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Talking things over on the NHS

Eddie Mair | 13:21 UK time, Wednesday, 10 October 2007

is the big idea here. We'll talk about it on the programme tonight. I wonder what you think.

Comments

  1. At 01:39 PM on 10 Oct 2007, witchiwoman wrote:

    Whilst not suffereing from depression or anxiety per se, I did suffer, and am still recovering from, a disorder that had elements of both.

    Luckily, I was in a position where I could receive/partake in Psychodynamic Therapy on the NHS. I had one hour long session per week for approximately 15 months. It helped me understand part of the cause of my problem, come to terms withh it and even develop skills to deal with it, all through talking things through.

    I can't deny it was hard work and revealed things that have been very hard to deal with and I may not ever have wanted to confront. But this was, for me, a keep to step in the process.

    I am so grateful I had access to this type of therapy and that I never had to go down the root of a pharmacutical 'cure' (which would probably only have masked the symptoms).

    Of course, this is all sunjective but I can't help but thinking this is a better way of doing things. Treat the patient, not the problem.

  2. At 01:40 PM on 10 Oct 2007, Ed Iglehart wrote:

    Some more talking therapy?

    Getting it all out of the closet!
    xx
    ed

    Now to go and see the doc to renew my scrip. ;-)

    Wed Oct 10 13:42:59 BST 2007

  3. At 02:00 PM on 10 Oct 2007, Big Sister wrote:

    I think this is excellent news, although long overdue. I know, though, that there will be lots of sceptics along the lines of "People used to cope without all this" - which may have been true in the days before families became so dispersed. Nowadays, many people don't have the same support groups to whom they might have turned when things were going bad - things such as workplace stress, bereavement, relationship traumas, etc., which can be very hard to manage alone.

    While endless talking about things can be self-defeating, constructive counselling, and techniques like cognitive behaviour therapy, can help people turn their lives around and help them to cope in what is a very complex world.

  4. At 02:25 PM on 10 Oct 2007, Roberto Carlos Alvarez-Galloso,CPUR wrote:

    Being from Florida, the NHS is the affairs of the people of Great Britain. In the USA, we do have a problem with Health Care and we have not realized it yet.

  5. At 03:12 PM on 10 Oct 2007, Ed Iglehart wrote:

    Back from the clinic.

    Well, My doc is right up to the trend of the moment! He didn't renew the scrip, but sent me away with reading matter and, when possible I'll probably get some talking to. Meanwhile I'll follow up the hyperlinks in the paper he printed off for me:
    http://www.patient.co.uk/printer.asp?doc=23068720
    (if anyone's interested)

    The modern medical practice is WIRED!

    Scrubbing floors and emptying bedpans has as much dignity as the Presidency.
    -- Richard Nixon

    Salaam/Shalom/Shanthi/Dorood/Peace
    Namaste -ed
    Wed Oct 10 15:19:57 BST 2007


  6. At 03:15 PM on 10 Oct 2007, Aperitif wrote:

    Mental health problems are classed and gendered and the simple "there's something wrong with your brain -- take a pill" response to the individual who is depressed and/or distriught becasue there is something -- even many things -- fundamentally wrong with his/her life is insulting and even violent. The pharmaceuticals indutrsy bears no small responsibilty.

    I applaud any increase in proven talking therapies. Whilst they cannot change the circumstances triggering the depression/other illness they can help the sufferer to understand its origins and thus to effect some relief from the burden of responsibilty and even guilt that (s)he has hitherto been bearing for a condition which is actually inflicted by society.

  7. At 03:27 PM on 10 Oct 2007, Dr Hackenbush wrote:

    I believe Big Sister’s comments about the dispersion of support groups are especially pertinent to this issue.

    Likewise Aperitif, as fixing a chemical imbalance in the brain, if there is one, is clearly not the same as fixing the (persistent) causes of such an imbalance.

  8. At 03:47 PM on 10 Oct 2007, Fiona wrote:

    I totally echo the sentiments of Witchi, Big Sis and Aperitif. This is absolutely a step in the right direction and well overdue. My sister is suffering from depression and is in desperate need of some constructive treatment such as Cognitive Behaviour Therapy. While it will not take away the cause of her depression (the breakup of her marriage) I know it would be hugely beneficial to her in terms of helping her come to terms with what has happened, understanding and dealing with some underlying issues, rebuilding her confidence etc. At the moment she cannot afford to see a private therapist and if she consults her GP he simply offers to write a prescription for some "happy pills".

  9. At 04:58 PM on 10 Oct 2007, Karen wrote:

    Oooh - this is probably why we recently had an education event organised for us pharmacists on this!

    Now I'm not trying to keep myself in a job here but there are some cases where the evidence is that you do need to be treating with a pharmaceutical as well as encouraging self help and talking therapies.

