Category Archives: Health and Wellbeing

A relational vision of human distress

Dr. Joe Hinds, Senior Lecturer at CCCU and practising integrative psychotherapist, discusses the distinction between mental illness and eccentricities, and the appropriateness of mental disorder diagnoses on atypical behaviours.

In 1961 the psychiatrist Thomas Szasz suggested that the concept of mental illness as conceived by the medical profession was vague and unsatisfactory, comparing the assessment of mental disorders with astrology. Indeed, determining the sane from the insane has never been straightforward (Rosenhan, 1973).

Munch’s “The Scream”

Now as then, there is a reliance on prescribed pharmaceuticals to medicate and ‘cure’ people who display out of the ordinary behaviours and beliefs. Where psychiatry once governed, contemporary approaches largely based on psychological rather than psychotherapeutic understandings reinforce the pathologising of experiences. For instance, according to interpretation of the diagnostic criteria of DSM (Diagnostic and Statistical Manual of Mental Disorders), where there was once shyness there is now social anxiety, high-spirited children now have ADHD and where we might observe people with strident differences of opinion we now see them labelled as having conduct disorder. Alongside some appeals against the overtly positive culture in which we are encouraged to participate (“Smile or die” – Ehrenreich, 2009), others have suggested that by strict adherence to the criteria of determining disorders in the DSM (and elsewhere) the concept of happiness is worthy of inclusion as a disorder also.

As a relational psychotherapist, I embrace the simple but important and sometimes difficult arts of listening, empathy, consistency, stillness, and being me in an intimate and emotional therapeutic encounter with another. Interpersonal dynamics, particularly in early life, have much to contribute towards our adult functioning and therefore the role of therapy is to provide a safe and understanding relational space in order to re-address these dynamics. The therapy described here is about demonstrating a genuine humanness and not to hide behind the implementation of techniques or assessment. Why would the person in therapy “Expose their tender under belly if the therapist plays coy and self-protective?” (Whitaker, 1976, p. 329).

In attending to people’s life stories I have found many who have been labelled as having or being something such as borderline personality disorder, bipolar, psychosis, and many others. Whilst undoubtedly these people on occasion may behave in ways that are non-conformist and disconcerting, these behaviours are often the coping strategies (‘symptoms’) of chaotic and often abusive or traumatic life experiences and I am not convinced that categorisation is a necessary nor helpful practice. I have not been tempted to formally evaluate people along any parameter of mental functioning – it is understanding that is needed here not the assessment and removal of symptoms.

“Every human being is born a prince or princess; early experiences convince some that they are frogs, and the rest of the pathological development follows from this” (Berne, 1966, pp. 289-290).

Moreover, the social and cultural conditions of living are increasingly competitive, time pressured, intense, confusing, and, when added to personal experiences of trauma or neglect, may result in increased instances of psychological distress (e.g., 2014 had the highest number [130] of UK adult student suicides: Office for National Statistics). Often the conditions of living are the cause of distress: the ‘problem’ does not necessarily reside within or as part of the individual. In the words of R. D. Laing, the celebrated radical psychiatrist, “Insanity is a perfectly rational adjustment to an insane world”.

Dali’s “The Temptation of Saint Anthony”

Salvador Dali

The difference between being mad and eccentric, and the acceptance of these in society, is often determined by degree of wealth or success: exemplified by creative genius – see Dali and his The Temptation of Saint Anthony above. The very needy or distressed are not seen as such because of their position in society or their acceptance by favourable sections of the population. Paranoia, narcissism and rigid dichotomous thinking (as indicators or symptoms of distress) displayed by elected world leaders, for instance, would attract the attention of health care professionals under very different circumstances.

Yet these characteristics may also be becoming more prevalent in various societies. Democratically elected leaders are after all voted in by sizable minorities who may recognise, applaud and share those characteristics. In addition, our own habitual practices when set against other cultural standards may not seem to be altogether beneficial or rational including the derogatory categorisation of people according to their level of social conformity. The DSM only completely removed the category of homosexuality (“Sexual Orientation Disturbance”) from the list of disorders in 1987. Therefore it becomes increasingly difficult to separate the so called ‘mentally ill’ from the so called ‘mentally well’.

Key References

Szasz, T. (2011). The myth of mental illness: 50 years later. The Psychiatrist, 35, 179-182.
Whitaker, C. (1976).The hindrance of theory in clinical work. In, P. J. Guerin (Ed.) Family therapy: Theory and practice (pp. 317-329). New York: Gardener Press.
Laing, R. D. (1965). The divided self. Harmondsworth, Middlesex: Pelican Books.
Berne E. (1966). Principles of group treatment. New York: Oxford University Press
Rosenhan D. L. et al (1973). On Being Sane in Insane Places. Science, 179, 250-258
Ehrenreich, B. (2010). Smile or Die: How Positive Thinking Fooled America and the World. London: Granta

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Animal rescues in the spotlight

Dr. Anke Franz, Senior Lecturer at CCCU discusses the regulations, or lack thereof, effecting the wellbeing of animals under the care of animal rescues and sanctuaries.

Before Christmas, BBC’s week in week out programme aired an investigation into an animal rescue in Wales, raising issues around standards and license requirements for animal rescues. “Sanctuaries […] aren’t regulated. Boarding kennels […] need a license because they are governed by the animal welfare act, so too are breeders and come to mention it circuses. As for sanctuaries, well the act doesn’t cover them, so they don’t need a license”. This isn’t a problem if they function well, and many local rescues do excellent work. However, if they don’t, there are limited powers to close them down or prosecute.

