Anti-exorcism

rosaryAn article in the Telegraph today interviews Dr Gallagher, a psychiatrist based in the US, all about how he thinks demonic possession is real and exorcism can be helpful.

The article doesn’t give any alternative point of view, or ask Dr Gallagher any particularly challenging questions, so it’s possible to read it and think it’s not that controversial.

The practice of exorcism is worse than controversial though. It’s not a neutral thing to do that might not work but doesn’t cause harm. It’s often frightening for the person and may prevent them from being able to access treatment that can be helpful. It often involves being restrained. The few exorcisms I have heard described to me have been been confusing and frightening at best and brutal and sad at worst. 

The way the psychiatrist in the Telegraph article talks about exorcism uses examples where a person has requested it themselves. This is by no means always the case however. Often the use of exorcism is instigated by families of young people who are experiencing significant mental health problems, for instance psychotic experiences such as hearing voices or seeing things other people can’t see. Whilst people are entitled to make sense of experiences through different frameworks of understanding, if the framework leads to the use of a ritual that is frightening and involves labelling a person as possessed or bad then this is not ok.

Exorcism is also be used when no mental health problems are present, but for some reason the child has still been scapegoated as possessed or evil.

Whether or not a child is experiencing their own mental health difficulties at the time, these scenarios are all abusive, and the London Safeguarding Board has clear guidelines about why this is unacceptable. The guidelines talk about how to work respectfully with faith communities engaging in this, whilst removing risk to the child.

Adults can be vulnerable too, and use of exorcism with adults against their will is just as abusive.

Use of exorcism with freely consenting adults presents more of a complex dilemma: we are all free to make decisions about what we want, but exorcism remains problematic in my view, in the way it offers false hope and possibly delays access to other more evidence-based help for whatever is making someone want to request an exorcism. It also often involves restraint even if it has been requested, which I think has huge potential to be traumatic.

The psychiatrist interviewed in the Telegraph offers “discernment” assessments to say whether or not he recommends exorcism. He is clear that he doesn’t think priests should charge for exorcisms, but he doesn’t state whether he charges for these assessments.  I would be very surprised if these are also free of charge, although I don’t know for sure, and the book on discernment that Dr Gallagher has coming out soon certainly isn’t.

 

Advertisements

Wellbeing for all

Screen Shot 2018-06-01 at 18.28.22A new NHS framework promoting health and wellbeing in healthcare staff was launched mid-May.

The investment of time and resource to write this report is to be celebrated. The framework emphasises the importance of NHS staff wellbeing and gives some concrete ideas for improving working conditions and individual skills to cope with difficult work. These have the potential to be helpful.

However, the report ignores one of the key reasons why this document is needed in the first place: funding constraints.

The NHS is losing staff and the staff it has are under huge pressure, largely due to the mismatch between the funding available to the NHS and the funding needed. The ongoing increased need for healthcare services is well-documented although there is less coverage of how the increasing need is likely linked to the chronic and ongoing cuts to social care and early intervention healthcare.

This framework for helping staff wellbeing highlights some fantastic services where things are working well, including ones with teams dedicated to staff wellbeing and training programmes in place which try to tap into key staff values. In these services there is clear use of staff time and resource fir these purposes. This is as a result of local decisions to prioritise staff wellbeing. The framework itself lacks any ring-fenced funding attached to its suggestions so it relies on already overstretched services choosing to follow its recommendations.

When there is not enough to go around for patients, it is really hard for staff to feel comfortable with using resources for staff wellbeing, even though research has shown associations between staff engagement and better patient experience, as well as reduced staff sickness.

These links between staff and patient wellbeing are important, as are the financial savings which the framework highlights, but staff wellbeing is also important for its own sake. Working in a caring profession is hugely rewarding and also hugely challenging. Occupational risks include compassion fatigue, secondary trauma and burnout. The divide of patient and staff wellbeing is helpful for research into how staff engagement and wellbeing can affect the experience of people using services, but it risks suggesting that these are two separate groups of people who will never overlap. In reality most NHS staff are also NHS patients at some point. All people need health services sometimes, for both mental and physical health problems.