    The long term outcome evidence for anxiety disorders does favour psychological therapy ahead of medication and self-help but with some acutely seriously unwell people there is often a need to do something pharmaceutically short term to enable them to access the talking therapies effectively.

    I'm not keen on trying medicines if there are equally or more effective non-pharmaceutical interventions available but you are often faced with a patient actually wanting a pill for their ill - it isn't all prescriber led.

    There are also significant problems with funding for all sorts of mental health issues with it being something of a Cinderella specialty in some ways. I think this is going to be harder to achieve than they thought without significant investment.

  10. At 05:25 PM on 10 Oct 2007, Aperitif wrote:

    Doc (7) How marvellously succinct. I wish I'd put it like that.

    Fiona (8), Is there any chance she could get a referral from a different GP? It's so important and, of course, difficult to fight for proper treatment when one is already depressed. I wish you both well.

  11. At 05:38 PM on 10 Oct 2007, Big Sister wrote:

    Karen: I think you are absolutely right, and that the right antidepressant (or antianxiety) product is often needed in the short term since serotonin imbalance can be a real issue.

    However - at the moment, the prescription is written, the medication is taken, but the patient may still be struggling to cope with the issues. Without access to counselling and CBT, many people are just temporarily patched up, or with a long term dependancy upon chemical fixes.

  12. At 05:43 PM on 10 Oct 2007, Millie O'Neare-Nott wrote:

    I am currently undergoing cognitive behaviour therapy - (private though!) and would recommend it to anyone. I had pills for a while and admittedly they helped me feel physically better but didn't get to the root cause. it has been hard - talking about some things and trying to change my behaviour -some of which has been ingrained in me for years - is tough but I need that boost of talking to someone to get me through it. Good decision to increase availablity of this for people suffering from depression etc.

  13. At 05:46 PM on 10 Oct 2007, Chris Ghoti wrote:

    My life, this is overdue. Reading the list, I find myself thinking about that 'network dispersal' thing and agreeing heartily.

    Cooking also plays a part! :-) No, that's not entirely frivolous. When I lived in my parents' house, we had a big old kitchen, and my mother cooked in it. While she cooked, people sat around randomly (often on the breadbin, which was a metal tub on the floor in a corner) and talked to her about this and that, and I *know* that several people who were feeling down and low and fed up with themselves and their lives later said that they'd benefited greatly by telling her their problems and getting mild replies that mostly said nothing more than 'I don't know, but I think you've got some good ideas there...'

    I have a smallish kitchen, but there's a seat in a corner and people come and sit there talking to me while I cook. I find myself saying almost exactly the same things my Ma used to, and every so often someone tells me it has helped. I hope it does.

    I also remember the way someone I knew some years ago had to deal with things. His wife walked out, he lost his home, and then he lost his job. He was a bit upset. When he went to the doctor, he was prescribed valium. What he said about it, when he was about half-way through kicking the valium habit with great difficulty, was, 'I could have done without. My wife hasn't come back, I'm still living in a bedsit, I can't get work because I'm not a good employment prospect at the moment, and on top of everything else I'm addicted to a chemical that isn't solving any of the problems.'

    You guessed it: he said that sitting in my kitchen while I cooked! I'm glad to say that over the next few months he did a lot of talking about how awful everything was, and I did a lot of saying 'Uh-huh' and 'have some sultanas', and he kicked the valium, found a job, got a flat and ended up married to someone really super. It wasn't just me: he had what I would call 'a good support network', quite a few people who simply had time for him. That's what we all need: people who have time for us.

    Some of the same on the NHS isn't as good as a feeling that one is part of a gang or family or whatever one wants to call it, who will be there when they're needed, but it's certainly a lot better than a family living a hundred miles away.

    As for it being an attempt to conceal from people that they live in a nasty capitalist society, phooey. Maybe if one means a *fragmented* society that might be a factor, but not I think otherwise.

  14. At 05:54 PM on 10 Oct 2007, Aperitif wrote:

    Heard the debate on the programme. Had a rant about it on the Glass Box.

    Good for you Millie (11), I hope it continues to prove useful.

  15. At 05:54 PM on 10 Oct 2007, ms s. gilbert wrote:

    Regarding the new 'cutting edge treatment' that has been promised by the Government for depression/anxiety. I have suffered from severe depression now for a number of years. At first, I was treated by a qualified doctor - who often didn't turn up for appointments - but was reasonably good. I asked to be re-referred and was confronted by an ill-trained therapist who said, and I quote, that she could 'cure me in three visits' and in addition, I was a waste of money if I had had to have numerous visits to the previous doctor. Well, if these are the 'new' type of therapists the Government want to recruit they are going push people to suicide and nervous breakdown. Put perhaps they would like us to kill ourselves - at least it would get rid of the problem.
    I found Oliver James, as usual, the voice of reason.

