Music, Sounds of Nature, Sounds of Happiness

Submitted by tonyplant on October 30, 2006 - 11:54.

One of my quick fix suggestions for mood-lifts is that people with MP3 players should put together a mood lifting playlist - pieces that always make your feet tap or get you moving. With the growing sophistication of mobile phones and MP3 players, I advise people to put together a slideshow of images that make them smile, give them a fond memory etc. When I ran a session for young carers recently, the photo of the young cottontail rabbit was very popular with the girls. There are lots of photographs available for download from Flickr and it can be mood-lifting just to look through them.

The Telegraph carries a piece about the Lake District Tourist Board who are doing their best to inspire us now that we are slumped in the end of year doldrums. They are offering a hotline and MP3 downloads of soothing sounds, ranging from the fresh air blowing across England's highest mountain, to a reading of Wordsworth's Daffodils or Cumberland sausage sizzling in a pan.

Eric Robson, of Cumbria Tourism, the organisation behind the telephone line, said: “Many people dread the clocks going back but our Lake District Escape Line will inspire them to think more positively about winter and get outdoors.”

Have a flick through the download files and see if there's something that suits you. For me, the only inexplicable omission, is the sound of contentment that accompanies eating that fine dish, guaranteed to contribute to any tourist's gruntlement, the Cartmel Sticky Toffee Pudding, along with the sound of someone scraping the pattern of the bowl-despite what their mummies told them-and the gentle swish of a tummy-rub.

Copyright 2006, Tony Plant Happystance Project

read more | add new comment | sounds | smell | quick fix | nature | happiness

From Itchy Wrists to Schizophrenia

Submitted by tonyplant on October 27, 2006 - 12:55.

Dr. Crippen saw a patient with 'itchy wrists' (Dr. Crippen's Case Notes, Thursday 26th October, patient no. 5).

There is nothing to see. I tell him I have not got a clue why his wrists are itching. Then he tells me why he really came. His 26 year old daughter has schizophrenia and has just been discharged from hospital after a prolonged 14 month admission, during most of which she was on a section.

This is not an unusual case. Parents have lived with schizophrenia for so long that, although their love isn't burned out, their resilience is. The daughter in this case has sheltered accommodation near to the parental home. However, she only stays there overnight: everyday, she turns up in the morning and only goes back to her accommodation when her parents take her there.

Dad cares for his daughter but cannot manage being with her for more than short periods. But he feels guilty if he turns her away. They need to have a distance between them, both physically and mentally. I have to try to give dad “permission” to do that. Not easy. He still feels guilty that he does not have her living with him permanently.

Some sheltered accommodation offers a full range of activities but they don't always appeal to the residents. I don't know if any facilities are available here. It would be good to know if Social Services are in touch with the family and listening to them during this time.

read more | add new comment | schizophrenia | dr crippen | carers

Oliver James Rubbishes CBT and Happiness

Submitted by tonyplant on October 24, 2006 - 16:37.

I like the work of Oliver James: he is an interesting speaker and an engaging writer. I've been aware for some time that he is not in favour of Layard's enthusiasm for cognitive-behavioural therapy (CBT) and he usually makes his viewpoint in a cogent manner.

Not today. Today, Oliver James has contributed a piece to the Daily Mail: Therapy on the NHS? What a crazy waste of £600 million! He starts off with the headline figure that depression and anxiety cost the £17 billion per year and then moves on to deride Layard's proposed £600 million investment in expanding the provision of CBT on the NHS.

It's an infuriating piece. James makes several sideswipes about the efficacy of CBT.

CBT is a form of mental hygiene. However filthy the kitchen floor of your mind, CBT soon covers it with a thin veneer of positive polish. But shiny surfaces tend not to last.

According to James

The CBT patient is taught a story to tell themselves, a relentlessly positive one. If the therapist is skilled, the patient becomes able to ignore many of their true feelings.

When tested at the end of the treatment, like a well-coached pupil taking an exam, they often regurgitate the positive story.

I thought that one aspect of CBT might be the examination of whether negative thoughts and feelings are grounded in unrealistic beliefs. Is it possible that these negative thoughts and feelings are false rather than true?

read more | 3 comments | Layard | happiness | depression | CBT | anxiety

Videos About Anxiety and Panic Attacks

Submitted by tonyplant on October 21, 2006 - 16:14.

