of tranquilizing drugs possible for as short a time as possible. Ivor explained that people need help in understanding the psychotic process. He also recognises the importance of therapeutic relationships, personal friendships and loving relationships, when it comes to healing from trauma and distress. What are referred to as “Anti-psychotics” e.g. Olanzapine, as mainly major tranquilizers.

Anti_psychotics

For people to have “Recovery spaces”, they need to be with supportive people who can tolerate, be patient and interact with the person in ‘Psychosis’. Soteria is a network of people in the UK promoting the development of drug-free and minimum medication therapeutic environments for people experiencing ‘psychosis’ or extreme states [16]. If a person is a carer for someone in emotional distress e.g. a family member, the long term goal should be to enable the person they are caring for.

The public have learned to associate the word ‘psychosis’ with violence and there is not necessarily a link, unless drugs or alcohol are involved [17, 18]. That can include prescribed psychotropic substances or withdrawal from these drugs [19].

People in distress need hope that they can recover and heal. Education from reliable, unbiased sources is an important part of that healing journey. As are supportive and understanding people who can hold space for the person in distress. These support networks also need education around Psychosis, what is helpful and what is not. Being judgemental, getting into arguments with the person, being critical and dismissive of their experience is usually unhelpful. Trying to stay calm and creating a calm space for the person, where they are not over stimulated, might be helpful. Everyone is an individual and has their own unique journey and experience.

Note: This blog is not medical advice and is mainly based on my own experience. But also on my extensive interest and learning in the whole area. Do not stop or change prescribed psychotropic drugs without advice, due to the dangers of withdrawal. Any changes need to be made slowly, under the supervision of an expert in this field. At the start of my journey I was never given that advice from the ‘experts’ I was dealing with and this delayed my healing journey.

Minor and major tranquilizers did help me at times e.g. with sleep, which can help restore some normality. But overall, in hindsight, I found that the large cocktail of drugs I was on (over a 3 year period) fueled symptoms, as opposed to ‘curing’ them. “The ethical use of psychotropic drugs is perhaps the single most important aspect of Psychiatric care that requires urgent attention” Dr Phil Thomas [20, 21].

References

[1] Understanding Psychosis and Schizophrenia, revised version 2017 ~

https://www.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/CAT-1657.pdf (Edited by Anne Cooke)

[2] Antidepressant-associated Mania and Psychosis resulting in Psychiatric admissions. Yale study (2001) www.ncbi.nlm.nih.gov/pubmed/11235925

[3] Smoking skunk cannabis triples risk of serious psychotic episode, says research, 2015 ~

https://www.theguardian.com/society/2015/feb/16/skunk-cannabis-triples-risk-psychotic-episodes-study

[4] Am I Bipolar or Waking Up? Sean Blackwell, 2011 ~

http://www.amazon.com/Am-I-Bipolar-Waking-Up/dp/1461178258

[5] Sean Blackwell’s work ~ www.youtube.com/user/bipolarorwakingup

[6] Corrina Rachel speaking to Sean Blackwell about Bipolar ~

www.youtube.com/watch?v=WLIeS6idzD4

[7] TED video by Eleanor Longden (Voice Hearing) ~

www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en

[8] Jacqui Dillon (Voice Hearing) ~

www.rte.ie/radio1/doconone/radio-documentary-sounds-mad-hearing-voices-psychology.html

[9] Rai Waddingham ~ http://www.behindthelabel.co.uk/

[10] Hearing Voices Network ~ www.hearing-voices.org

[11] OPEN DIALOGUE: an alternative Finnish approach to healing psychosis (by Daniel Mackler) ~

https://www.youtube.com/watch?v=HDVhZHJagfQ

[12] A collection of resources on Open Dialogue and Open Dialogue practices ~

http://willhall.net/opendialogue/

[13] New York ‘Parachute’ programme for people with acute mental distress lands in the UK ~

https://www.theguardian.com/society/2015/oct/20/parachute-therapy-psychosis-new-york-uk

[14] Mental health pilot focus of Finnish film ‘Open Dialogue’ ~

http://www.irishexaminer.com/ireland/mental-health-pilot-focus-of-finnish-film-open-dialogue-393492.html

[15] A fresh approach to mental health ~
http://www.irishexaminer.com/lifestyle/features/a-fresh-approach-to-mental-health-396031.html

[16] Soteria ~ www.soterianetwork.org.uk

[17] ‘Mental disorders’ are neither necessary nor sufficient causes of violence ~ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/

[18] Dispelling the Myth of Violence and Mental Illness ~

https://psychcentral.com/archives/violence.htm

[19] Prescription Drugs Associated with Reports of Violence Towards Others

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0015337

[20] Psychiatry in Context : Experience, Meaning & Communities by Dr Philip Thomas

https://www.amazon.com/Psychiatry-Context-Experience-Meaning-Communities/dp/1906254729

Dr Philip Thomas highlights the limitations of neuroscience in explaining Psychosis or distress. He also explores how Racism plays a key role in many black people’s experience of Psychosis.

