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Archive for the ‘psychiatry’ Category

I’ve had an article published today in the Medical Journal of Australia called Doctors and writing: stranger than fiction? It’s available here on eMJA, but it does have a paywall so is only for subscribers unfortunately. It’s in the paper version too which may be more readily accessible, especially to those of you in the medical field.

It’s been quiet here otherwise, but I should be more active soon. I’ve been trying to write the first draft of my second novel, and also been busy organising a new website which will be coming soon. On top of that, I’ve been a bit sick as I’m pregnant with my third child! I’ll post details of the new website when it’s available.

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You may have seen some recent media reports into the phenomenon of ‘internet addiction’ in young people. Dr Philip Tam, who has previously written a guest post on this blog on the topic of overuse of the internet, has launched a new website NIIRA with his colleagues to promote discussion, debate and dissemination of topics related to the internet and wellbeing. 

You can find lots of information there, including an article that I wrote, The Internet and Creative Writing: Opportunities and Challenges.

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I have just read an amazing short memoir called ‘Last-Ditch Attempt’ by Rebecca Epstein in Griffith Review. From her bio, Rebecca is a Masters student (in non fiction writing) at Iowa State University, and she also has Bipolar Disorder.

In this memoir, Rebecca describes her mental illness beginning in her teens, and how it was eventually diagnosed in her early adulthood. It not only includes vivid descriptions of how it feels to her to be hypomanic and manic, but also shows glimpses of her experience of the medical system: her psychiatrist, hospitalisation, and being both on and off medication. She writes beautifully, and given that she wrote at least some of it in a hypomanic state, the writing at times reflects the thought disorder and pressure of someone whose mood is elevated.

This is the best piece of writing I’ve come across that helps to capture the experience of mania and you can read it online here, or in print in GriffthREVIEW33 ‘Such is Life’.

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The following is a guest post by Nadia Jones. Nadia’s daughter experienced her first episode of mental illness while she was living away from home at University, leaving Nadia to have to try and manage this from afar. She has written below about her own advice to any other parents who worry about their child’s mental  health when they are away from home. She writes:

 

“For many parents, worrying about their children, especially when they move away from home for the first time, it is natural. Of course, there are many specific things that parents worry about concerning their college-bound students, but perhaps the most worrisome for those who have a family history of mental health disorders is that big changes—moving away to experience a lack of structure for the first time–could cause stresses that later manifest into full-blown disorders. This was my experience with one of my children, who was eventually diagnosed with bipolar disorder but had shown no signs of the disorder prior to college. Here are a few of my tips for maintaining your child’s mental health when he or she no longer lives with you.

1.     Be communicative without being overbearing.

When I first began attending college, my parents called me every day, but we never had substantive conversations. It was more of an exercise in “checking up” on me and a way to assuage their empty nest syndrome. Of course, you will want to call all the time, but it is much more effective to call your child every few days and have longer, more substantive conversations in which you can extract how they are really managing the transition. Since your child is experiencing independence for the first time, she will likely be less receptive to your communication if you call too often.

2.     Get to know your child’s friends.

Of course, this won’t happen right away, but it is important to know and have contact information of those who actually live and study with your child. It is very easy for your own child to say “I’m fine, don’t worry.” Close friends who have your child’s interests in mind will be more open to talking honestly if a serious problem begins to arise. Whenever I came to visit my child in college, I would always invite her closest friends to dinner. Being close with your child’s support group is absolutely essential if your child later struggles with mental health issues.

3.     Watch for small signs of anomalous behavior.

Most of the time, it is very easy for a burgeoning mental health problem to slip completely under the radar until it becomes an obvious problem. In my experience, especially if you already know about mental health disorders from relatives who may have them, it’s most important to look for very small changes in behavior. Even seemingly positive behaviors can be a sign. For example, when my child began calling me bubbling over with enthusiasm about a thesis project, I was excited for her. When the calls became more frequent and the enthusiasm turned into obsession, I knew that there was a problem.

