Tuesday, 31 January 2017

Type 2 anorexia – my experience

This week's guest post is by a young person living in Mid Powys.

Perfectionistic, body dysmorphic, obsessive and depressive are accurate words to describe anorexia. Six months in a psychiatric hospital suffering from the disease has proved this beyond question. However, the experience also revealed to me two different manifestations of the disease - characterised by varying degrees of the traits above:

Type 1, where the sufferer has a severely distorted view of their body and therefore exercises and starves themselves in the pursuit of looking ‘normal’. This is what most people perceive anorexia to be about, but I (and others in hospital) didn’t identify fully with this and hence believe there’s a second type. 

Type 2, where an obsessive routine of eating and exercise develops in order to avoid irrational consequences despite perceiving oneself as normal (perhaps slightly overweight). Here, the consequences could revolve around any aspect of your life but mainly around weight gain where the goal is to be thin - better than normal. Hence, those who identify with the second type are likely more perfectionist, academic and hardworking. However, they’re probably more at risk (due to these underlying personality traits) as it’s probably more dangerous to act on self-perfection than on self-perception.

The obsessive, perfectionistic roots of type 2 affect many aspects of the disease making it clearly distinguishable from type 1. In type 2, food itself isn’t an issue, the calories are (hence half the hospital chose to have liquid supplements and the other half had food despite being equal in calorific intake). Exercise is also more of an issue in type 2 than type 1 as it becomes built into a rigid routine and must be done to relieve anxiety (as opposed to accelerate weight loss). Type 2 anorexics are also more likely to be deceptive and compete with other sufferers to be perfect in other people’s eyes rather than just in their own to become the ‘best’ anorexic they can be. In this respect access to online material and social media create a competitiveness which likely makes many people’s condition worse. Finally, in type 2, anorexia cannot be separated as an entity from the sufferer (hence getting to draw/name it isn’t effective despite working well for type 1 anorexics). This is because for them the disease takes advantage of their personality traits and becomes an extension of them.

We should use our understanding of each type of anorexia to personalise the otherwise universal treatment plans. Personalised medicine is a hot topic in modern medicine. Gene sequencing and editing has allowed us to choose the treatments which we know will work best on patients. Why not extend this to anorexia?

Of course, the line between the two groups is blurred, but there are many instances where placing me into one of these groups would’ve helped mine and other sufferers’ recovery. Catching it early will inevitably reduce the likelihood of the disease worsening but recognising when further intervention (from Child & Adolescent Mental Health Services to psychiatric hospitals) is necessary is just as important. Taking away the choice by involving professionals is often the only way people too far into the disease can recover and increase their weight enough to correct the depression and distorted thinking associated with anorexia. 

Also, the incentives for recovery are blocked by body image or compulsions for type 1 and 2 respectively. We could therefore target these blocks differently for each type. Classical conditioning is used to treat Obsessive Compulsive Disorder (OCD) and involves patients doing what it is that causes anxiety (or not doing it in the case of a ritual). After being in a better mentality to do so, I decided to try it. I went home over a weekend and didn’t sneak off and exercise at all. That weekend was the only time my weight dropped during my whole recovery. My anxieties were practically gone from this point onwards. 

Finally, the qualities associated with type 2 sufferers can be redirected from weight loss to something beneficial. For me, I became very academic which allowed me to preoccupy myself and give enough incentive to remain fully recovered. Incentive is the key to the cure. Access to mental health services is the key to prevention.

After sharing my thoughts on service provision I’d like to talk about what it’s like to have been a male anorexic. I imagine that you’ve pictured a female through reading this blog and hope that you’re somewhat surprised that the author, the sufferer, is male. I wasn’t at all surprised to be told I had anorexia - I knew about the disease and could tell things weren’t right especially after comments from almost everyone I knew expressing their concern. I have a female twin and understandably my mother has since admitted she was always conscious of the fact that she could become anorexic. These were probably unconscious thoughts felt by everyone around me - I wasn’t expected to become anorexic and hence I was allowed to get progressively worse without it crossing anyone’s mind. I’m sure that this allowed my mind set to change and my weight to drop enough that the anorexia had developed into something that couldn’t be solved without professional help.