This is a human need, and thinking about how work affects us all is also a human dilemma to consider. The boundary between our professional and personal selves is not always a clear one. It moves, it changes, sometimes it feels more permeable than others. The more we can think of both patients and staff as human beings with broadly similar needs for good care, good communication and realistic expectations, the more successful I think we will be at looking after everyone. The framework is a helpful tool, but to truly champion wellbeing in healthcare services, for everyone involved, takes ring-fenced time and money to show that wellbeing for all is important.

Cuts and knives

knife“This is a complex crime and you cannot arrest your way out of it,” said Amber Rudd this morning on Radio 4’s Today programme, as she talked about the rise in knife crime in young people in London.

I couldn’t agree more that arresting our way out of this is not the answer. But then what is? The rise of violent crime in London’s youth is complex, although sadly not surprising.

The impact of the policy of austerity on young people should not be under-estimated. Cuts to services have been brutal and chronic. Cuts to education maintenance allowance, to social service provision, to youth services such as career advice centres and voluntary sector project groups, to mentoring schemes, to child and adolescent mental health services…  the list is long. These cuts have accompanied the reductions in police numbers which are more highly reported, yet not necessarily more important.

The context that we are raising young people in is one where there are fewer and fewer resources to help them with their education, wellbeing, safety, and emotional understanding, and at the same time one where more and more is being expected of them. More frequent exams, negotiation of digital social landscapes, employment hunting in a world with fewer jobs and more expensive university fees… The environment we have created is one where there is not enough to go round, where there is huge pressure on the individual, and one in which the backdrop of “adult” discussion on the news is routinely of war and violence.

Subsequent discussion on radio 4 this morning mooted the usual suspects: the idea that we could blame knife crime on violent lyrics, or on social media. I’m surprised video games didn’t get a bit of a look in too. Of course it isn’t this simple, and of course we have more responsibility.

In the clinical settings I have worked in the violence I have witnessed has often been related to fear: a fear of being hurt, of not knowing what will happen next, of being out of control, of not knowing who to trust. Training on managing situations where someone is likely to be violent included making sure that they had a way out of the room: that they didn’t feel trapped.

What ways out are we giving young people? How are we helping them with the people and things that they are afraid of?

This problem is complex, and there is also lots more we could be doing to unpick it. The under-funding of key services mean we are raising a generation with fewer opportunities and under greater pressure. It is hard to statistically model the effects of all of the different ingredients of this cocktail, although it’s important to try, but in the absence of a clear cause of rising youth violence, I think we could be doing more to call out the common sense explanations and to do something about these. Looking at police capacity to be present is one thing, and likely important, but we can go much further than this – and look at how to increase the numbers of youth workers, youth services and youth opportunities that are available. 

Supermoon!

Supermoon by Adrian Scottow

Image by Adrian Scottow

It was a Supermoon the other night and I was admiring it and thinking about how the moon looks like it is glowing, when in fact it is reflecting light from the sun.

It made me think about how things are not always what they appear to be, and how it’s possible to view the same thing in different ways, sometimes depending on what other information is available to us.

Optical illusions are a nice example of seeing things differently. The duck-rabbit, for example, which can be either a duck or a rabbit depending on how you look at it or what you expect to see.

rabbduck

The old woman/young woman (at the bottom of the page) is another example where you can see two different images depending on how you are looking at the picture. 

How we perceive situations and relationships can be similarly tricksy. The same situation can be interpreted in a variety of ways, often depending on how we are feeling that day.

If I send a text message and my friend doesn’t reply for a bit I could have different perceptions about what that means: they might want to reply but be really busy, they might be cross with me, they might not have good phone reception, they might have injured their thumbs, they might have run off to join the circus…. there are multiple possibilities, some more likely than others. We often jump to one conclusion pretty quickly though, without considering other options or weighing up the relative likelihoods of different scenarios. Those conclusions can be problematic if they are overly negative or self-critical – the ones where we assume someone hates us, for example.

