Minding the Mind: A comprehensive guide to mental health

By Eoin Meegan

Picture: Google Images.

It is estimated that one in four people will experience mental health problems in their lifetime. The World Health Organization’s Commission on Social Determinants on Health stated that depressive mental illness will be the leading cause of disease in high-income countries by 2030.
Research has shown that people with mental health conditions have a much higher mortality rate than that of the general population, and also suffer disproportionate rates of physical illness. This proves that our mental health does have a bearing on our physical well-being, and that caring for it was never more important.
To promote awareness of this issue, St John of God Hospital ran a series of public lectures throughout April. The lectures were given by senior clinicians from the hospital, and the topics covered were dementia, anxiety and the internet, addiction, and general mental health. The series was organised by Kate McCallion. NewsFour was there.

Dementia: a new approach
The first talk entitled ‘Dementia, Who Cares? We Do’, was given by Norma Sheehan and Elaine Byrne, from St Joseph’s Shankill.

Dementia is an umbrella name for a large group of illnesses which include Alzheimer’s, Vascular dementia, frontotemporal dementia, Huntington’s, and Creutzfeldt-Jakob Disease (CJD). There are about 200 types in total.
The number of people with dementia in Ireland is expected to more than double over the next 20 years, from 55,000 today (two thirds of whom are women) to 113,000 by 2038. One in ten people diagnosed with dementia in Ireland is under 65.
Among the many myths about dementia is that it’s a natural part of growing old. This is not true. Dementia is not an inevitability of the ageing process, which is really good news. Nine out of ten people over 65 do NOT have dementia.
There are four progressive stages of dementia: Early Stage, Altered Reality, Repetitive, and Later Stage. Each stage presents its own problems and complexities.

The first sign that a person has dementia is usually cognitive behavioural changes: having difficulty following conversations, confusing their current home with the one they grew up in, not knowing how to use a knife and fork, and seeing colours differently. And of course the ubiquitous memory lapses.
Often, dementia sufferers are seen as aggressive or challenging, however, such labels of convenience are not only unfair, but also misleading. We should remember acted out behaviour can be a form of communication. It is better to listen to that communication and determine what it is they are trying to tell us, or ask for; in short to get inside the bubble they live in.
And this is exactly what a radical new approach to dementia known as the ‘Butterfly Model’ is aiming to do.
The Butterfly Model challenges us to live in the world of the patient rather than expecting them to conform to ours. It sets out to make the world a softer and more manageable and friendlier place for them. One of tonight’s speakers, Norma Sheehan has been to the fore in introducing this new model in St Joseph’s.
It is a move away from a medical-centred form of treatment (which chiefly served the institution’s needs) to a new social model, which is patient-centred, and caters, firstly, for the patient’s needs.
The patients no longer live in large dorms, but in smaller, manageable lodges tailored to the particular stage of the disease they’re at. They go and come within the home as they please, get up and have breakfast at whatever time they want, just as you would do at home.

Staff do not wear name badges or uniforms, and are not set ‘apart’ from the patients. There are no drug trolleys, or nurses’ stations. All signs of authority are smoothed back.
Dementia is an incurable illness that can have a very long trajectory. This new butterfly model holds great hope for the future for those suffering with dementia. It has been a great success in St Joseph’s. All that’s needed is a small shift in our thinking, away from seeing dementia as something to ‘fix’, to one of fixing our attitude to it.

Anxiety and the Internet
Internet usage, as I’m sure you know, has mushroomed in recent years, and many people are concerned by our growing dependency on it, and its attendant anxiety.

In the second, very stimulating talk, Dr. Amy Watchorn explored the topic of ‘Anxiety in an Age of Information Overload’. She describes two kinds of people online; digital natives and digital immigrants
Digital natives are people who were born in the 80s or later, also known as millennials. They have an almost umbilical connection to the internet, and feel they can’t do without it.

Digital immigrants, on the other hand, are those born before the internet came into existence. They use it for specific things, such as sending an email or booking a holiday, but it is not essential to their existence.
With continuous attention switching, multi-tasking, and bombarded as we are by a constant stream of alerts and messages that more and more demand our attention, online overloading can become a very real concern. Factor in intermittent detachment, attention span deficit, and you just ratchet up the rising sense of anxiety. Further, the sheer volume of information available online can actually retard, rather than assist decision making.