Eric Wilinski has put together an intriguing selection of videos and talks on the topics of anxiety and panic disorder. I've met a few carers who have developed anxiety, depression or panic attacks: some of them link this to their experiences battling with the various 'services' that don't seem to provide much in the way of service to carers or those for whom they care.

1 attachment | add new comment | panic disorder | panic attacks | anxiety

It's Carers' Week in Australia

Submitted by tonyplant on October 19, 2006 - 15:42.

It's Carers' Week in Australia. Health Psych has written a nice blog about the week and the events: Caring for the Caregivers. add new comment | carers

Poor Care For The Elderly

Submitted by tonyplant on October 18, 2006 - 13:49.

The Times, amongst others, has a report on the poor state of home-care for elderly people. The 15 minute time slot came in for particular criticism.

In the first ever major study of domiciliary care services in England, the Commission for Social Care Inspection (CSCI) found that councils were unable to attract and retain staff because of poor pay and that both carers and the cared-for complained of being rushed, demoralised and unable to form meaningful relationships.

The "15 minute slot", in which a care worker is expected to visit a person, wash them and get them dressed and ready for the day, was identified as a symbol of a regime that will be unable to handle the growth of Britain's older population.

The 15 minute allocation is clearly a nonsense. Too many people don't receive the amount of care that they need at the time they need it, even if it would keep them independent and active for longer and delay the need for more intensive and extensive care.

However, it is all very well for Age Concern etc. to welcome the report but what we need is an authoritative and well-costed report on what it would cost to provide appropriate social and personal care.

There seem to be several reports about the deplorable state of hospital food and the numbers of elderly people who need assistance to eat in hospital but don't receive it.

There has been a persistent problem with patients not getting the nutrition they need while in hospital. The release of the figures, in a parliamentary written answer, follows a study by Age Concern into what it called "the scandal of malnourished older people in hospital". Nine out of 10 nurses told the charity's Hungry to be Heard survey that they did not have time to provide the elderly with the help they need at meal times. (Telegraph)

Dr. Crippen has some discussion about using volunteers to feed patients but I don't think that this is a practical alternative for a number of reasons.

read more | add new comment | homecare | enhanced disclosure | costs | carer

Why Kindness And Good Manners Matter

Submitted by tonyplant on October 17, 2006 - 10:51.

AADT offers an interesting overview of Daniel Goleman's book on the neuroscience of Social Intelligence. Advances in imaging technology reveal the objective reality of instinct that man of us have that

the daily interactions we have with others, particularly those whom we care about, affect us far beyond the surface responses we experience after every independent stimuli or conversation.

Imaging studies show that

agreement brings about similar chemical responses in the brains of all involved, rejection spurs activity in the same area of the brain that regulates physical pain.

In a recent article, Goleman writes that:

When you realize that trivial interactions can affect a person's physiology, somehow you have to take them more seriously.

Most of us know that we can influence others through our mood and vice versa. There is some general understanding that we can influence the healing or well-being of others. Do we need clinical proof that there is good reason to be kind, well-mannered and considerate to each other?

Click on the photograph to be taken to Flickr.

Copyright 2006, Tony Plant Happystance Project

read more | add new comment | physiology | neuroscience | happiness

What Is A Cost?

Submitted by tonyplant on October 16, 2006 - 12:22.

There has been a lot of discussion about the NICE decision to block the prescription of various drugs in the early stages of Alzheimer's Disease.

For one thing, they do not just benefit the patient but also the carer, which actually halves their true cost to £1.25 a day – or about the same as four cans of cat food.

If you look at the wider picture, take the drugs away, and carers will not be able to support their loved ones as long as they would choose to do so. Sufferers will be forced into care homes, which cost on average £500 a week, much sooner. Now that is not good value for money – compared with a week's worth of pills for £16.50.