  16. At 05:56 PM on 10 Oct 2007, david derry wrote:

    Did anyone catch the name that Oliver James suggested we Google?

  17. At 05:59 PM on 10 Oct 2007, K. wrote:

    I was suffering from social anxiety a few years ago, and received almost no (useful) help on the NHS. Waiting for counseling took 3 months, after a fairly useless few sessions I was referred further up the chain, to a Psychologist, which took approximately 4 months for an initial assessment, and would have taken another 12-24 months for treatment on the NHS.

    Needless to say, with almost no support (I qualify for full tuition fee support from the government), I was forced to go private in the end. Thankfully, after about 10 sessions of EMDR (http://en.wikipedia.org/wiki/EMDR) I'm up on my feet and back at university. I'd recommend EMDR, with a CBT element, to anybody in my situation.

    That more treatment is being made available on the NHS is good, but I'll reserve judgement until I see it filtering through the system.

  18. At 06:02 PM on 10 Oct 2007, Ed Iglehart wrote:

    Good words Chris, Uhuh!,

    The best term I learned for describing our modern society while studying Human Ecology, was "atomised" Says it all.

    xx
    ed

    In every hierarchy the cream rises until it sours.
    -- Dr. Laurence J. Peter

    Society is like a stew, if you don't keep it stirred up, you get a lot of scum on top.
    -- Ed Abbey

    Wed Oct 10 18:05:06 BST 2007

  19. At 06:05 PM on 10 Oct 2007, Working Class Hero wrote:

    I am also undergoing CBT in addition to the medication I have been taking for about 6 years.

    I believe we have something of a depression epidemic in this country and this additional resource is welcome. I hope this will not be used cynically to start ejecting the unfortunate from Incapacity Benefit prematurely.

    Or is that my anxiety talking? It tends to do that.

  20. At 06:06 PM on 10 Oct 2007, John Hope wrote:

    The government have settled on CBT as their therapy of choice because it offers an apparent quick fix; however, just like much drug therapy it can appear to be treating symptoms without addressing the underlying problem. I am a trainee counsellor and it is proving almost impossible to find GPs who will offer placements for the essential practical training. No training no counsellors.

  21. At 06:06 PM on 10 Oct 2007, alan fair wrote:

    Two cheers for Oliver James. It is clear that attempting to offer a pseudo-psychological solution to the demands made by consumerist capitalism is worse than a mere plaster dressing, it is an attempt to legitimise alienation and the despair caused by greed and rampant individualism. maybe we should set these psychologists on to the super-rich and the heads of advertising companies who are really responsible for a asspirational culture that pys no heed to the asspiration to do the decent/ethical thing. No wonder people suffer anxiety in the face of the impossible carrots that this culture dangles before our eyes.

  22. At 06:06 PM on 10 Oct 2007, Millie O'neare-Nott wrote:

    Chris (13) how wonderful. yes , in the past I've been a listener ( not usually whilst I'm cooking though - I hate people in the kitchen watching me attempt to cook!!) usually over a cup of tea! and there are friends who have been there for me and I'm extremely grateful. However I've found it an advantage to confide in a "stranger", someone who can look at my life from "the outside" and isn't part of the group that might be connected to my depression (sorry don't mean to sound negative and horrible about my friends/work colleauges etc!).

    But I totally agree with you that listening is a wonderful gift and I'm sure your friends are thankful to you. Just feel that in this age where we all lead such busy busy lives that this is a dying gift.

  23. At 06:07 PM on 10 Oct 2007, eleanor dace wrote:

    Silly me, preparing to warm up to rant mode and express my unsurprised disgust at the cynical window-dressing – with the media as mannequin-dressers-in-chief – in the dingy mental health service provision shop-front. 'Is no-one going to ask about the likely effect this will have on the treatment, and perception by others, of those people suffering mental distress for whom CBT will not be considered an appropriate treatment?' I asked myself... Not to worry, your interviewee who reluctantly conceded that CBT is not a panacea did so in terms that, in a paradoxical, Orwellian sort of way, set my mind at rest that nothing has really changed ... I quote: 'those who show a failure to recover'...! I hope some of the 'cock-a-hoop' (as described elsewhere, and earlier, during Radio 4's news coverage today) were listening to PM and feel a bit calmer in the knowledge that there's still an awful lot of work to do, an awfully long way to go. Sigh.

  24. At 06:08 PM on 10 Oct 2007, Hal Westhead wrote:

    The fundamental difference between talking therapies and drug therapies is simply one of quality.

    Drugs have varying effects and side-effects but at least you can (Chinese manufacturers aside) ensure that what you are putting into the body is of a consistent quality.

    With talking therapies you have to put up with a wide range of skill, motivation and unresolved issues in the therapist.

    Drugs can be manufactured easily, they don't go off sick, don't need endless chats to discuss 'issues' and don't take tea breaks.