[21] My review of this book ~ www.goodreads.com/user/show/46943899-anne

This review was published in the Journal of Critical Psychology, Counselling and Psychotherapy (Volume 16, Number 1, March 2016)

Other relevant Resources

* ‘I was unaware of potential adverse effects to my prescribed antidepressants’

https://www.independent.ie/life/health-wellbeing/mental-health/aines-story-i-was-unaware-of-potential-adverse-effects-to-my-prescribed-antidepressants-31218347.html

* One woman’s account of suffering from Psychosis ~

www.todayfm.com/One-womans-account-of-sufferinbg-from-psychosis

* Course ~ Caring for People with Psychosis and Schizophrenia (pharma funded which influences the advice given) ~

https://www.futurelearn.com/courses/caring-psychosis-schizophrenia

* Intervoice (International Hearing Voices Projects) ~ www.intervoiceonline.org

* Hearing Voices Network Ireland ~
http://hearingvoicesnetworkireland.ie/

* The Icarus Project ~ http://theicarusproject.net/

* CRAZYWISE – Official Extended Trailer ~ https://www.youtube.com/watch?v=iKfQd0bk214 

* Peter Lehmann “Recovery from Psychosis and Depression by Taking Psychiatric Drugs versus Recovery by Coming off Psychiatric Drugs”

www.peter-lehmann-publishing.com/articles/lehmann/pdf/recovery-from.pdf

* 8 Tips to Help Stop Ruminating ~
www.psychcentral.com/blog/archives/2014/02/16/8-tips-to-help-stop-ruminating

Shortened version of Hysterectomy story

For quite a while I had been struggling with some female problems. My GP referred me to a gynaecologist who sent me for an ultrasound and hysteroscopy (procedure for looking at lining of uterus). Not long after the hysteroscopy the gynaecologist rang my GP to tell her that I needed a hysterectomy. I was sent for an MRI scan.

The next step was to meet with the surgeon, Dr. Astbury. We had already met in the cervical screening clinic. Towards the end of July I met with her and a clinical nurse specialist Joanne. The doctor listened without judging me which was important.

After a discussion with them and asking questions about a laparoscopic procedure, I decided to go ahead with an abdominal hysterectomy. In hindsight that was a good decision. I asked to keep my ovaries, if possible. My mood can get quite low at times and I didn’t want to be plunged straight into the Menopause. The surgery was scheduled for August 25th.

I discovered a good website dedicated to women going through hysterectomies called HysterSisters [1]. Leading up to the surgery I got a call from the nurse Joanne to ask how I was. She advised me to rest and eat healthily.

I continued to do daily Yoga to build up my strength. I improved my eating habits and cut back on sugar and lost about 7 lbs. I ate more fruit and vegetables (organic if possible) and invested in various supplements and herbs. I took Hemaplex which included iron, antioxidants and amino acids.

That paid off in the end as I didn’t need a blood transfusion. Luckily I didn’t loose too much blood from surgery. I took a good quality chlorella, magnesium, organic flaxseed oil, krill oil, garlic, cumin and turmeric. I would recommend giving up alcohol or reducing it to a minimum so that the liver can be at its peak for processing all the drugs that are given during and after surgery.

The day before the surgery I took the train to Galway and met with Dr Astbury. I signed an informed consent form and had been made aware of some of the risks. She said I would be given an antibiotic as a precaution, in case of infection. I was on that for just the first day.

I stayed in the hospital the night before and the doctor came around with some of her team about 8 am. I got into my gown and DVT stockings. I was wheeled across in my bed to the main hospital for surgery. I spoke briefly with the anesthetist. They froze my hand, inserted a cannula into a vein and that was all I remembered. I woke up in a certain amount of pain and with a nurse sticking various attachments to my body which agitated me. Dr Astbury came around and I seemed to settle and calm down.

The surgery had taken an extra hour as my womb was attached to my intestine due to some old endometriosis that I was unaware of. I was given some oxygen while they checked my pain levels on a scale of 1 to 10 and reduced my level of discomfort. I was brought to the PACU unit (Post Anesthetic Care Unit). The first night there was a sense of relief that this major surgery was over. I had many connections and monitors attached. My blood pressure and other vital signs were been constantly checked by an automated devices.

The next morning a nurse helped me out of bed to sit out on a chair. I had tubes and wires everywhere. I listened to some online meditations and healing on youtube. By afternoon I was wheeled in a bed from the PACU unit back to my room by a porter and kind nurse.

I got amazing care in St. Monica’s ward. For 2.5 days I was on a drip while my intestine started to work again. I didn’t realise that the bowel would be so affected by the surgery and was in a certain amount of pain. On the 3rd day it was good to be sitting out on a chair at 7 am. To avoid getting a chest infection regular deep breaths are necessary.