The article quotes the conventional wisdom that carers save the country £57 billion. Caregiving exacts its own high-price toll. It is easy to demonise groups who don't agree with us but it is impossible to believe that the very smart, thoughtful and even altruistic (why else go in for a career in public service) people who work in the relevant government departments don't know this. They must know the cost of doing nothing. Presumably these people know all about how to appriase not only the financial costs and clinical benefits but the wider, human costs and those that are more indirect. Are we failing to have a conversation about the costs because we would not like the conclusions or the outcomes? If we can't be involved in these decisions and discussions, how else are we ever going to understand the decisions that are made on our behalf about rationing decisions and the treatment of ill or elderly people and their carers?

read more | add new comment | cost | carer | caregiver | alzheimer's disease

Chronic Illness and Marriage Breakdown

Submitted by tonyplant on October 14, 2006 - 15:05.

I've just come across a discussion of the bleak finding that 75% of marriages break down where chronic illness is present.

Seventy-five percent of marriages where chronic illness is present do not last. That is an overwhelming number to me, and it might be misleading. People divorce for all sorts of reasons, and it doesn't necessarily mean there is a cause and effect relationship between chronic illness and divorce. It could be one of many mitigating factors, but looking at the statistic, it's not possible to weed that out. But certainly between lost income due to sickness, high medical bills, loss of identity, pain, frustration, etc, there are a lot of ways to look at how chronic illness could be implicated in these findings.

I wouldn't be too surprised if chronic illnesses contributes to financial and other social problems that, combined with problems that resemble depression, do make some people feel that their only option is separation. However, with all due respect to the wonderfully nochanlant Sinatra in the picture, I believe that it is rare to "Divorce Your Loved One With Dignity" even if it is etched in stone.

Time after time, the research indicates that marriage is good for people's health and resilience, yet it can be overwhelmed by so many outside forces. I have permission to share some details of a couple I came across when I was running a workshop. The man is separated from his wife (he hopes temporarily) because of their financial problems, brought about in part by the wife's condition. The wife does not yet have any support in place, so he pops in most days to make sure that she is OK and to do things for her because she has no family or friends who are close enough to carry out these chores etc. for her and she has significant mobility and upper-limb problems. The wife is still waiting to be paid any benefit (she was sent the wrong forms and this is taking a long time to rectify). Because the husband once answered the phone to a DWP enquirer when he was over at the house, the couple have been hauled in to be investigated for fraud because this action was deemed to be suspicious - the investigators don't care that there is a note on the wife's case that says to contact her in writing rather than by telephone because she has hearing-loss and doesn't answer the phone. Anyway, it seems that because the husband visits his estranged wife regularly and does chores for her that she can not do, then her claim is seen as invalid. Despite the fact that they are separated and don't live together. The husband broke down when he was telling me this and apparently broke down during the interview. He had even been asked questions about when they had last had sex. Carers really can have a raw deal on so many fronts. I more and more understand why Carers UK questions whether carers have any human rights.

read more | 1 comment | relationships | marriage | chronicillness | carers

Is It Depression or Bleak Life Circumstances?

Submitted by tonyplant on October 13, 2006 - 12:40.

Have you come across the Patient Health Questionnaire (PHQ-9)? Pfizer is terribly proud of the PHQ-9 and claims that it is an

easy to use patient questionnaire [which] is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders.

I'm met a number of carers who have been put through the PHQ-9. By anecdotal report, the lowest score to date is 20 (severe depression). Oddly enough, lots of carers have trouble falling/staying asleep, particularly if they are listening out for sounds of illness or an indication that someone is up and wandering (e.g., someone with Alzheimer's Disease). Some carers lose their appetite with anxiety and others overeat for comfort. A number are in such distressed financial straits if they've given up work to care for someone that it's not unusual for them to feel like they're failures and face a future that is so bleak that they don't want it. These questions would catch a lot of carers and their everyday circumstances.

Is it hopelessly naive to say that the PHQ-9 is describing a state of mind that would disappear in many of the affected carers if they had appropriate resources and their future didn't look quite so bleak? The GPs who administer the PHQ-9 are familiar with the circumstances of carers: do they administer anti-depressants or offer talking therapy (good luck with that waiting list), or do they look at the score and decide that it is not really indicative of depression?

read more | add new comment | happystance | happiness | depression | carer | caregiver