    If we have an epidemic of psychological issues in English-speaking cultures (to use that as a convenient grouping) and the UK in particular then labour intensive therapies will never be affordable en masse.

    And the evidence, such as there is, shows little relationship between the level of formal training and the therapy outcomes. It is perhaps a case of some people have and some people don't - and training simply provides qualifications rather than competence and beneficial outcomes (as measured by independent assessors, rather than the therapists themselves).

  25. At 06:08 PM on 10 Oct 2007, Mawdo wrote:

    I have been on medication on and off now since my teens - 21years. I decided to have a real go and sort myself out, get counselling and sort out my problems and issues or just why I do/feel what I do.

    It is now more than 2 years since I was referred to a specialist and I have only been seen 3 times - always by a junior member of the team. Generally I have an appointment only for it to be rescheduled just before the day, often with months added to my wait. I was told it would be up to 1 year before I would be contacted about (person centered) counselling, but it has been 2 and I have had no word.

    It is about time this got sorted out. I ended up having a breakdown earlier this year and have missed a lot of work so far and feel bad about how this has affected me, my career and family especially.

  26. At 06:09 PM on 10 Oct 2007, Pamela wrote:

    I've just finished a course of CBT, after being prescribed pills for anxiety nearly 2 years ago. I'm now ready to cut out the pills and take on board some of the practical tips (it's not just about talking) that my therapist has given me. I'd recommend CBT to anyone. Good news then about the increase in therapists...we need them.

  27. At 06:09 PM on 10 Oct 2007, Jeremy Stanford wrote:

    CBT may be an appropriate form of 'talking therapy' in some circumstances, but I think that the real reason for its popularity with the current government is its comparative cheapness in comparison with other forms of psychotherapy. CBT as I understand it takes place over a defined period of 6-10 sessions. I think the more important issue is widening access to, for example, psychoanalytic psychotherapy which is a more open-ended and radical approach to the problem of mental illness. I think that this is the third leg to the tripod which must include CBT and medication. I know that there is an issue about allowing people access to open ended (or, at least long-term) therapy; yet it is, I believe, the best response to problems which, as Oliver James pointed out, have their origin in childhood. The NHS has centres of excellence such as the Tavistock and Portman Trust and the Cassel Hospital (to name but two) which carry this work forward in a distinctly hostile (not to say ignorant) political climate: we should be looking to them for our 'alternatives'. If you have money, then psychoanalytic psychotherapy will often be the treatment of choice; if you are dependent on the NHS, then you're more likely to get the pills or the CBT.

  28. At 06:13 PM on 10 Oct 2007, Cathy Austin wrote:

    I am the Director of a Counselling Cenre in Norwich. We offer low cost long or short term therapy. We have 26 trained, qualified and experienced counsellors some trained in CBT.

    All are volunteers as we have no funding.Doctors are our main referers and we have been in existance for 30 years and helped many thousands of people.

    Different therapies work for different people,3 sessions can do more harm than good (see previous comment).

    Please can we have some of that NHS money we have a proven track record and could help so many more people especially those who simply cannot pay!!!

  29. At 06:13 PM on 10 Oct 2007, Megan Edwards wrote:

    Why do reporters always have to drag out Oliver James, thank you David Clarke for a reasoned, well-presented outline of both CBT and the evidence base behind it. One paper is insufficient to write off CBT, NICE studied numerous RCTs before recommending it.
    CBT begins with an exploration of how someone’s problems are being maintained, but it is incorrect to suggest it goes out of its way to ignore people's childhoods- there is a wealth of literature written about core beliefs and their role in depression and anxiety disorders, but rather than simply discuss experiences, CBT seeks to help people make sense of why they developed the beliefs they hold, and how to begin to reframe these beliefs, based on new life experiences.

  30. At 06:15 PM on 10 Oct 2007, Alan Smith wrote:

    As somebody who has experienced depression first hand and had several courses of medication, I can safely say it was CBT that helped me most, my therapist explored all aspects of my life not just the here and now but my childhood, in order to understand why i was behaving as i did and why i felt the way i do. I have heard Oliver James talk before and as usual he would us all lay on a couch for ten years naval gazing, with no movement forward as usual Oliver James is talking out of his navel and we need to listen to research that has been done and inject money not in to therapies that do not work but into therapies that work like CBT

  31. At 06:19 PM on 10 Oct 2007, joan gallina wrote:

    I have suffered from depression for years. I am clinically obese and I have never been offered any help apart from speaking to a dietition. I am on several presciption drugs. I am 62 and no one has ever asked me why I am slowly killing myself. Please can someone explain to me why Bulimia and Anorexia are considered mental health problems and not obesity.

  32. At 06:21 PM on 10 Oct 2007, Rowena wrote:

    As someone who has suffered serious depression i found this item quite offensive. The idea that 'talking therapy' is just as effective as chemical therapy completely misses the point. Neither should be advocated to the exclusion of the other.