Some useful things to try if you catch yourself jumping to a conclusion:

  • how much do you believe that conclusion?
  • try to weigh up the evidence for and against that conclusion
  • force yourself to generate some other possibilities too
  • weigh up the evidence for and against the new possibilities
  • ask yourself what you would say to a friend if they were jumping to your original conclusion?
  • check in again – how much do you believe that first conclusion now?

old young woman

Guilty pleasures and are pets good for us?

dog grooming

Photo by Ricky Brigante

I’ve been indulging in a guilty pleasure recently: binge-watching The Apprentice. I don’t have a telly and tend not to watch loads, but when I do I really get into it. The Handmaid’s Tale, Bake Off, and now Alan Sugar and his job applicants…

There is something I enjoy about watching the naked ambition and downright competitive nastiness of the candidates. Every series someone says “I’m not here to make friends”, which is blatantly obvious in the scenes in the boardroom where they are all fighting for their place in the competition and passing the blame.

A recent episode combined the pleasure of reality tv with the pleasure of seeing loads of pets, because the candidates had to work in a pet grooming parlour. Dogs were having blueberry facials and pawdicures, and attending doggy dancing lessons (it was great).

There’s a lot that gets said about pets and happiness, and people generally tend to presume that having a pet boosts your wellbeing. The evidence on this is mixed though, as Harold Herzog, from Western Carolina University, found out when he reviewed it in 2011. Although there are many studies which show associations with better physical health, happiness and wellbeing, there are also many studies showing no impact on loneliness, or even worse, adverse effects on some physical health measures. Herzog concludes that we just don’t know enough about whether pets are good for us, although he acknowledges that his review doesn’t consider the benefits of therapy dogs and cats (which do seem to be helpful in a range of settings).

Thankfully, Herzog wrote as a call for more research (which still applies today) rather than trying to put the dampeners on the idea of getting a pet. It’s more a “we just don’t know” whether pets will make us happier or healthier, than a warning against getting one. Whether or not a pet will make us feel happier or healthier probably depends on a lot of individual factors relating to how much we like animals, how much the specific pet influences our exercise routine and what the reasons for getting the pet are in the first place.

As for why watching The Apprentice seems to make me feel happier – pets or no pets – that’s one to mull over another week.

Compassion-focussed therapy

heart in handsI’ve been reminding myself of some of the basics of compassion-focussed therapy recently, and I thought I’d blog about it because we could probably all use a bit of this. Compassion-focussed therapy is a third-wave CBT approach, which means it has grown out of cognitive behavioural therapy even though it looks quite different to traditional CBT. A key part of it involves learning to show more compassion to ourselves as well as others.

Compassion-focussed therapy draws on neuroscience to explain some of its practices. It highlights three brain systems in particular (for more detail check out Mary Welford’s book Building Your Self Confidence Using Compassion-Focussed Therapy):

  • The threat system: the brain system involved in spotting threat in the environment and preparing us to run, hide, or fight. Back in the day this system helped us spot sabre-toothed tigers. Now we are more likely to experience this as we scan situations for social risks, for work terrors, or relationship frights.
  • The drive and resource acquisition system: the system involved in making us feel motivated to try for things we want and which gives us a sense of achievement when we succeed.
  • The contentment and soothing system: the system involved in attachment to caregivers and affiliation with others. A very social system, and one that kicks in when we are safe, secure and content.

Think about what day to day experiences you are having – run through which tend to activate your threat system, drive system and soothing system… Most work experiences, for example, tend to activate one of the first two.

For many people, especially people experiencing low mood, anxiety, and low self esteem, the contentment and self-soothing system in our brains tends to be less in use than would be optimal for a sense of well being. Connections in our brains get strengthened by use, so if we don’t use a system as much it is also likely to be less easily triggered than the others.

Compassion-focussed therapy helps us to balance the systems out by really focussing on the soothing system and actively practising compassion for ourselves as well as others.