Unfortunately, I was taken to the GP surgery twice and both times was told that my weight wasn’t low enough to cause major concern. I was, however, referred to CAMHS on the second occasion. To an anorexic this was like being told you’re not thin enough. Furthermore, the naivety of the doctors to accept all that I said (that I eat lunch and have snacks, only exercise every couple of days and am still sociable and happy) prevented them from assessing me on anything bar the weight-age percentile I was in.

As a boy my original motives were also different to those of girls. At 7 and a half stone, I was plump and had innocent comment from friends and family saying the same. I thought I should try and lose some weight and gain some muscle (as mentioned, the muscle gain I wanted was impossible for a 12 year old). I started with cutting out food and exercising more and liked the results so continued doing this to greater and greater extents. The weight loss and routine consumed me - I lost friends and my confidence, my work suffered, my hair began falling out, my skin flaked away, I was constantly cold and remember dreading the thought of standing or walking because of how faint they made me feel - this is certainly a mental and physical disease. 

Waiting almost a month for an appointment with CAMHS gave me the time to rapidly worsen. I was lucky to have an exceptional psychiatrist - the best of many I’ve had since. However, weekly appointments with her were of little benefit and my weight continued to drop. A paper cut in class one day caused me to faint and have a small seizure which prompted my removal from school and a two week bed rest. Another month of this saw little improvement - I didn’t want to get better. My family and I were becoming more and more depressed and with all of us finding life unbearable, I was taken to a psychiatric hospital where I was the only boy. 

By removing the choice of recovery, my weight rapidly gained and I began to see more clearly - food really is the ultimate medicine and choice is its antagonist. After six months I returned to school where everyone supported me through my last steps. It took almost a year of going at my own pace before simply wanting to be normal gave me the incentive to recover - I came off my meal plan, started socialising, working hard and enjoying life again. Once in the healthcare system being male didn’t affect anything, however - expect a man as you would a woman to develop an eating disorder and don’t shy away from talking to them about it. 

There’s a reason anorexia in males is becoming more common. Social media has recently become inundated with pictures and quotes encouraging men to love women with curves and promoting curves by redesigning children's characters (particularly Disney princesses and Barbie) to reflect more realistic figures. Unfortunately, there is no male equivalent. All I ever see are pictures of ripped and good-looking men, one even quoting “women like butts too”. This sends the message out that men must love overweight women but that men must have a knife-sharp jawline, a sculpted body and of course, a peachy bum to be considered equally attractive. Its reasons like this that Body Dysmorphic Disorder is becoming worryingly common especially in males. 

We need equality to favour all genders - encourage everyone to be happy with how they look as long it’s healthy. I’ve gained so much from my experiences and have helped many to overcome their problems but the horror of anorexia and how much of life it affects is only known by sufferers and their families. It’s not a route that social media should inadvertently encourage people to go down  - we’ve ensured this with women but I feel men are increasingly led along this path due to the lack of society expecting them to do so.

Postscript from our guest author:

On the last day of an eventful year, I need to say this. The expectation of men to be strong and brave - to be masculine - is quite literally killing people. It's this expectation that allowed me to fly under the radar when my mental health suffered and it's this expectation that has killed four silently suffering but definitely loved friends in the last month alone. We need to be so much more aware of the hurt that people around us are feeling and not hesitate to talk to them about it. It really can be just a few words, a quick check up or a smile that can break that depression and give someone reason to think about the future which is otherwise non existent in the mind of a depressive. Please, have a Happy New Year and make this your resolution so that in 2017, good people aren't hurt by their mental health.

Many thanks to our guest author for sharing his experiences of anorexia. There are several charities specialising in providing support for people with eating disorders. These include:

If you know of others, let us know in the comments box below.

Tuesday, 24 January 2017

To DBT or not to DBT? That was the question...

This was the intriguing title of one of the key presentations at the recent Powys Research, Therapies and Health Sciences Conference: Inspiration and Innovation to Drive Patient Centred Care. I attended the conference last November and subsequently wrote How is telehealth working in Mid Wales? The day was packed full of inspiring talks and workshops on all aspects of innovative health work and research going on in the county – do go this year if it’s on again and you get chance.

Anyway, Dr Kathryn Walters, Consultant Clinical Psychologist and Dr David Pyle, Associate Specialist Psychiatrist, told us all about a relatively new service that has been developed in South Powys, to deliver Dialectical Behaviour Therapy (DBT) for the first time in the county. They were joined by Richard, who has been through the programme in Powys and was able to tell us what it was like for him.