    My personal experience was better dealt with by antidepressants, i tried therapy by itself because it was impressed on me that it was the only 'proper' way to deal with depression. However, although i could see what had caused the original slide into depression, knowing something intelectually is of no use when your body is incapable of kicking itself back into balance. But even after i started taking the drugs i could not have coped with out support from my family, my doctor, and my counsellor, but isn't that true for every serious illness, mental or not?

    Naturally i am not claiming that drugs should be used to treat every case, that would be just as stupid a course to take. My worry is the tendancy for people to make sweeping statements about the appropriate treatments which ignore that cases of mental illness are each individual and unique. No-one should be dictated to that x or y is the best course to take without the person advocating x or y knowing the full details, any more than a patients with cancer is given a treatment before the type and extent and other details of the cancer are known.

  33. At 06:28 PM on 10 Oct 2007, Simon the Pilgrim wrote:

    It would be easier to have some faith in the news about extra resources for mental health services were it not for the evidence. We have an excellent local unit, offering psychiatric and psychotherapeutic support to those of us who suffer. For the past two or three years, the unit has been regularly "reorganised", staff have had to re-apply for their own jobs and the whole unit is regularly threatened with closure.

    Perhaps the authority could reassure us that we shall continue to be served by what we already have before promising us tomorrow's jam.

  34. At 06:34 PM on 10 Oct 2007, james wrote:

    It's so disappointing to hear that this is reduced to sheer economics; it ignores the actual people who have the problems and the reality of the complexity of why people have difficulties they do, and that they often need bespoke interventions that may be drawn from one or many different therapies. Some people do well with CBT, some do not, most need interventions from a variety of therapies. Even the quoted NICE guidelines for depression acknowledge this. The very name is misleading, in that there are many therapies that lay claim to the title, and where did brief come in? Beck's approach started with 20 sessions. There should be an agenda of choice that is more than just CBT or medicine, but one of providing the therapies that are right for the individual from the wide, and effective, choice. If your only tool is a hammer, then you will treat everything as if it were a nail. Have a read of Professor Cooper's article if you want a more balanced appraisal of what works for whom: http://www.strath.ac.uk/Departments/counsunit/features/articles.html

  35. At 07:05 PM on 10 Oct 2007, Ed Iglehart wrote:

    Simon the P (),
    "For the past two or three years, the unit has been regularly "reorganised","

    "We trained hard, but it seemed that every time we were beginning to form up into teams,
    we would be reorganised.
    I was to learn later in life that we tend to meet any new situation by reorganising, and a wonderful method it can be for creating the illusion of progresswhile producing confusion, inefficiency, and demoralisation."
    Caius Petronius, AD 66

    Plus ca change, eh?

    xx
    ed

    Marriages are made in heaven and consummated on earth.
    -- John Lyly
    Wed Oct 10 19:05:42 BST 2007


  36. At 07:29 PM on 10 Oct 2007, Rachel wrote:

    I was struck down with depression just a few years ago. I did all the right things, saw my GP, was offered therapy both privately and on the NHS and took up the opportunity of all the help I could get. I asked for counselling on the NHS and was on a waiting list for 11 months, but went ahead with it anyway. I think talking therapy in itself is fine, helps you perhaps see the source of the problems. The difficulty is though that without any sort of support network you might as well just have been talking to the cat. The stigma at work was horrendous, friends I once thought of as friends avoided me and my family abandoned me because of mental health difficulties. For me the therapy was as useful as telling someone they had a broken leg and should now go home and sort it out themselves. I still suffer terribly from depression, I just don't talk about it anymore. It is the stigma and fear of something so common place that causes the problems, the lack of community, the lack of support, perhaps even the world we live in today where communication seems to be by computer and no one really cares anymore. Just my experience, but the talking therapy if anything just made things 10 times worse, not better.

  37. At 07:48 PM on 10 Oct 2007, Michael Skelly wrote:

    Drew Westen, amongst others, has produced a large number of papers indicating that there are:

    a) limitations to the effectiveness of any psychotherapy where the person is discharged into the same social circumstances.

    b) Oliver James is supported by a vast array of evidence simplified in book form by Professors Marmot (Status Syndrome) and Wilkinson (Unhealthy Societies)

    c) Even the BMJ has complained about the medicalisation of life whilst disease mongering is epidemic in Mental Health (see Mad in America by Whitaker - good source of references, see also Critical Psychiatry Net/Joanna Moncrieff).

    d) Some studies have shown that regular exercise, preferably with the right support, produces outcomes comparable to psychotherapy alone - see Professor Marie Donaghy's professorial lecture on the Queen Margaret Univesity web site.

    As the a doctor said this evening on Case Notes - Radio 4 - "what is good for your heart is good for your brain".