Compassion is defined as a deep sympathy for suffering, alongside a desire to remove that suffering. Kristen Neff, expert in researching compassion, describes it in terms of three key components:

  • Kindness versus judgement: This means kindness in a very active sense of the word – really trying to do what we can to alleviate suffering, either of others, or of ourselves. As well as things that are more traditionally seen as kindness to ourselves (having a break, doing self soothing things) this can also include holding ourselves to account for things like preparing work in advance, doing exercise, eating well, pushing ourselves to try new things even when they feel difficult – things that might feel effortful but which set us up well.
  • Common humanity versus isolation: This is the idea which we might all know, but which is less often felt, that we are all part of a huge human population, all of whom suffer at times.
  • Mindfulness versus over-identification: Noticing how we are in the moment – right now – is vital for knowing if we are suffering and if this is related to our attitude towards ourself.

What can we do about it if we think we are less practised in soothing and self-compassion than we would like? Neff suggests some quick and easy ways to start in a 2 minute video that you can watch here:

  1. Give yourself permission to be kind to yourself. It isn’t selfish, it’s necessary.
  2. Try to notice how you speak to yourself – would I say this to a close friend?
  3. Try writing a letter to yourself as you would to a good friend.
  4. Try using soothing touch when you are feeling stress or suffering – placing your hands on your heart, or face, or clasping your hands together.

Not enough mental health services to go round for young people

nspccOver 100,000 children referred to local mental health services in England have been rejected for treatment in the last two years. Figures requested from NHS Trusts by the NSPCC, released today, show that an average of 150 referrals a day are turned away from NHS children’s mental health services, despite Childline reporting record numbers of calls. From a total of 652,023 cases referred to child and adolescent mental health services (CAMHS), 109,613 children were turned away. The NSPCC has called on Government to focus on early intervention to reduce numbers who reach crisis point.

These figures are very concerning, and reflect the chronic levels of underfunding which mental health services, and in particular child and adolescent mental health services, have experienced. With ever-shrinking and unprotected budgets for child and adolescent mental health and social care, services are sometimes pushed to raise the threshold for access higher in order to prioritise high-risk and crisis cases. It is mad that a system there to help young people should have to wait until they are in crisis before it can.

Not every assessment should necessarily result in access to a service – some referrals aren’t appropriate and some young people could be better helped in other ways, but these sky-high numbers suggest that the need for mental health services for young people is much greater than the provision. In addition the care received in different geographical areas of England differs, so waiting lists and access to services depends on where you live. This data is only for England but we know other areas of the UK and Ireland are also affected by stretched services, with Wales in particular suffering from having very little access to evidence-based talking therapies for children and adults.

It’s important these figures don’t become yet another stick to bash the NHS with.The data shows a greater need than there is capacity for, which is different from showing that the services themselves aren’t good. There is simply not enough service to go round, which is not OK.

What might help? Several things:

  • Ring-fence current funding and increase it. There has been a huge amount of rhetoric about parity of esteem between mental health and physical health problems, but until there is parity of funding it is hard to believe this. Child and adolescent mental health funding in particular has had such a chronic lack of under-funding for so long that it needs even more growth in funding to be able to provide the care that young people want and that professionals want to be able to give.
  • Getting in there early. Providing good services early on before mental health problems become severe and enduring is crucial. This doesn’t mean cutting back on specialist services – we still need them – but it does mean also making sure there is enough funding for early intervention to try to nip problems in the bud and also enough funding for the education and social care supports that need to go alongside.
  • As well as early intervention we can think about prevention: putting more effort in even earlier, perhaps in school settings, to help young people understand and negotiate powerful emotions and have the emotional literacy they need to talk about their feelings, might help head off some of these problems before they begin.
  • Thinking about why these young people are so distressed. The rise in numbers of reported mental health problems in children may be partly to do with increased knowledge of mental health issues and increased ability to speak up, but it’s also likely to have much to do with the huge pressures young people are under. There are more exams than ever before, there are new social media pressures to encounter, it’s really hard to be a young person in our society today and we should be addressing that.

50% of adult mental health problems are already present at the age 14. If we could help young people avoid this we might set them off on a different trajectory for their adult lives.