In the adolescent brain, the impulsivity striatum, or pleasure centre, is more dominant than the prefrontal cortex; it’s not until we hit 25 that the latter catches up. Therefore, information overload is even more or a concern for teens and young adults.
When the body experiences extremes of anxiety, it goes into fight or flight mode. This is an evolutionary mechanism designed to assist us in genuinely stressful situations, which becomes a hindrance if it gets triggered all the time. It was obviously never intended to get activated by the numerical amount of ‘likes’ we may have received on our favourite social media platform.
So, having recognised the new phenomenon of digital overwhelming, what is the solution?
Dr. Watchorn outlined that our online activity, like any other, needs to have a purpose to it. We need to choose when we will go online and how long we stay there. This is known as satisficing, the ability ‘to choose when to choose.’ Doing any kind of mindfulness practice was also advocated because it puts the person back in the present moment. The important thing is to maintain a balance between time spent online and off.

So, purpose, presence and balance are the words to remember. “It is not selfish to take time out and care for yourself,” says Dr. Amy Watchorn.

The next question is, are we becoming addicted to our mobiles and social media, and, perhaps more saliently, is this causing an increase in cases of ADHD, autism and panic attacks?
The answer is we simply don’t know whether cases of autism and ADHD are more prevalent now than in pre-digital years or if it’s just that these conditions are being seen and recognised more now. And indeed, if they are, whether social media is the significant driving factor behind them. Therefore, it is dangerous to jump to conclusions for which there may be no scientific basis. Research is still only catching up and we are on the back foot with this subject.
In the discussion which followed this talk, it was unanimously agreed that it is too simplistic to blame the internet and social media for these very serious conditions.

And that sounds like good advice. Instead of setting out to demonise all social media, it is better to understand the causes as to why people are spending so much time there. Equally, to be familiar with your type, whether you are a digital native or a digital immigrant, and then, from that perspective, try to understand the other and not see them as something alien. One is not better than the other, they are just different. Obviously, this is even more important if you’re a parent striving to understand your digital native offspring!

Digital anxiety and information overload are undoubtedly real, and can pose a problem for the changing society we live in, but understanding that we’re different and being comfortable with that goes a long way to eliminating unwanted and misplaced fears. Handled this way, and taking into account the safeguards and suggestions put forward, we can embrace social media in its positive aspects, a tool for education, gathering information, and connecting in a meaningful way with others, without becoming overwhelmed by it.

A way out of Addiction
The third talk, ‘Addiction Services and Treatment Pathway’, delivered by Senior Addiction Counsellor Louise Rose, dealt with a subject that has sadly impacted on all too many families.
Addiction can be broken into two categories: substance addiction – that is substances ingested, such as alcohol, drugs, food – and process addiction; gambling, exercise, the internet, and so forth.
At St John of God’s hospital addiction is seen as an illness, one that can be treated, and no blame is apportioned to the individual concerned. The approach is an holistic one, and is tailored to meet the needs of the individual patient. It is not a one-fits-all approach.

Rose explained that when someone is caught up in an addiction, reality for them can become distorted, leading to a proclivity to understate and minimise the problem and their role in it. How this can manifest will vary; it may be a tendency to blame others, one’s job, spouse, or just the stresses of life. Or it can show itself in complex forms of defence, such as always appearing well groomed in public, or showing up on time; in short, behaviour one might not readily associate with addiction. Comparing oneself favourably with other addicts is another tactic. The person may say, “well I’m not as bad as so and so.”
In St John of God the person with the addiction is taught to take ownership of their problem and not rely on these unsound crutches.

Then, when the denial starts to crack open, the person begins to get a real insight into how they were manipulating events around them and the story they were telling themselves. This is when recovery really begins to happen. They now start to get a true picture of their condition, not the distorted one the addiction was creating.
Understandably, this can be a very painful time for the patient, and they are given all the support needed.
This is where, Rose points out, the nursing contingent in the hospital plays such a vital role. The first point of contact for most patients will be the nursing staff, who not only help to allay initial fears but remain a constant source of strength throughout the programme. It is a very difficult decision for a person to come through the gates and admit they have a problem and this act of courage is duly recognised.