    We operate a project, in partnership with a Voluntary Agency and initally funded by Choose Life, where we use trained volunteers to provide long-term support into maintaining exercise programmes in the community. There is also access to health care professionals and the staff and support networks via the voluntary agency. This is also backed by potential for 'psychotherapy' and social services input - since the evidence suggests that social stressors are important if not key in Mental Health problems.

    Caspi et al., 2004, indicates that although genetics may play a part "lifetime history of stress" is the crucial factor in the aetiology of depression - interestingly this also seems to apply to fibromyalgia syndrome and chronic fatigue syndrome.

    Our input may include massage because of its effects on oxytocin, human growth factor, cortisol and the monoamine system (ie 'the usual suspects' serotonin, noradrenaline and dopamine) The main research in Mental Health has been regarding adolescents by Field et al.

    We also suggest nutritional change due to the work done by Food and Behaviour Research, (FABR), Amanda Geary, Patrick Holford - in the tradition of Orthomolecular Psychiatry - i.e. we get people to read and make their own minds up. Fundamentally a really good diet helps the brain function better with some exciting research regarding the omega 3 eicosapentanioc acid.

    We also direct people to read the works of Professors Bentall (Madness Explained) and Healy (Let Them Eat Prozac), after all knowledge is power.

    We point out that most of the guidelines are inevitably biased since millions of pounds are thrown at pharmaceutical research, thousands at psychological research and pennies at the rest.

    Finally we encourage service users to expand their support networks, look at social constructionism as it applies to psychiatry, and become volunteers themselves. People who do voluntary work tend to be healthier in all dimensions than people who don't - which brings us back to Oliver James!

    At last you might say!

    CBT and IPT are useful systems but need to be part of a bigger whole that needs to build in wider social support networks and have a socio-political dimension.

    Ultimately we need to build a less competitive, less consumerist and more just society with - according to Marmot - minimal if any differences in status, power and wealth.

    Psychiatry/Psychology has been criticised for helping to maintain a destructive and illness generating social status quo, and rightly.

    The question for Oliver James is that until the dawning of Utopia when science and justice will rule rather than narrow self-interest what are we to do - remember Marcuse (An Essay on Liberation)?


  38. At 08:02 PM on 10 Oct 2007, Chris Ghoti wrote:

    Rowena @ 31, I agree, I agree, I agree! At least, it seems to me that there are as many sorts of 'cases of depression' as there are people who are depressed, and that to decide for some reason (financial or fashionable, does it matter?) is a terrible mistake.

    Some people might be helped by the valium that just made things worse for my unfortunate friend; the thing that was wrong was that the doctor seemed to have given it on autopilot, without stopping to think whether it might be as useful as an elastoplast on a broken leg in that particular situation, because it wouldn't bring back wife, job and home.

    In fact I think the motto ought to be 'Patients Are People Too!', and talking to people ought to be available and so should drugs. People are all different from each other, and each may need a different sort of help when things go wrong.

  39. At 08:04 PM on 10 Oct 2007, eejay wrote:

    Mawdo - just phone up and pester them. I was in a similar position and the Samaritans gave me that advice, and it worked. So did the therapy - couselling followed by hypnotherapy in my case.

  40. At 08:07 PM on 10 Oct 2007, Mike Henderson wrote:

    A few comments:

    Whilst it is true that the idea of adding a lot of CBT may be simplistic, there is no doubt that increasing access to an evidence based psychological therapy is a good thing.

    Both Psychological Therapy and medication can have a role in the teatment of depession, what works for one may not for another. It is important that people have informed choice and that neither option is seen as 'bad', the evidence does not support this.

    I am concerned at the claim that 50% will be 'cured' for good, that does not stand up to the evidence that there is and may lead to those who struggle to improvbe feeling that they have failed as they 'should' get better.

    You may wish to visit www.livinglifetothefull.com an innovative, Scottish NHS site that offers guide slef-help using a CBT approach.

  41. At 08:23 PM on 10 Oct 2007, Chris Ghoti wrote:

    Rowena @ 31, I agree, I agree, I agree! At least, it seems to me that there are as many sorts of 'cases of depression' as there are people who are depressed, and that to decide for some reason (financial or fashionable, does it matter?) that all will respond favourably to the same treatment is a terrible mistake. (Your cancer example is brilliant!)

    I've been very lucky: I am called 'very unhappy' when things go wrong, rather than being told I'm 'depressed', and so far it has been possible to deal with my bad times without chemical help. But that's just one case... Some people might have been helped by the valium that just made things worse for my unfortunate friend; the thing that was wrong was that the doctor seemed to have given it on autopilot, without stopping to think whether it might be as useful as an elastoplast on a broken leg in that particular situation, because it wouldn't bring back wife, job and home.