4.     Emphasize the importance of consistent sleep and overall balance.

Eventually, my child’s friends and I were able to convince my child to seek professional help. And one thing that parents should know from the very beginning is that professional help is an absolute necessity if mental health problems come up. I have known far too many young men and women whose lives were ruined by mental health disorders because they or their parents were in denial and delayed seeking help. But after seeing an appropriate doctor, the most important aspect of maintaining mental health is sleep and leading a balanced life. Make sure to emphasize this when talking to your child.

It goes without saying that there is much less that you, as a parent can do when your child moves away from home, and it can be extremely stressful. Being as loving and supportive in any way you can be, while trusting your child to grow into independence, is the most effective way to ensure a stable transition from home to adulthood.”

Author Bio:

This is a guest post by Nadia Jones who blogs at online college about education, college, student, teacher, money saving, movie related topics. You can reach her at nadia.jones5 @ gmail.com.

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Here in Australia, hardly a week goes by without a story about asylum seekers, also known as ‘boat people’ or ‘queue jumpers’ (NOT my terms), arriving in Australian waters by boat. A few months ago, we saw horrific images on one such boat being destroyed by heavy seas off Christmas Island. This week, the High Court has ruled that the government cannot send asylum seekers – including unaccompanied minors – to Malaysia, as had been proposed  (see ABC’s news report here).

Having worked with refugees who were survivors of torture and trauma, I have heard some of the horrific stories that were literally about life and death. I was left in absolutely no doubt that if I was in their shoes, I would sell everything I had and pay whatever it took to get out of that country immediately to save the lives of my family. When we think about trauma in refugees, it is overwhelming: the pre-migration factors that led to them having to flee (persecution, violence, war), the migration factors (journeying on a small, overcrowded boat with no idea how long it will last or whether you’ll survive) and post-migration factors – such as being held in detention and the difficulties of settling in a foreign country.

It is these post-migration traumas that we can help with. It is awful enough for adults, but children are especially vulnerable. Detention increases the exposure of these children to trauma, robs them of developmental opportunities, and increases their risk of mental health disorders.

The Royal Australian and New Zealand College of Psychiatrists (of which I am a member) has a position statement on the detention of children that summarises the issues. The High Court’s decision is encouraging, but we still have a way to go in this country in making sure we contribute in a positive way to the mental  health of children and families who seek asylum.

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I just wanted to post a link to a post written by a woman called Danni Miller that includes an article by Jessica Rowe, who has spoken publically about her own experiences with postnatal depression. I think it’s beautifully written, and honest, and is worth a read here.

If you are at all concerned about your own mental health, or that of someone close to you, please talk to your doctor. More information on PND can be found at justspeakup.com.au

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I just wanted to say thanks to phdinpsychology.org for listing this blog in their top five blogs about developmental psychology. There are fifty blogs listed there, many of which would be of interest to readers of this blog.

I haven’t been blogging much recently as I have been finishing my novel (more on that to come) but hopefully will be a bit more active now.

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The Government announced in last week’s Budget a plan to screen children at the age of three for not only physical health, but also emotional health. It’s part of a bigger package of spending on the prevention and early intervention of mental illness in infants and children.

Can we even diagnose mental illness in three year olds? And is it a good use of money?

Prevention and Early Intervention

 We as a community readily accept the concepts of prevention and early intervention in physical health. To prevent illness, we immunise our children. We try to detect diseases at an early stage by screening babies in utero and at birth, and as adults we go for cervical smears and mammograms.

Like physical illness, mental illness causes serious suffering, disability and even death. Depression alone will affect 20% of adults, and according to the World Health Organisation is the leading global cause of years of health lost to disease. Mental illness encompasses more than depression: when we add in anxiety, psychosis, and substance abuse the impact is staggering.

We can’t immunise against mental illness, but we can detect problems at an early stage and act on them.

Do mental health problems in young children even exist?

Yes, without a doubt. Studies show that 11%-18% of children under two have a mental health disorder. They don’t present in the same way as adults, but emotional and behavioural disturbances are common.

A quarter of people with a mental disorder experienced their first episode before the age of 12, and almost two-thirds before the age of 21.

Why should we screen for mental health problems in young children?