Dr Kathryn Walters
First things first. What exactly is DBT? Over to Kathryn and David: 

“DBT is a cognitive behavioural treatment that was originally developed in the United States to treat chronically suicidal individuals diagnosed with borderline personality disorder and is now recognised as the gold standard psychological treatment for clients with this diagnosis. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post traumatic stress disorder and eating disorders.” 

Apparently 20% of mental health inpatients have been diagnosed with BPD/ Emotionally Unstable Personality Disorder.

And so this is my next question: what is borderline personality disorder? 

We’re not very keen on psychiatric labels on this blog, but this one is used routinely by the mental health services in the UK, including here in Powys. Kathryn referred to the DSM V definition (the Diagnostic and Statistical Manual of the American Psychiatric Association) which is extremely detailed. There is a good description on the mental health charity Mind’s website, where people have also posted about what it feels like for them: “having BPD is like the emotional version of being a burn victim. Everything in the world hurts more than it seems to for everyone else and any 'thick skin' you are supposed to have just isn't there”. First thing on a Monday morning and probably most people would meet the criteria for BPD… but for those where difficulties continue and go on to become very extreme, and when people self harm often or attempt suicide, then they are very likely to come into contact with mental health services.

Kathryn explained more about the biosocial theory of BPD – that some people are born experiencing emotions more acutely, and have difficulties managing their emotions. This could be reinforced by the responses of family, friends and services, and ultimately it can be very difficult to change behaviours.

So, why DBT? Dialectics is about balancing opposites: balancing acceptance and change. It incorporates elements of mindfulness and radical acceptance, and helps people to accept the world as it is rather than battle against it. In other parts of the UK it had already been shown to be successful as a kind of “mental health gym” to improve the lives of people with a BPD diagnosis. A study in South West Wales where DBT is provided by Hywel Dda Health Board highlighted that financial savings could also be achieved. So, three years ago, in recognition of the fact that there was at that time no DBT service available to Powys residents, a bid was submitted to charitable funds to train six multi-disciplinary members of staff in order to set up a DBT service in South Powys.

Dr Kathryn Walters leads this team, which comprises Psychologists, Community Psychiatric Nurses (CPNs), an Occupational Therapist (OT) and a Psychiatrist. If, following assessment, someone is referred for a course of DBT they will join a rolling programme and be offered individual and group therapy, skills training, and phone consultations. (People in secondary mental health care with a care co-ordinator and a diagnosis of BPD can be referred. Care co-ordinators generally make referrals for DBT assessment). Feedback from people who have received DBT indicates that there is a general trend of improvement in people understanding and managing their difficulties better, and most are greatly satisfied with the programme.

Richard was in one of the first cohorts receiving DBT in Powys and spoke very favourably of his experience on the programme. Prior to joining he described his life as very difficult: “meds, meds, and more meds”, and not much support. It was rare for him to think through his thoughts – they were automatic and he would react to them. He was experiencing difficulties with his personal life to the extent that he self-harmed a lot. But this all changed once he started the 14 month DBT course. At first Richard felt that the programme went completely over his head. However, he committed himself to DBT and to the group, and he bonded quickly with fellow participants. It was reassuring to be with others who knew how he was feeling so that he didn’t have to explain all the time.

A third of the way through the DBT programme Richard had an experience which really changed his life. Everything suddenly became clear, and he felt changes within himself. He started to discuss his thoughts. By the end of the course he felt that he was a completely different person from when he had started. It is now 2 years since Richard completed the DBT programme, and he has not tried to self-harm or “do anything crazy” since. In fact, he is now into the third year of running his own business, has a good relationship with his partner, and a new baby.

Kathryn explained that people are encouraged to meet up as a “graduate group” once they have finished the course. There is also an open door for participants to get back in touch if that is what they want. The team stay in contact with annual Christmas cards. Meanwhile, demand for the South Powys DBT service has grown and there is currently a waiting list of 20 clients and three further members of staff have been trained to join the team.

So, in conclusion, it looks like the answer to the original question was definitely: “To DBT”. Which is perhaps not surprising, as much has been written online about the positive effects of DBT, such as: “DBT is not just a form of psychological therapy but a life-programme which patients use, initially to prevent serious self-harm or suicide and ultimately to build fruitful, satisfying lives”.

