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    "There is nothing like returning to a place that remains unchanged to find the ways in which you yourself have altered."
    Nelson Mandela, posted by Daniel

HA

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My long day?s journey into light
Psychiatrist Cathy Wield tells Penny Wark how she recovered after years of drug-resistant mental illness

Cathy Wield can still see the brown and gaudy curtains that surrounded her bed when she was a psychiatric patient in Southampton. ?I remember the pattern because I used to trace it and retrace it. I desperately wanted a window and I was so miserable when I could look only at the curtains.?

Wield does not go as far as saying that the grim hospital environments in which she has spent five years contributed to the severity of her illness. But she does believe that living in a rundown and sometimes grubby ward shared with aggressive patients, and being looked after by overworked and undertrained nursing staff, did nothing to help her recover.

This week a report in The Lancet made the same point: many wards are at best untherapeutic and at worst unsafe, it said. The power of Wield?s story lies in her dual perspective: she is a doctor, and most recently worked as a psychiatrist. Last year she wrote Life After Darkness, a powerful and illuminating account of the seven years she was treated for chronic treatment-resistant depression in Southampton and, for a short period, in Dundee. The NHS psychiatric service is chronically underfunded, she maintained, citing a lack of training of nurses, their lack of time for patients, and the need for a modern, clean and comfortable environment that gives patients privacy.

But 13 years after she first became ill she finds that little has changed. When a relapse took her back to hospital in Dundee recently she received excellent medical care, but still found herself in an unhygienic environment where patients? needs were often ignored.

?The funding issue is central and there is still a chronic shortage of trained nurses. Our food was cooked in Manchester, chilled, driven to Dundee. Crazy. Hygiene was poor because the cleaners kept cloths for washbasins in the same bucket as a toilet brush. They wore rubber gloves, which they kept on when they used door handles, so basic rules of hygiene were not being observed. Nursing staff wouldn?t take any responsibility because the cleaning was contracted out and, surprise, surprise, we all got tummy bugs.?

She also cites noisy night staff, the difficulty of complaining as a patient in case it affects your care, and the 11 queues she had to join each day for medication and food. Most of the care was done by untrained staff.

?Nursing assistants were accessible but they?re not trained to talk to you,? she says. ?I think that?s wrong ? you need nursing staff and they were often busy doing notes. If someone came in with pain to a surgical ward they?d be given painkillers. In a mental hospital you?re in terrible pain and you?re not given any relief. The major painkiller is someone listening to you and you feeling understood.?

Reading her account, and the details of the many occasions when she tried to kill herself, you understand that this was a woman who felt lost, lonely and worthless, her depression fuelled further by the guilt that she felt at being apart from her husband and their four children. So it is heartening to meet a calm, gentle and dignified woman of 47 who says at once that her experience of being a patient has shaped her attitudes as a doctor.

?When I first worked as a doctor and people would come in with overdoses, or who had self-harmed, my attitude was like most of the staff: these people are just doing it to attract attention and if you were nasty to them they wouldn?t do it again. These attitudes are unhelpful. I discovered myself that anyone who harms him or herself has low self-esteem. If you make their esteem even lower by being nasty to them they?re more likely to do it again. In any case, in a caring profession you should never get away with being judgmental and having negative attitudes towards people.

?I suspect that if anything could have changed my behaviour it would have been the staff, by doing the complete opposite of what they did, certainly on one of the wards. When I cut myself it was, ?Not again, well I suppose we?ve got to go to A&E?. I was sometimes sewn up without local anaesthetic, or with not enough. I put up with it because it was my own fault. If people had been nice, it wouldn?t have made me do it more because I wasn?t into that sort of attention. I never turned over the tables or shouted or screamed or attacked people. I was passive.?

Wield has been treated with 13 classes of drugs and more than 100 bouts of ECT, some of which saved her life, she says. She has also had regular psychotherapy that, she believes, has given her the opportunity to be listened to by a sympathetic doctor. In September 2001 she had a bilateral anterior cingulotomy, a procedure in which a heated probe is inserted into the anterior cingulor, a processing area in the brain, destroying a tiny amount of tissue. This is thought to interrupt the pathways responsible for some types of depression. Not all patients benefit but, without precedent, Wield?s depression lifted eight days later and during her recent stay in hospital her condition did respond to treatment, an improvement she attributes to the surgery. She was also prescribed exercise, a regime she continues. She plans to return to work part-time asa psychiatrist.

?Experiencing what it?s like to suffer with a serious mental illness gives me more than just compassion,? she says. ?I?m able to be in touch, I think I?m able to get to the heart of the problem with relative ease and I?m not embarrassed by what?s happened so I have no reason to be embarrassed by what I hear.?
 

Daniel

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Wield has been treated with 13 classes of drugs and more than 100 bouts of ECT, some of which saved her life, she says. She has also had regular psychotherapy that, she believes, has given her the opportunity to be listened to by a sympathetic doctor. In September 2001 she had a bilateral anterior cingulotomy, a procedure in which a heated probe is inserted into the anterior cingulor, a processing area in the brain, destroying a tiny amount of tissue. This is thought to interrupt the pathways responsible for some types of depression. Not all patients benefit but, without precedent, Wield’s depression lifted eight days later and during her recent stay in hospital her condition did respond to treatment, an improvement she attributes to the surgery. She was also prescribed exercise, a regime she continues.

Since this article doesn't mention therapy, I get the impression this patient seemed to favor neurosurgery to therapy, lifestyle changes, exercise, etc. I also find it unfortunate though understandable that it seems she starts trying to use exercise as a treatment only near the end of the long road of psychiatric treatments, apparently only after the cingulatomy rather than before it. It reminds me of an episode of the TV show "House M.D." where the doctor combats his sadness by illegally attempting to get a controversial neurosurgical implant rather than trying to make friends. Granted, treatment-resistant depression is extremely difficult to deal with, but I wonder if she really tried everything, especially CBT.

Anyway, as the article states, getting a cingulotomy (a couple centimeters of brain tissue removed) is rarely a good idea.
 
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HA

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I'm not sure of the time frames of her depression treatment but one paragraph suggests that it was 13 yrs until a recent relapse and 13yrs ago there was little if any research that showed exercise as being a therapeutic treatment.

I never even paid attention to the surgery part, I thought she had some brain stimulation. I focused more on the fact that they need more modern hospitals with more privacy and standards of care equivalent to physical illnesses.

During my mother's recent heart surgery, I continually compared the treatment and facilities to mental health. Our family had access to a beautiful new psychiatric hospital and it does make a difference. There are still too many very old psychiatric hospital buildings around.

I would like to read her book.
 

David Baxter

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how she recovered after years of drug-resistant mental illness

I think you also have to note the phrase "drug-resistant" here too.

In general, depression that does not respond to medication at all tends to be a deeper and more chronic depression.

Her experience would have been especially true prior to the "explosion" in pharmaceuticals which brought us a wider range of medications to treat depression.
 

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