Among the many treatments provided at St John’s is the 28-day programme. This is a residential form of care, with the patient being allowed home on the second and subsequent weekends. This serves to re-integrate them back into society by degrees, as well as being a testing lab for the progress they are making. As part of any recovery process, decisions must be taken as to the appropriate changes in the person’s lifestyle, habits, and former associates.

On completion of the 28-day programme, patients are encouraged to participate in an after-care programme, where they visit the hospital once a week for a year. This is a chance to discuss their progress with trained staff, as well as to strengthen new, healthy friendships formed with other recovering addicts. These are encouraged as they help to foster a sense of togetherness.
As well as the medical and psychological services St John of God provide complementary therapies, such as aikido, pilates, yoga and mindfulness body work. Rose says patients particularly love this aspect of the recovery programme, as, again, it forges connection and is a lovely way of slowing down the mind and bringing people back into themselves.
Undoubtedly, families of those with addiction suffer too, not only with concern for their loved one, but also feeling there is no one they can turn to. St John’s organise special days where families can meet and bond with others in a similar situation. This helps alleviate feelings of isolation, and can be a great source of strength and comfort for all concerned.
A very interesting and illuminating talk on the caring and compassionate work St John of God do for those suffering with many forms of addiction.

The Art of Being Happy
Are we genetically predisposed to being kind? This is a question which has been considered by many great thinkers down the ages and one which Clinical Supervisor Ciaran Cuddihy, in Building Better Mental Health, the final talk in the Minding the Mind series, unhesitantly answers yes. He points out that because in our evolutionary past we had to look after each other in order to survive, we are wired to be altruistic.
A scientific study seems to prove this. In the study, participants were divided into three groups and given money. The first group was told to spend it on themselves, the second to give it to a charity, and the third group instructed to spend the money on somebody they knew. At the end of the experiment all three groups were tested on their happiness level. And while all three reported an increase in happiness, it was the third group, who spent the money on someone they knew, who rated their happiness the highest.

Another study, this time carried out by Harvard University, has shown that 40 percent of our genetic makeup is there at birth, like the colour of our eyes, etc. and there’s not really much you can do about that. But the hidden potential in this study means that there is 60 percent you can change or work with. So, by making small changes in your life you can make a very big difference.

There is growing evidence that mindfulness, good nutrition, and time spent in nature can all help at the milder end of depression.

Mindfulness is deliberately returning your attention to the present moment with acceptance. It is really the practice of paying attention to what’s going on around you and bieng aware of yourself – your feelings and thoughts in the moment.
It is recommended we do thirty minutes exercise each day. Ciaran suggests running in the outdoors rather than on a treadmill in the gym; also not to exercise alone, but to bring a friend or workmate along, as another important health benefit is to enjoy meaningful interaction with others; that is surround yourself with people who make you feel good (a feature we saw in the talk on addiction.) This way, we benefit from the physical aspect and the social.

Do you constantly worry about the future, or find yourself having hypothetical arguments with others in the shower? Sometimes we don’t value ourselves enough. When stressed, it is crucial we find a suitable way to deal with it and not be afraid to ask for help. Growing old should not be equated with failing health (remember nine out of ten people over 65 do not get dementia) but excessive worrying can cause premature ageing.

Practice gratitude. Be grateful to yourself. Think of three things every day which you are truly grateful for, and write them down. Too easily, we find ourselves distracted (for instance, with social media) and focus on stuff that’s not important. A change of routine is also good, don’t get stuck in a rut. Some people are more inclined to be happy than others, but if we can be flexible and adaptable in life, this gives us a head start.
There is evidence that doing these things can help prevent mental illness.
The meaning of life is finding the thing you like to do, and do it as often as you can. Above all, Ciaran stresses, be kind to yourself.

All of which affirmed the WHO’s statement above that the state of our mental health has an impact on our physical health, and vice versa, while ending an excellent series on an upbeat note.
SJOG run Wellness Courses, and Mindfulness Based Stress Relief Courses throughout the year. For more details see their website www.stjohnofgodhospital.ie
If you wish to view these lectures, you can do so online at https://www.stjohnofgodhospital.ie/news/240-public-lecture-series-may-2018

Page 16: Dr. Amy Watchorn. Photo: Eoin Meegan.

This page: Control your time on devices; get out in nature, connect with people and activities.
Picture: Google Images.