    In fact I think the motto ought to be 'Patients Are People Too!', and talking to people ought to be available and so should drugs. People are all different from each other, and each may need a different sort of help when things go wrong, so we should try to get all the sorts of help available to cover all the bases.

    I hope very much that you have got the help you needed to end up how you want to be, rather than being controlled by any state of mind whatever.

  42. At 09:18 PM on 10 Oct 2007, JB wrote:

    Congratulations to the BBC another slick trick. Context is everything. The debate on incapacity benefit is discussed by upper middle class “medical” professionals – without the balance of a disability rights campaigner. This is a debate about who controls the “aberrant” in society. No health economist again?

    The Westminster consensus it gets even more blatant when they discuss tax on the BBC. A declaration of interest would go down well.

    The issues of control in a person’s life paramount in mental health stability.

    I remember a time when a time when CBT would save the world.
    (I remember thirty years relaxation guru scoffing at T.A saving the world.)
    CBT would be free on Open Access programme. You would be able to use this therapy in comfort of your own home P>C.
    This would be without the permission of the NHS – The DHS – The kings Fund or being badger to take a Mac job. A couple of session bingo won the lottery of life job at the BBC next.
    How many working class people get jobs at the BBC without or with mental health problems. They are more have more chance of getting depression. It is not PC to talk about class.
    Laugher maybe the best therapy and love the best doctor. What a being fulfilled in life? Why not get a decent well-paid job.

    If the BBC are to promote the government’s agenda then surly they must they must offer a number of jobs to people on incapacity benefit.
    As the BBC is prone to pointing out that the highest incapacity claimants are in ex-mining towns in Wales. Not many public schools here.

    It is a normal consequence of doing heavy manual work you suffer ill health – you are surrounded by a degrade environment. Very little control over local agencies or service providers. Bingo you are coming up - high in the ill health stats. Fuel poverty etc.
    The health establishment know all this.
    Question and Answer session.

    As far as CBT goes what is the policy.

    Patient “I would prefer acupuncture I think that will better for me.”

    Politicians and medical establishment “we think that CBT will give you better control over your condition and we can berate you into to getting off benefits.
    A Chinese doctor would probably say you have physical problems we know better.”
    It is common knowledge that people wit irritable bowl syndrome benefit form hypnosis. If you have depression related to IBS do you get a choice? CBT?


    It is well documented that certain jobs have a higher incidence of repetitive strain injury. The government could place health warning on jobs and charge employers for the treatments these RSI susceptible workers require. Depression prevention?
    There been strikes by NHS Mental health nurses in Manchester. Did the medical establish raise up as one man and tell the government no more cuts in Mental Health provision? I think we all know the answer to this question.


    Another example of the Westminster consensus. See below

    To give an example I am reminded of the now forgotten debate on school encouraging non - competitive sports.
    The politicians the media and the government funded bodies such as the BBC. Went along with “it all the loony left. “ Idea.
    This was advice from educationalist to exercise throughout life for good mental and physical health.
    This is an example of a bandwagon and wilful dishonesty. The BBC call this type of fraud miselling. These people are still in charge of the media agenda.

  43. At 09:34 PM on 10 Oct 2007, hemsty wrote:

    The idea of talking therapy in conjunction with medication is not new, it was introduced in Australia about a year ago and Psychologists can now be paid by Medicare for up to 6 counselling sessions as part of a mental health care plan prepared by the GP. The government does not prescribe CBT and its up to the therapist in conjunction with the doctor to decide on the most appropriate therapy for the individual. I think its a pity the UK is so specific about the treatment to be used. I hope that it is not limited to depression and anxiety, since spoken therapy is also recognised as being of use in treating Schizophrenia for example.

  44. At 10:37 PM on 10 Oct 2007, suzanna wrote:

    I would support Hemsty's comment re. the unfortunately prescriptive tone of this evening's announcements about funding for CBT. Over the last few years a lot of research has focussed on this particular type of psychological therapy and it has become "fashionable" since there currently appears to be an evidence base to support the concept that this therapy "will deliver cost-effective outcomes". I would welcome Governmental recognition and support for developing a plurality of approaches towards assisting recovery of those who develop mental health problems. Since each person and their experiences will be different, timely access to well-informed and comprehensively holistic assessment and help would be welcome.

  45. At 09:00 AM on 11 Oct 2007, JC wrote:

    Thank goodness for people like Oliver James and some of the commentators above ( Hemsty, Susanna..) I am a therapist who works from a Humanistic model and while I don't have a problem with CBT per se ( I feel it can benefit some clients in some cases). However, I was appalled to hear promises from MPs that 50% of patients diagnosed with anxiety and depression would be 'cured' by a short course of CBT....

    While I value an emphasis on talking therapies as opposed to ( or in conjunction with) medication, it seems very wrong to suggest that CBT is the only talking therapy available.