We can reliably diagnose many common disorders in young children. We know that emotional and behavioural disorders in childhood seriously harm a child’s development. A child who is displaying problems even before going to school will not be able to make friends, or learn, or develop a healthy self esteem. Problems will continue throughout adolescence and early adulthood. They will lack social and educational protective factors and be far more vulnerable to mental illness and substance abuse later in life.

Children with mental health issues are suffering, as are their families.

They are children. We need to do something.

Could the money be better used elsewhere?

 It’s a harsh reality that Australia has a limited budget and decisions must be made about where each health dollar is spent for the maximum impact. There is $11 million (over 5 years) earmarked for this project: a small amount in the grand scheme of things, really.

Children with emotional difficulties grow into adults with emotional difficulties and mental illness. There comes a time when we need to try to break the cycle. We can keep spending all the money on those people who have already developed mental illnesses, or we can try to allocate some of the budget to child and adolescent mental health, and make sure our children grow into healthy, resilient teenagers, adults, and parents.

Prevention is better than cure

There is no doubt that the entire public mental health system needs more money. Ideally, all Australians with mental health issues would be promptly assessed and have optimal access to community and hospital resources, regardless of their age, location or diagnosis.

But with the limited resources that we have, isn’t prevention better than cure? By intervening early in life, we can make sure that as our children grow up, the rates of mental illness in adults are reduced. Investing in the mental health of our young children now means that we can make a step towards improving the mental health of our adolescents, adults, and their own children.

 

References

 http://www.budget.gov.au/2011-12/content/glossy/health/html/health_overview_02.htm

 The Royal Australian and New Zealand College of Psychiatrists: Report from the Faculty of Child and Adolescent Psychiatry. Prevention and early intervention of mental illness in infants, children and adolescents: Planning strategies for Australia and New Zealand, 2010

 

 

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I came across this article recently, reporting that some school photography companies in Australia offer to ‘airbrush’ school photos to cover up blemishes such as pimples or scars. The article includes a comment from Prof Louise Newman, president of the Royal Australian and New Zealand College of Psychiatrists, of which I am a member, and I completely agree with her.

As a mother, and as a child psychiatrist, I am very concerned about the increasing emphasis in our society on having to look perfect. I’m not saying that it’s a new thing, and certainly people have always strived to meet the cultural ideal. What I do think is new though is that this is gradually invading into youth and childhood, and a major contributor is the use of technology to create an unattainable ideal. The use of undernourished models in magazines is bad enough, but when we then start using computers to change people’s shape, size or appearance, it takes it to another level. Children – and adults – then see a computer enhanced figure being promoted as pretty, or beautiful, or successful and there’s no way that they can ever live up to that.

People may think that removing a scar, or acne, from a child’s school photo is no big deal and that I am overreacting, but I think that it gives our children the message that they are not good enough the way they are. It tells them that their parents will be prouder to show off a picture of them without their ‘blemishes’, and therefore that they are less acceptable the way they are. And this contributes to poor body image and poor self esteem, leading to poor mental health.

Let’s allow our kids to be kids, including spots, scars, missing teeth and bad haircuts, and accept them unconditionally.

Updated 30/03/11: There is a post on this same topic with lots of comments on Mia Freedman’s blog ‘mamamia’ here

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At around 18-24 months, children begin to enjoy scribbling: they are able to draw a squiggle and tell you that it is a ‘lady’ or a ‘doggie. This is the stage at which children use  symbolism, ie representing things with symbols. Language is also a form of symbolism, as well as art.

This has been described by the developmental psychologist Jean Piaget as part of the ‘preoperational reasoning’ stage of child development, beginnning when children are around 2 years old. Children also start to use pretend play at this stage.

In child psychiatry, we use play as a method of communication and ‘therapy’ with children, as play is used by children in the same way as complex language is in adults. A child will explore events that they have experienced, or worries that they have, through play. For example, a child who has been traumatised may act out that trauma with their toys, or a child who is being bullied may reenact this with toy animals.

This developmental stage is a huge leap for children who previously could only express their frustrations directly, such as by crying when upset. It is exciting for both the children and their parents.

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