Posts Tagged ‘psychiatry’

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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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.




 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 have always been interested in how mental health is depicted in literature. Shakespeare was brilliant at it, and throughout the history of literature, psychiatric illness has provided rich material for novels and poetry. Some of my favourite novels have mental health as a major theme: Anna Karenina by Leo Tolstoy; Madame Bovary by Gustave Flaubert; The Virgin Suicides by Jeffrey Eugenides; and We Need To Talk About Kevin by Lionel Shriver. It is novels like these that initially inspired me to write my own novel, in which an ‘ordinary’ family is changed forever by mental illness.

In my early psychiatry career, I read Sylvia Plath’s The Bell Jar. It was the first book that I had read that was able to really make me live a patient’s experience of mental illness and treatment. While she wrote this as a novel, it is accepted that much of the story is autobiographical. Infamously, Sylivia Plath died of suicide, after a long struggle with severe mental health issues.

I always remember her description in the novel of receiving ECT (electroconvulsive therapy) as a treatment whilst in a psychiatric hospital:



“Doctor Gordon was fitting two metal plates on either side of my head. He buckled them into place with a strsp that dented my forehead, and gave me a wire to bite.

I shut my eyes.

There was a brief silence, like an indrawn breath.

Then something bent down and took hold of me and shook me like the end of the world. Whee-ee-ee-ee-ee, it shrilled, through an air crackling with blue light, and with each flash a great jolt drubbed me till I thought my bones would break and the sap fly out of me like a split plant.” (p 151)


I was reading Ted Hughes’ book of poetry Birthday Letters yesterday. Ted Hughes, himself a great poet (and poet laureate to Queen Elizabeth),  was married to Sylvia Plath, and this book of poems are almost all about his life with her. In one, The Tender Place, he writes about his experience of seeing her having ECT. The poem needs to be read as a whole to appreciate its power, but this excerpt shows how moving it is:



“…Somebody wired you up.

Somebody pushed the lever. They crashed

The thunderbolt into your skull.

In their bleached coats with blenched faces,

They hovered again

To see how you were, in your straps.

Whether your teeth were still whole.

… Terror

Was the cloud of you

Waiting for these lightenings. I saw

An oak limb sheared at a bang.

Came up, years later.

Over-exposed, like an X-ray —

Brain-map still dark-patched

With scorched earth scars

Of your retreat…”


Of course, ECT now is done very differently, under general anaesthetic, and with muscle relaxants to stop the physical manifestations of the induced seizures. It is a very effective treatment in the right circumstances and I have seen some extremely sick patients respond amazingly to it. But these descriptions, through the medium of creative writing, describe the base fear and physical horror that a patient and her carer experienced in having this treatment in the 1960s. From what I’ve read, there is no doubt that Sylvia Plath needed this treatment, and it seemed completely appropriate – and worked at the time to improve her mood. But there is something in both her, and Ted Hughes’ use of language that describes it far more effectively than I have ever heard it described before.

In my own novel, one of my characters undergoes a similar treatment. Re-reading these works has reminded myself of why I write, and what I hope to achieve in my own creative writing.

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This post is not strictly to do with my parenting experiences, but I wanted to share my delight anyway. About a year ago, I started writing a novel with the support of Queensland Writers’ Centre’s Year of the Novel programme.

It is in its third draft now. I recently entered the Hachette/QWC competition and found out a few days ago that my manuscript has been longlisted! As usual, timing couldn’t have been worse: I had 48 hours to submit my full manuscript to them to be forwarded to the publishers, and this happened on the day that we were moving house. I had edited about half of the manuscript, and had no time to do anything other than tidy it all up, so I am not happy with my middle section, so I don’t hold out much hope of being shortlisted, but I am very excited that I managed to finish a novel, and that a panel thought that it showed enough promise to be longlisted.

I was subsequently chosen to participate in the retreat – read about this here.