Do you have any experience of DBT? Whether you have or not, let us know what you think in the comments box below.

Thursday, 19 January 2017

Celf Able - disability and the arts in Powys

This week's guest author is Amanda Wells - one of the founder members of the group Celf Able in Powys.

Celf-Able is a new group by and for disabled and disability artists in Powys. We provide opportunities for people to meet and create art, supporting and learning from each other. Our aim is to reduce isolation and raise awareness of disability arts and disability issues. We meet at Oriel Davies, Newtown one month and at Centre Celf, Llandrindod Wells the other. We are very grateful to have Arts Council of Wales ‘Sharing Together’ funding to meet until the end of March 2017. So the search for further funding to carry on beyond that has begun! 

The four initial members of the group had met on the Celf o Gwmpas Artist Training and Mentoring project, which ran from 2009 to 2014. As well as meeting regularly to develop our arts practice, we’d had some adventures including trips to Edinburgh, Glasgow and Finland. When the project came to an end we wanted to carry on meeting as a group as we all found working together and supporting each other very valuable with our various disabilities and the exclusion that disabled and disability artists often experience. We were lucky enough to secure funding from ArtWorks Cymru to meet bi-monthly, and meetings started in May 2015. 

We are pleased that some new members have joined the group since then. We have enjoyed sharing art skills and techniques, peer support, and we have even had a go at performance art, preparing and performing a short piece for ArtWorks Cymru conference in November 2016. For the performance we all chose a barrier that we face personally to engaging in opportunities, and between us we wrote a script about how the barriers affect us and how they might be overcome. The message we were trying to get across was serious but we used a lot of humour in the performance. 

We have just completed the process of becoming a not-for-profit company. This will open up the possibility of more grants for us. We would like to carry on getting together and are currently having discussions as to how the different members of the group would like to see Celf-Able develop. Some members just want to come along to do art in a supportive atmosphere, other members are more ambitious for the group, but there’s room for everyone to take part in whatever way they wish.

For our performance piece it somehow came about that we all took on the characters of birds (don’t ask, I really can’t remember how the idea came up but we decided to work with it), and we are now working on a group installation piece called ‘Bird House’. Celf o Gwmpas are kindly giving us a space to work in over several weeks, we have no funding but are meeting the costs involved ourselves, just because the idea came up and we all want to do it and we enjoy working together.

We are open to any new people who would like to come along, maybe just to meet us and find out what we’re up to. 

Our upcoming meetings are at Centre Celf, Llandrindod Wells, January 24th 11.00am - 3.00pm, and at Oriel Davies, Newtown, February 28th 10.30am - 3.00pm.

To mark the end of the Arts Council funding we are running a training day on arts and disability, and how the arts can be used for inclusion and wellbeing. The sessions are open to disabled people, arts workers, community workers, health and social workers and others. The days are taking place on March 21st in Newtown and March 28th in Llandrindod. The sessions are free and lunch is provided. To book a place call 01938 810058 or email admin@celf-able.org


Voluntary (Un!)-co-ordinator, Celf-Able

Many thanks to Amanda for telling us about this innovative arts and disability group. You can read more on the Celf Able website, including a blog post by the Chair Sue Patch who writes "What Celf Able has done for me".  And you can learn about the development of Disability Art in the 1970s and 80s as a result of the new political activism of the disabled peoples' movement.

Tuesday, 3 January 2017

Top mental health podcasts

And now it’s 2017! Happy New Year! Traditionally we kickstart January by recommending some of our favourite blogs. In the past we’ve covered mental health, dementia and vlogging. This year we’re looking at mental health podcasts.

Podcasting is a form of audio broadcasting on the internet. You can download apps or programmes to listen to podcasts, or alternatively you can just listen on the podcast webpage. It's usually possible to subscribe to a regular podcast and receive notifications of new episodes if you find one you really like.

Personally I love listening to the radio, so finding interesting podcasts is just taking that one extra step on a highly rewarding audio journey. You can find out more about other people’s views, experiences and stories around mental health – not just in the UK but anywhere in the world. An added bonus: they’re usually free. And the real joy is that you can listen anytime and anyplace that has an internet connection (or download for later if you’re going somewhere offline).

