Making Sense of Voices- Maastricht Interview Training
(This training is targeted at all mental health workers, criminal justice personnel, and third sector agencies)
Facilitators: Pete Bullimore and Chris Tandy
|The Crown Hotel, Crown Place Harrogate, HG1 2RZ – 3rd, 4th and 5th July 2013|
The Institute of Mental Health Building , Innovation Park, Triumph Road, Nottingham NG7 2TU- 17th, 18th and 19th September 2013
|Wirral Mind, 90-92 Chester Street, Birkenhead CH 41 5DL- 15th, 16th and 17th October 2013|
The Maastricht Interview is a semi-structured questionnaire that is used in therapy with voice hearers. It explores the experience at length and can assist voice hearers in a number of ways. It helps people overcome the shame of talking about the voices and encourages them to describe their experiences. The therapist will need to show the voice hearer that they recognise their experience by demonstrating a completely open-minded interest. By asking the right questions, in this way, the therapist can offer people the reassurance that hearing voices is in fact a well known phenomenon, enabling the voice hearer to feel properly acknowledged. The questionnaire should then facilitate discussion about the voices and confirm the reality of the experience. It is also a means of systematically mapping all aspects of the voices to gain more insight to the experience. This promotes acceptance and empowers people who hear voices.
(Places are limited)
Apply now: please email Karen Sugars firstname.lastname@example.org to book a place on this training
Some quotes from our previous attendees from our joint training initiatives:
‘A truly inspiring training experience. This gave me so many useful strategies ideas for working with voice hearers’
‘Logical and practical solutions for working with voices’
‘It focuses upon Romme and Escher’s ground breaking work with voices which is fantastic!’
‘Excellent trainers that consider the key implementation issues from a voice hearer and worker perspective’
Guest Post By Lesley Farrington: Do You Have A Story To Tell About The Reality Of Your Life As A Sick Or Impaired Person Claiming “Sickness Benefit” ?
WHAT IS YOUR STORY ABOUT CLAIMING EMPLOYMENT AND SUPPORT ALLOWANCE AND ITS IMPACT ON YOUR LIFE?
Do you have a story to tell about the reality of your life as a sick or impaired person claiming ‘sickness benefit’?
I am conducting research to show the everyday lives and of people who are unable to work because of sickness and disability, and the impact of Employment and Support Allowance. Some people say that the ‘fit to work’ process fails to take full account of people’s real lives as well as medical professional’s knowledge.
To gain a picture of everyday life, I am researching the complexity, detail and context of people’s lives. This is why I am looking to recruit 30 participants in the Greater Manchester area, to undertake an in depth interview, in a convenient location. I am also interested in how you think things could change for the better and where you see your future. Information will be given in confidence.
Professorial Lecture – Professor Gail A Hornstein -First Person Accounts of Psychosis: Challenges for Mental Health Professionals
Professorial Lecture – Professor Gail A Hornstein
First-person accounts of psychosis: challenges for mental health professionals
Friday 31 May 2013
5 for 5.30pm
Room 9130, Cantor Building, Sheffield Hallam University City Campus
Lecture supported by Sheffield Hallam University’s Department of Nursing and Sheffield Arts and Wellbeing Network
A vast gulf exists between the way medicine explains psychiatric illness and the experiences of those who suffer. Professor Hornstein’s lecture helps us to bridge that gulf, guiding us through the inner lives of those diagnosed with mental illness and emerging with nothing less than a new model for understanding mental distress, one another and ourselves. She will address the importance of listening to the accounts of those who have experienced psychosis as a central component of any mental health practice.
Gail A Hornstein is Professor of Psychology at Mount Holyoke College in South Hadley, Massachusetts (USA). Her research spans the history of 20th century psychology, psychiatry and psychoanalysis and has been supported by the National Library of medicine, the National Science Foundation and the National Endowment for the Humanities. She has compiled a bibliography of first-person narratives of madness which now lists more than 1,000 titles. Her new book, Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness (PCCS Books, UK edition), shows us how the insights of those diagnosed with mental illness can help us radically reconceive fundamental assumptions about madness and mental life. For more information on her work see http://www.gailhornstein.com/
The lecture will be introduced by Peter Bullimore, one of the Chairs of the Hearing Voices Network, and the Chair of the Paranoia Network. Peter heard his first voice aged seven, after suffering sexual abuse at the hands of a child minder. Through the help of the Hearing Voices Network he was able to reclaim his life from the system. The Hearing Voices Network is a voluntary organization that is made up of people who hear voices and professionals who all share the same ethos that hearing voices is a common human experience. Peter has worked collaboratively with Manchester University for 12 years on the COPE course collaboration in psychosocial education. He also teaches at many other Universities and runs workshops internationally on voices and paranoia working in countries such as Australia, New Zealand and Greece. He is currently undertaking a research project at Manchester University, examining the 10-year collaborative work between the University and the Network.