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Can you tell us how we should be going about developing a secure attachment? I’m also interested to read how the insecure – avoidant and insecure – ambivalent types come about.

This question was posted in response to my blog post on attachment, and I wanted to respond to this, as it’s probably a question that all parents who read about attachment theory are interested in.

Studies show that the attachment style that we had with our own mother (again, mother can be substituted for primary caregiver) is generally predictive of the attachment style that we have with our own children. We generally parent in the way in which we were parented. There is evidence of neurobiological brain changes in infants and children which relate to their early experiences, and there is therefore an argument that our attachment style is hard- wired from a very early age.

Most children — and adults — are securely attached, so for the majority of people, we can just do what comes naturally when it comes to parenting and our children will develop secure internal working models. The factors which help this are parents being warm, empathic and consistently responsive. Parents respond to their children when their attachment behaviour is activated (crying, trying to get close to mother), and are able to empathise ie put themselves in the child’s shoes and recognise what they need at that time, and provide it.

Parents with insecure attachment styles  with their infants will generally have had that pattern with their own parents(analysed with an interview called the Adult Attachment Interview). Other factors which may influence the development of an insecure attachment include maternal mental illness (postnatal depression, psychosis), trauma, illness of the child, separation of the pair in early life etc – basically anything which affects a parent’s ability to respond to their child as above.

For this group of parents, there are things that can be done to promote secure attachment at-risk groups and individuals. The aim is to help parents develop an awareness of both their own and their child’s internal mental experiences — their reflective functioning –(Slade, 2005); to be able to put themselves in their child’s shoes; and to help with basic parenting skills.

I think that the most important thing to remember that the vast majority of parents are doing the best that they can with what they have. It’s such an important area of intervention for infants that has huge implications for the future health of our communities., and is still under-recognised and under-funded.

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At work, I use attachment theory to guide my clinical practice, and in my new work as a mother, I have been observing this every day, so I thought it was about time that I wrote about it.

Attachment, in child psychiatry, refers to a quality of the relationship beytween an infant and her mother (I’ll say mother as that is the usual attachment figure, but it could be the father or other primary caregiver). John Bowlby and Mary Ainsworth are the two people most associated with this.

                                                                                                                                                                                                                                         Bowlby studied juvenile delinquents in the early 1950s and believed that delinquency (antisocial/psychopathic traits) was associated with maternal deprivation, or being separated from their mothers at an early age. He also looked to work that had been done in the animal kingdom such as baby animals following adult animals around to ensure survival (imprinting). He concluded that infants have an inbuilt attachment system — activated at times of stress — to ensure that they stay close to their mother for physical survival.  

The idea is that the mother’s response to an infant gives the baby an internal working model of relationships. It’s as if they file away the expectation of what will happen when they are distressed and how their mother will respond. A mother who is warm, empathic and responsive to her baby’s cries teaches that baby trust and security.

Mary Ainsworth worked under Bowlby, mainly at the Tavistock clinic, and developed a laboratory ‘test’ called the strange situation to categorise attachment styles. This involves a room with video cameras, a 12 month old infant, her mother, and a ‘stranger’. The infant is exposed to increasingly stressful situations while being filmed, eg being left alone with the stranger. The child’s reaction to this stress, and behaviour on reunion with their mother, is analysed to put them into one of 3 categories:


The infant gets upset when mum leaves the room, seeks comfort when they are reunited, settles quickly with mum, and goes back to play.

Insecure – avoidant

The infant doesn’t show she’s upset when mum leaves the room, is distant when mum comes back in and doesn’t cling to her.

Insecure – ambivalent

This infant is often anxious even before  mum leaves, and becomes very upset when she goes and doesn’t settle. When they are reunited, the child is angry yet clingy and difficult to console.

What is the significance of this?