As usual the bias in our choice is mainly (although not entirely) towards medical distress as opposed to medical illness. (You can read more about the debate around the medicalisation of mental health on this blog). However, you only have to type "mental health podcast" into your internet search engine and you will discover that the choice of listening options is endless. So, if our top picks are not yours, just start looking. But now to our list:

Shrink Rap radio

Later this month I’m starting a free online course with Future Learn - Psychology and Mental Health: Beyond Nature and Nurture with Professor of Clinical Psychology Peter Kinderman of Liverpool University. And then, as luck would have it, I found this podcast with him: Exploring the Disease Model Debate.

It’s just one of hundreds of podcasts on the Shrink Rap radio site from US clinical psychologist David Van Nuys. “All the psychology you need to know and just enough to make you dangerous”.

The Psychology Podcast

Psychologist Scott Barry Kaufman brings us The Psychology Podcast.

“Each episode will feature a guest who will stimulate your mind, and give you a greater understanding of yourself, others, and the world we live in.” Recent topics have included – exercise and mental stamina, and the psychology of improvised comedy.

On Being – a social enterprise with a radio show at its heart

If you're interested in finding out how trauma can affect your mental health, then here's a podcast worth tuning in to: "Restoring the Body: Yoga, Eye Movement Desensitization and Reprocessing (EMDR), and Treating Trauma" with Bessel van der Kolk. Bessel is the Medical Director of the Trauma Center at the Justice Resource Institute in Brookline, Massachusetts in the United States.

Wellbeing podcasts from the Mental Health Foundation

The Wellbeing podcasts aim to help you relax and improve your sense of wellbeing. They feature a number of subjects including mindfulness, stress and relaxation, positive thinking, wellbeing and nutrition, and exercise and mental health.

All In The Mind - ABC Radio National

An Australian radio station has a podcast on the innovative Open Dialogue approach which was developed in Lapland and is now spreading around the world due to its high success rates in helping people experiencing severe mental distress. We hear about the way it’s working in Bradford at a Soteria House.

Wellcome Collection – Feeling Emotional

This podcast from the Wellcome Collection features psychoanalyst, psychotherapist and writer Susie Orbach in conversation with writer, campaigner, international speaker and trainer Jacqui Dillon, Chair of the Hearing Voices Network.

University of York podcasts

What’s it like being a Dialectical Behavioural Therapist or a Mental Health Nurse? Listen to interviews with mental health nurses who talk about their roles within the profession, what they get out of their jobs and why they followed these career paths.

The League of Awkward Unicorns

With a title like The League of Awkward Unicorns you just have to find out more! This is a podcast from friends and authors Alice Bradley and Deanna Zandt who talk about anxiety, depression and all the other ways your brains can play tricks on you.

Act for Change - A Night with Mental Health 

A trio of talks from 2014, including Professor of Clinical Psychology Richard Bentall on the social causes of psychosis. Hosted by YouTube but audio not video.

All in the Mind – BBC Radio 4

Another All in the Mind, this time from the British Broadcasting Corporation. These BBC Radio 4 podcasts explore  "the limits and potential of the mind, how we think and how we behave". Claudia Hammond is the regular presenter.

Medicine Unboxed

Medicine Unboxed engages the public and front-line NHS staff “with a view of medicine that is infused and elaborated by the humanities”.

Here we have Research Psychologist Eleanor Longden, Consultant Psychiatrist David Sturgeon and Professor Richard Bentall in discussion on The Heard Voice.

Royal College of Psychiatrists

Interview based podcasts from 
the professional medical body responsible for supporting psychiatrists throughout their careers. You can dip into a huge range of topics: everything from the Demonisation of psychiatrists in fiction to Tasers and tasering.

Chartered Institute of Personnel & Development

A podcast promoting and supporting good mental health in the workplace.

And finally...

Public Health Network Cymru will also be launching a new podcast series any minute now. It has been recorded over the past few months, with topics including LGBT health, the Knowledge Exchange, and Adverse Childhood Experiences (ACEs). The Network will also create short 5 minute podcasts with topics including the Well-being of Future Generations Act, and the Public Health Wales Wellbeing statement and plan.

Dip into some of these podcasts and let us know what you think. We always love to hear from you – you can ring, email or post a comment in the box below. And tell us about your favourite podcasts too.

All the best for 2017 from the mental health team at PAVO – Anne, Carla, Jane and Jackie.