Places are free and include pre-event refreshments, but must be booked in advance. Email email@example.com
From Richard Bentall:
Last week, Dr Frank Hirth of King’s College London was on Radio 4 saying that his research into the neural circuitry of the fruit fly might help us understand neurodevelopmental disorders such as schizophrenia. To cut a long story short, I got copied into some correspondence about this between Dr Hirth and a colleague and was moved to join in as follows:
My friend and colleague Dave Pilgrim forwarded me your email to him, which I feel moved to reply to. I am copying in various colleagues who are as concerned as I am about the naive biological reductionism that seems to be dominating media discussions of mental health these days. Briefly, the problems with this view when applied to ‘schizophrenia’ are:
(i) Schizophrenia is a meaningless construct
There is no syndrome of schizophrenia and nobody can agree on who is schizophrenic. To my knowledge, no statistical study has ever identified a cluster of symptoms that correspond to the Kraepelinian concept or its subsequent revisions. Most recent studies have converged on a multidimensional model that incorporates all psychosis diagnoses (schizophrenia, schizoaffective disorder, bipolar disorder, delusional disorder, depression with psychotic features etc) within five dimensions of positive symptoms, negative symptoms, cognitive dysfunction, depression and mania/excitability, or even more complex structural models (see Demjaha, A., et al. (2009). Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11? Psychological Medicine, 39, 1943-1955 and, one of my own papers, Reininghaus, U., Priebe, S., & Bentall, R. P. (in press). Testing the psychopathology of psychosis: Evidence for a general psychosis dimension. Schizophrenia Bulletin, available online). In recent field trials, the proposed DSM-V criteria for schizophrenia generated a derisory kappa of 0.46, showing that clinicians working with a precise definition of the disorder and following a diagnostic interview often could not agree on who was schizophrenic and who was not (Regier, D. A., et al. (2013). DSM-5 field trials in the United States and Canada, Part II: Test-retest reliability of selected categorical diagnoses. American Journal of Psychiatry, 170, 59-70)!
(ii) Heritability coefficients are misleading
It is often forgotten that heritability coefficients are, actually, just fancy correlation coefficients. We all know, or should know, that correlation does not necessarily prove causality. Heritability coefficients are statements about populations and not individuals so that it is wildly misleading to suggest that high heritability = mostly genetically caused (for a detailed discussion of this, see Bentall, R. P. (2009). Doctoring the mind: Why psychiatric treatments fail. London: Penguin.).
In fact, precisely because heritability coefficients are correlations which attempt to parse up the variance in a trait to genetic and environmental causes, low variance in the environment leads to inflation of the apparent effects of genes. This is why, for example, IQ is highly heritable in middle class families (where environmental variation is low) but very low in working class families (where environmental variation is high) (Turkheimer, E., et al. (2003). Socioeconomic status modifies heritability of IQ in young children. Psychological Science, 14, 623-628). Also, heritability coefficients assume an additive model of genes and environment, which is wildly implausible given what we know know about how genes work. Again, assuming an additive model when there are G x E interactions leads to massive inflation of heritability and an underestimate of environmental effects (Dickins, W. T., & Flynn, J. R. (2001). Heritability estimates versus large environmental effects: The IQ paradox resolved. Psychological Review, 108, 346-369). This is probably why, as you know, molecular estimates of heritability are generally much lower than those based on the methods of classical genetics. The ‘missing’ heritability in these studies is probably phantom heritability.
Incidentally, you will also know from the genetic studies that you cite, that the consensus amongst geneticists is now that many common alleles (perhaps many hundreds) probably each confer a tiny risk of all kinds of severe mental illness. Although some CNVs have much higher association with psychosis, they account for only a small proportion of patients and are also associated with intellectual disabilities and autism (Owen, M. J. (2012). Implications of genetic findings for understanding schizophrenia. Schizophrenia Bulletin, 38, 904-907. doi: 10.1093/schbul/sbs103). This is further evidence, if ever it was needed, that schizophrenia is a meaningless construct and confirms the impossibility of devising a genetic test for the disorder.
(iii) There is massive evidence that environmental factors are causal in severe mental illness
The implications of ii above are that you can’t estimate environmental influences from heritability estimates – you have to look for them and measure them in their own right. Recent studies have pointed to a wide range of environmental factors associated with psychosis. These include social disadvantage, migration, living in cities and various forms of victimisation. I attach a recent meta-analysis I conducted on the evidence linking childhood adversity to psychosis (Varese, F., et al. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective and cross-sectional cohort studies. Schizophrenia Bulletin, 38, 661–671. doi: 10.1093/schbul/sbs050.) The bare odds ratio between childhood trauma was stable across methodologies (retrospective/prospective) and came in at about 3, much higher than any association with common alleles. More importantly, there is evidence of a dose response effect, with ORs climbing to around 50 for children who have been multiply traumatised. Reaction in the psychiatric community has sometimes been bizarre, with convoluted attempts to explain away the data (see a recent editorial I wrote about this, also attached).