Studies have shown that the attachment style at 12 months is predictive of the attachment relationship throughout childhood and into adulthood. Our own attachment style generally predicts the attachment relationship that we will have with our own children. Insecurely attached children/adults have higher rates of mental health disturbance and social and emotional difficulties; a secure attachment is protective.

At the moment, I can’t leave the room without A crying, crawling after me and clinging to my leg. Last week, we went to dinner at a friend’s house. When we first got there, A took a look around and cried while clinging to me. AFter 5 or 10 minutes, she settled and started to explore, though if she became too stressed, she’d crawl back over to me for some reassurance. When A cries, and I respond, I know that I am teaching her that I am a secure base for her. Sadly, in our society, we seem to value children who don’t cry or protest – those with avoidant attachment styles. How many times have you heard “Oh, she’s a good baby – she’ll go to anyone, she hardly cries!” It is normal and desirable for babies to cry, and they should be clingy and wary of strangers. This is the way they have been designed so that they can survive. This is attachment at work.

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This is a bit of an aside post, as it’s not to do with parenting. I am pleased to report that Prof. Patrick McGorry has been awarded the title of ‘Australian of the Year’. He is a psychiatrist who has done heaps of work in youth mental health. He has also worked with refugees and has made a public comment today about the fact that keeping asylum seekers in detention is a recipe for mental health problems. I worked for a while for an agency who treated torture and trauma survivors (refugees) and  I was horrified at what these people had been through pre-migration, and just as horrified at what had happened to them when they arrived here, so I am pleased that he has made such a comment at a time when the newspapers will jump on it.

Psychiatrists rarely are in the media, as mentally ill people are still unfortunately stigmatised and judged in our community. We hear about doctors who treat burns, cure cancer and cut out brain tumours, but not psychiatrists. I hope that Prof. McGorry’s award helps to publicise mental health issues, particularly in young people.

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In their first year of life, babies start to play the ‘lets drop toys from the highchair’ game. This is the start of a phase which a psychologist called Jean Piaget called ‘Object Permanence’.

Piaget theorised that young infants believe that their world consists of only what they can see. So, when they can’t see a toy, or a person, they believe that the object no longer exists.  So, a young infant believes that when their mother leaves the room, they have disappeared from her world, and that frightens them.

As babies get older, they start to learn that things exist even when they don’t see them, and this is what Piaget called object permanence. A child at this stage throws a cup away, she realises that it is still nearby, so looks for it as and delights when it reappears. This can also be seen in playing ‘peek a boo’. With time, she will gradually learn that even if her mother is not with her, she still exist and will come back to her (this links into infant attachment). Their separation anxiety will lessen, and the appeal of throwing toys down on the floor will diminish…


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“The good-enough mother…starts off with an almost complete adaptation to her infant’s needs, and as time proceeds she adapts less and less completely, gradually, according to the infant’s growing ability to deal with her failure”

This was written by Donald Winnicott, a paediatrician and child psychoanalyst, in 1953 . I have thought a lot about the concept of a ‘good enough mother’ in my new role as a mum. At face value, the phrase can be taken to mean that as a mother, you don’t have to be perfect all of the time; that you can simply be good enough.  In clinical practice, I used to think of this phrase daily. When I saw mothers who were struggling to care for their children through mental health or drug and alcohol issues, I had to remember that they may not be parenting in the ideal way, or the way in which I thought they could be, but they were doing their best, and that best was usually (not always) ‘good enough’.

But Winnicott meant more than this when he coined this phrase. He actually thought that a ‘perfect’ mother, one who is constantly responding to her child’s communication and distress is hindering the child’s development. He believed that when a baby is born, mothers do – and should – respond very quickly to their distress, as the infant is not capable of doing much independantly. However, as the baby ages, she can tolerate her mother’s ‘failure’ to respond more and more, ie the baby can deal with some distress on their own, which allows the child to experience success, failure, and to learn new skills.

I like the concept of being good enough. None of us is perfect – and doing everything for our babies potentially stops them from developing confidence, skills and independance.

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