On the Monday I saw the physiotherapist who gave me very good advice e.g. pelvic floor exercises etc. On youtube I listened to cell healing, chakra healing, Wayne Dyer & Louise Hay. A mindfulness colouring book gave me something to do. And the book “The Healing Code” was a great help [2].

I was groggy from painkillers and the various drugs and had two balls of painkillers connected by fine tubes to my tender abdominal area, where there was a 9 inch incision along the bikini line. It was difficult to think straight or to remember things. Coughing or laughing caused some pain. Other basic biological functions took some time to return to some kind of normality.

I rested in my bed, wombless, listening to the occasional screams of babies coming into the world, as there was an emergency theatre down the corridor. I cried on the way into hospital and didn’t want to be there for major surgery. I also shed a tear on the way out. It was like leaving the womb without a womb. A cocoon. I felt I would never get such great care again. I had been minded like a baby.

Respite

After hospital I spent a week in respite while my body healed from major abdominal surgery that had cut through my core muscles and left me without my usual strength and independence. The large, carefully minded scar was healing well without any infection. In a world that is now full of antibiotic resistance luckily I didn’t get an infection [3, 4].

In respite, it was great to have an adjustable bed, railings, a lift and an adapted shower. On my first day in respite my GP came to examine me. I had some strange sensations in my legs from all the drugs and felt like I was walking on a trampoline. I continued to wear the DVT tights for a few weeks.

The nurses had me on a schedule taking various medications but eventually I needed to keep a record myself and develop a routine for taking pain medication & the anti-inflammatory drug Difene. I got off the drugs as soon as I could, while been sure to have my pain under control. Everyone is different, so this is not medical advice.

I went to see a good nutritionist called Linda in the town I live in. She gave me some advice e.g. I took Kefir to help build back the good bacteria in my gut and drank a green anti-oxidant smoothie with wheatgrass. When it came to inflammation I supplemented turmeric into my food, after I came off the Difene. Turmeric is a natural anti-inflammatory. Advice from a doctor or nutritionist may be needed when it comes to any contraindications.

I slowly tapered off the drugs. About 2 weeks after surgery I went home and out to a world full of highly sprung doors, where I needed to fend for myself most of the time. My next door neighbour was very kind when I arrived home. I was able to slowly and carefully do a certain amount of housework e.g. dishes and laundry. 3 weeks after surgery I was able for a 20 minute walk, with some rest along the way.

4 weeks on I had electrical zaps in my tummy after overdoing things. 6 weeks after surgery I went back to Dr. Astbury for a check up and thanked her for a job well done. I am very grateful for the work she did. While some people can be judgemental when I tell them various parts of my journey, she instead praised me for going for the test and the necessary surgery.

7 weeks on I still wasn’t really able for lifting a small backpack of groceries. My body let me know. I suggest waiting at least 3 months for any intimate relationships, which is the average recovery time for the internal healing.

As someone that’s been through a difficult decade, I had a new appreciation of people, doctors & nurses, the HSE and life in general [5]. Some therapy /counseling would have been helpful and/or a support group. The whole journey was a test of my own resilience that involved a lot of maturing and personal growth. A support group would have been helpful.

I need to stay focused on nutrition and take personal responsibility for my physical and emotional health on a daily basis, which at times can be a struggle. Functional medicine needs to play a bigger role in our health care system. Dr. Mark Hyman explains it well [6].

To conclude, overall I was very pleased with and grateful for the care I received from our health service. I have empathy and understanding about this ordeal. Some people understood the severity of the procedure and the impact it has, both physically and emotionally. Others were not very understanding.

To those that have supported me I am forever grateful. And finally, I am grateful for the skilled hands of the surgeon Dr. Katharine Astbury, her team, the nurses in St. Monica’s ward in University Hospital Galway, staff in Portiuncula hospital, those that looked after me in respite and my GPs.

 

Some links that may be useful

[1] www.hystersisters.com ( A website I discovered that was of great help e.g. On what to expect as the weeks progressed)

[2] The Healing Code & book ~ http://thehealingcodes.com/

[3] Antimicrobial resistance ~ http://www.who.int/mediacentre/factsheets/fs194/en/

[4] Antibiotic resistance could spell end of modern medicine, says chief medic ~
https://www.theguardian.com/society/2017/oct/13/antibiotic-resistance-could-spell-end-of-modern-medicine-says-chief-medic

[5] HSE information on Hysterectomy ~ http://www.hse.ie/eng/health/az/H/Hysterectomy/

[6] How Is Functional Medicine Different from Conventional Medicine?

https://vimeo.com/37277787 (Dr. Mark Hyman)

Other relevant links

* Louise Hay You Can Heal Your Life ~

https://www.youtube.com/watch?v=CTtmHvM1opo

* Flipping the Script on Menopause: Dr. Christiane Northrup & Dr. Kelly Brogan

http://kellybroganmd.com/flipping-the-script-on-menopause-dr-christiane-northrup/

* Marilyn Glenville on Hysterectomy ~

https://www.marilynglenville.com/womens-health-issues/hysterectomy/