Monday, 30 January 2017

ethnographic study #GroundedTheory get involved! entering into it #HenriBergson

Grounded Theory in Ethnography and Intensive Interviewing pages 21-26, Kathy Charmaz 2006; evening study, 29 January 2017.

"To exist is to change, to change is to mature, to mature is to go on creating oneself endlessly." Henri Bergson


Time and Free Will: An essay on the Immediate Data of Consciousness; Henri Bergson Feb1888

Mind-Energy, lectures and essays; Henri Bergson, 1920

Friday, 27 January 2017

resuming #StayingWellAfterPsychosis Ch7 Paranoia; maintaining strength & resilience

QTime 26Jan17
Getting back to Staying Well After Psychosis book after a bit of a hiatus.  

Question Time on BBC One and talk of Brexit, Trump and Scottish Independence via Angus Robertson MP.

Thursday, 26 January 2017

rejecting diagnosis #HistoryBeyondTrauma the breaking point; aloneness

p131 footnote History Beyond Trauma

History Beyond Trauma: Footnote p131.12: "After 100 days of continuous combat, it appears that almost everyone becomes a casualty ... It has been recognised that there is a finite quantity of courage and bravery" (Kentsmith 1986, p93)

Eddi Reader - Ae Fond Kiss

Sunday, 22 January 2017

pons asinorum: donkey bridge; facing the Real Other #HistoryBeyondTrauma

from New World Encyclopedia
back cover

Bus to Glenrothes for shopping, reading History Beyond Trauma, there and back, following on from First Crisis, Nth Crisis; (helper reduced to) A Minor Character, 20 January 2017, on bus to Dundee.

From readings today and Friday, what struck me again were the feelings of homecoming regarding the psychoanalytic engagement, working with mad people, in psychosis.  It makes sense.

people without capacity don't require advocacy: said psychiatrist Stratheden IPCU 9Feb12

Stratheden Hospital blog started July 2012
or words to that effect, from Dr Bill Dickson, Consultant Forensic Psychiatrist, RMO, Stratheden Hospital IPCU, at the first meeting I had with him over a week after my son was transferred in his underpants and bare feet, broken hand and bruising, from Lomond Ward, Stratheden, by porters in a minibus.  I witnessed this from car park at approximately 4pm.  Didn't know about the broken hand or Midazolam injection.  Or that he had been assaulted by a nurse prior to face-down restraint.

I also didn't know about the locked seclusion room, no toilet, no water, in the dark, for hours on end, unobserved.  Yet I'd been engaging with Stratheden Hospital since 1995 when my first son was an inpatient of Lomond Ward, had a critical incident with ECT.  Then was an inpatient myself in Lomond, 2002.  

The locked seclusion room in Ward 4/IPCU.  Naughty step.  Dirty secret.

I set Dr Dickson straight about the need for advocacy for mental patients, particularly those deemed to be "without capacity" and proceeded to advocate for my son whenever he asked me to.  At clinical meetings headed up by Dickson in the IPCU.  On one occasion Dickson lost the head after my son sat on his chair, had his jacket on back of it.  Dickson said to my son: did you not notice my jacket?  Of course he did.  That's why he sat on the doctor's chair.

Dr Dickson retired end of March 2012 then got supply work at Carseview Dundee psychiatric unit.  
front page Scottish Sunday Express 5Oct14
Psychiatric Patient's Treatment Slammed; Express Sunday 5Oct14

back door IPCU/Ward 4 2012, where I had to enter ward, other folk got in front door

19 July 2012 Courier article

photo taken by me Jul12 Stratheden grounds
cigarette ends left by Stratheden staff on pavement outside back of IPCU 2012

Friday, 20 January 2017

#HistoryBeyondTrauma First Crisis, Nth Crisis; (helper reduced to) A Minor Character

"Gilda was looking for someone who could sustain the shock of her experience" p169 

"It is better to conceive of all crises of madness as beginnings" p168

"The crises of the patient, which are always the first crises, are answered by the analyst's critical moments, which are, each time, initial moments." p172 

"Interpretations by themselves do not determine meaning" Wittengenstein, footnote 8. p170

Monday, 9 January 2017

Psychological approaches to understanding & promoting recovery in psychosis and bipolar disorder

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Southampton (UK): NIHR Journals Library;



Recovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.


To facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.


There were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.


Measurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total; p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78; p < 0.006).


This research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.


The National Institute for Health Research Programme Grants for Applied Research programme.  

Plain English summary

Psychosis (including disorders such as schizophrenia, which are characterised by hearing voices or paranoid beliefs) and bipolar disorder (BD) (characterised by mood swings) are common forms of serious mental health problems. Clinical services typically define recovery in terms of absence of symptoms. In contrast, service users conceptualise recovery as a unique process rather an end point, with key themes including hope, rebuilding self and rebuilding life. Our research aimed to understand and promote recovery in psychosis and BD, in a manner that is acceptable to and empowering of service users. Six linked projects were conducted using a variety of methods to develop new ways of measuring recovery; to understand what recovery means to service users and what factors promote recovery; to understand how recovery, symptoms and psychological well-being are related; to examine what sort of factors predict recovery; and to test three new interventions. All projects were conducted in collaboration with service users and the research team included two service user researchers. Our research has made significant additions to our understanding and promotion of recovery, including the development of two new measures which were shown to be valid and acceptable to service users. We have shown that we can measure recovery, that factors such as reduced negative emotions, increased self-esteem and hope are predictive of recovery judgements and that the new interventions tested showed promising benefits to people with psychosis and suicidal thinking and people with BD. These findings have important implications for future research and for clinical practice.