(iv) Brain studies do not provide clear evidence of neurodevelopmental disorder in psychosis
The evidence linking the basal ganglia to psychosis is far from clear cut. The best evidence is from response to antipsychotics, but recent studies suggest that only about 20% of patients show a genuine clinical response (Marques, T. R., et al. (2011). The different trajectories of antipsychotic response: antipsychotics versus placebo. Psychological Medicine, 41, 1481-1488). In any case, abnormal basal ganglia activity could just as likely be attributed to environmental factors – animal studies show that chronic victimisation leads to sensitisation of dopamine pathways in this part of the brain (Selten, J.-P., & Cantor-Graae, E. (2005). Social defeat: Risk factor for psychosis? British Journal of Psychiatry, 187, 101-102).
Current structural and functional neuroimaging studies of psychosis are probably not to be trusted for a variety of complex methodological reasons (Ioannidis, J. P. A. (2011). Excess significance bias in the literature on brain volume abnormalities. Archives of General Psychiatry, 68, 773-780; Button et al. (2013), Power failure: Why small sample size undermines the reliability of neuroscience, Nature Reviews Neuroscience, published online 10 April 2013; doi:10.1038/nrn3475 – this study estimated that the median statistical power of 461 individual fMRI studies contributing to 41 separate meta-analyses was 8%!), not least the emerging evidence that drugs affect brain structure (Ho, B.-C.,et al. (2011). Long-term antipsychotic treatment and brain volumes. Archives of General Psychiatry, 68, 128-137).
In any case, the observed abnormalities could well be the consequence of social and environmental factors (Hoy, K., et al. (2011). Childhood trauma and hippocampal and amygdalar volumes in first–episode psychosis. Schizophrenia Bulletin. doi: 10.1093/schbul/sbr085).
(v) A narrow neurodevelopmental approach is damaging to patients
There is little evidence that the biological approach to psychiatry is benefiting patients. Outcomes for patients suffering from ‘schizophrenia’ have not improved since the Victorian age and an increasing number of people are disabled by psychiatric conditions. This is precisely the opposite to what has happened in physical medicine, where genuine advances have led to improved outcomes and reduced disability (see my Doctoring the Mind, and also Whitaker, R. (2005). Anatomy of an epidemic: Psychiatric drugs and the astonishing rise of mental illness in America. Ethical Human Psychology and Psychiatry, 7, 23-35). Just as importantly, although it is often assumed by doctors that promoting a biological understanding of psychosis will reduce stigma, empirical research provides strong evidence that the opposite is the case, and that biological models actually promote stigma (Read, J., et al.(2006) Acta Psychiatrica Scandinavica, 114, 303-318; Angermeyer, M. C., et al. (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. British Journal of Psychiatry, 199, 367-372.)
The claim that biological research (on flies or whatever) will one day lead to a cure for schizophrenia is a common rhetorical trick designed to gain publicity and guarantee grant funding. I have no problem with research on the CNS of flies, which seems valuable in its own right. But linking flies to schizophrenia (whatever that is) is really about self-promotion and is damaging to the interests of patients.
Members of International Health Humanities network may be interested in an upcoming event. As part of a series of workshops for the Leverhulme-funded project “Fashionable Diseases: Medicine, Literature and Culture” at the Universities of Northumbria and Newcastle, we are pleased to welcome Professor Ian Hacking (Philosophy, University of Toronto) on 15th May 2013, 10:30am at the MEA House Auditorium, Northumbria University.
Professor Hacking will give a lecture entitled “‘Making Up People’ Reconsidered” exploring the ways in which new scientific classifications of diseases such as multiple personality disorder and autism may affect experiences of them and thus give rise to a new type of person and way of being. You may wish to read the following article in preparation for the event: Ian Hacking, “Kinds of People: Moving Targets.” Proceedings of the British Academy 151 (2007): 285-318.
All are warmly invited to attend. See the poster below for details.
Dr. Anita O’Connell
Department of Humanities
My Secret Past
The aim of the documentary is to bring personal issues with mental health out into the open to help people realise that it is something which people do have difficulty with, and that it doesn’t have to be something we can’t talk about openly. This is to be a sensitive documentary aiming to capture the realities faced by mental health service users, in order to help raise awareness of these important issues. Jon and Nicolette who are working on the programme are really keen to speak to anyone who may be interested in taking part in the programme by sharing their experiences with mental health.
Whatever your background and history of mental illness, if you feel able to take part Jon and Nicolette would really like to hear from you.
call 07802 604756.