    Furthermore, it is well known in the profession that there is a lack of research into humanistic therapy as opposed to 'outcome measurable' CBT, but that does not mean it is less effective.

    I have also heard rumours that nurses and other health practitioners will be given brief training in order to deliver CBT - I feel that the lay person needs to understand the distinction between this and the rigorous training mainstream therapists have to undergo and I am concerned that,without such training, practitioners may be unable to manage some of their own and their clients' more difficult issues. This could be very damaging to vulneable mental health patients.

  46. At 11:29 AM on 11 Oct 2007, Ed Iglehart wrote:

    JC (44),

    "I have also heard rumours that nurses and other health practitioners will be given brief training in order to deliver CBT -"

    Whatever is happening, you can bet it'll be driven by lowest cost, or am I being unduly cynical?

    Perhaps it's the Effexor wearing off....

    Salaam/Shalom/Shanthi/Dorood/Peace
    Namaste -ed

    If I want your opinion, I'll ask you to fill out the necessary form.

    Thu Oct 11 11:22:07 BST 2007

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    In the war of wits, he's unarmed.
    Thu Oct 11 11:22:57 BST 2007

  47. At 11:38 AM on 11 Oct 2007, Fiona wrote:

    Dear Chris Ghoti - how I wish I could come round and sit and watch you cook. You are so very right in what you said. As I mentioned in my previous post my sister is dealing with depression brought on by her marriage breakdown. For her personaly I know she needs something more constructive than simply someone to listen to her. However I know how much I long that for that sort of support network on a regular basis. My parents (who are both getting on and can't really cope with anyone else's problems) and sister live 500 miles away, and SO's parents are both dead so I frequently find myself longing for some sort of adpotive family that I can just go and have a cry to when things get too much, someone to give me a hug and say "there there" and "have a cup of tea". I wonder how many of those suffering from depression could possibly have been brought back from the brink if that support network had been there for them?

  48. At 12:16 PM on 11 Oct 2007, Ed Iglehart wrote:

    A new kind of head-patting therapy?


    There, there, it'll all be allright, and it's cheap and fully legal.

    ;-)
    ed

    QOTD:
    "Like this rose, our love will wilt and die."
    Thu Oct 11 12:24:20 BST 2007

  49. At 12:27 PM on 11 Oct 2007, Big Sister wrote:

    Fiona: I think that applies to many people. So often, nowadays, we find ourselves having to shore ourselves up, or are cast in the role of being 'strong', and therefore being the listener. Yet we all need support of one kind or another.

    There is a lot to be said for the traditional family structure, where generation supported generation in a cyclical way, and I've observed how effective this has proven in many mediterranean countries where it still prevails. However, on the negative side, it does require a great deal of tolerance amongst family members, and I'm not sure we're so good at that any more.

    I've often fantasised about the perfect commune, like a chosen family, but I know this is utopian. Human nature, unfortunately, will always ensure that such structures are inherently flawed.

    But this, our Blog, is perhaps a little bit of a substitute family, don't you think?

  50. At 01:04 PM on 11 Oct 2007, Ed Iglehart wrote:

    Sis,

    "But this, our Blog, is perhaps a little bit of a substitute family, don't you think?"

    Aye, and very nice, too, but how sad is that?

    ;-{

    xxxx
    ed

    FORTUNE'S RULES TO LIVE BY: #23
    Don't cut off a police car when making an illegal U-turn.
    Thu Oct 11 13:04:42 BST 2007

  51. At 01:04 PM on 11 Oct 2007, witchiwoman wrote:

    Big Sis - I think you and I have talked about this kind of thing before. I am about to my back in with my Mom and her partner (who I haven't lived with before) plus his 'occassional' kids. I can't wait to be back in a family environment. Plus room for my SO (when I find him!)

    One of the reasons I am particularly looking forward to it is having that support around. Friends and (ex)partner have been wonderful but there comes a time when family offer that little bit more. I have done the 'being strong' thing for myself and others and do need some time to relax that.

  52. At 01:15 PM on 11 Oct 2007, Big Sister wrote:

    Ed: Maybe it is a bit 'sad', but it is better than nothing, don't you think?

    WW: Yes, I think you're right, we've discussed this before. And I do hope it works well for you when you move in with your mother. Is this in any way related to your news on the job front, by any chance?

  53. At 02:42 PM on 11 Oct 2007, Ed Iglehart wrote:

    Far far better than nowt, indeed, Sis. Goes without saying. Just taking note. I can't get the image from last night's TV out of my head. Rows upon rows of therapists with headsets in a call centre.....

    I seem to recall a joke about automated exchanges:

    If you're calling because of obsessive compulsive disorder, keep pressing 3.....

    xx
    ed

    It's only by NOT taking the human race seriously that I retain what fragments of my once considerable mental powers I still possess.
    -- Roger Noe
    Thu Oct 11 14:42:29 BST 2007

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