So how can we know that the local rescue that we donate money to or where we got our dog/cat/rabbit from, is a good rescue?

A good place to start is the Code of Practice written by the Association of Dogs and Cats Homes (ADCH) to be adhered to by its members.

However, are all necessary standards covered in the ADCH Code of Practice? If not, what standards should rescues adhere to? And who will benefit from inclusion or exclusion of certain standards?

Ana Fernandez, Liz Spruin, Nicole Holt and I have been working with several small independent animal rescues across Kent. As part of this work, we asked them what rescue standards animal rescues should adhere to, which of these are basic standards and which of these are Gold standards – standards rescues should strive towards beyond the basic ones.

The basic standards were:

  1. Rescues have to thoroughly assess all animals that they take on
  2. Rescues have to provide necessary vet care, including neutering/ spaying and micro-chipping
  3. Rescues have to hold a valid insurance, including 3rd party insurance
  4. Rescues have to provide a safe and suitable place to keep the animal, either in a kennel or in a foster environment
  5. Rescues have to complete home checks for all foster and adoption placements
  6. Rescues have to follow up on adoptions, ideally through follow-up visits
  7. Rescues have to offer guaranteed Rescue Back-Up for the duration of the dog’s life (this means that the dog will be taken back by the rescue at any time if the dog cannot be kept by the owner for any reason)
  8. All foster and adoption agreements have to be subject to a contract
  9. At all times, rescues have to be professional and approachable and recognize potential lack of knowledge in fosters and adopters and ensure adequate information and training is provided

The gold standards were:

  1. Rescues should provide ongoing mentoring and behavioural training and interventions to fosters and adopters
  2. Rescues should provide general advice on owning a dog, including costs and nutrition
  3. Rescues should ensure that adequate information regarding potential adopters has been received
  4. Rescues should set up a registry of unsuitable dog owners
  5. Wherever possible, rescues should provide financial and other assistance to struggling dog owners as well as adopters to ensure animals can stay within suitable home environments
  6. Rescues have to provide a high quality of life for all animals in their care, particularly for long-term or permanent residents
  7. Rescues should be transparent about their destruction policies
  8. Forums for social and long-term contact with adopters should be available and fostered.

One topic we discussed at length was euthanasia. Our partner rescues felt transparency regarding destruction policies would be useful. It would allow everybody to know where problem dogs could go without the risk of euthanasia. However, some of our partner rescues had witnessed serious backlash from other rescues regarding decisions that they had been forced to take leading to a reluctance to engage openly with this issue. This was also raised by the ADCH guidance which falls short of requiring rescue organisations to be transparent about their euthanasia policies. Yet, greater openness about realities such as these are vital for arriving at workable standards and regulations.

Generally, there is a lot of overlap between the ADCH Code of Practice and the rescue standards that our partner rescues developed, however, there are some key differences.

Our partner rescues, usually smaller rescues, often run completely by volunteers and frequently relying on foster homes, focused on procedures targeted at increasing success in adoptions, such as conducting home visits for all potential dogs, with dogs often only being rehomed within small geographical areas. In the ADCH guidance home visits are seen as useful but not essential. For many larger dog rescue centres that, for example, take in stray dogs for the council, the reality of euthanising dogs for a variety of reasons is very tangible. This was highlighted by the Sun newspaper in January 2016, when it revealed the numerous dogs being euthanised by large animal rescue organisations such as Battersea, Blue Cross and the RSPCA https://www.thesun.co.uk/archives/news/74549/sun-investigation-we-expose-charities-killing-1000s-of-healthy-dogs-for-growling-too-much/. Rehoming dogs to people living further afield and even on occasion in a different country can equate to having to destroy one dog less, even though the chance of the adoption being successful is decreased.

In addition, the responsibility of a rescue to take back animals at any time when things don’t work out was non-negotiable for our partner rescues while the ADCH strongly encouraged this, but did not enforce it.

If regulations were to be introduced, it should certainly be done in a way that does not penalise good rescues, small or large, and that takes account of the diverse workings of different rescues. While larger, more structured rescues could help smaller rescues to put in place legal structures and auditing procedures, small rescues and sanctuaries can often offer a lifeline to animals that larger rescues might not be able to work with due to problem behaviour, including aggression. They also often have well-functioning informal networks helping them find expert rescue and sanctuary places for difficult or specialised animals needing a second chance.

There are plenty of excellent rescues of all shapes and sizes, including many small local ones, and it is important that they are able to continue their work, especially in an environment where the sheer number of animals requiring rescue places means that rescues have to refuse many more animals than they can help.

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Comfort Dogs and the Spiritual Experience

Nicole Holt, research assistant to Dr. Liz Spruin, has been exploring the use of dogs for rehabilitation and wellbeing, and the benefits that ‘comfort dogs’ can provide

In America, a new role for dogs has been created called “comfort dogs”. These dogs and their handlers regularly go out into the community and interact with people at churches, schools, nursing homes, hospitals, and various social events throughout the community. The label “comfort dog” was suggested by the Lutheran Church Charities organization in Northbrook, Illinois, going on to write that ‘[comfort dogs] share the mercy and compassion of Jesus Christ with…people’.

While compassionate engagement with the community is commendable, some have argued that this work focuses on vulnerable individuals, particularly when the same individuals might be asked for financial donations. There is a wider issue about the safety and welfare of the dogs involved, but so far no substantiated reports of (mis)treatment have emerged.

However, though it is important to note criticisms of the scheme, we should also consider some of the benefits. For instance, these dogs are also used all around the United States to help people in disaster response situations. One also has to applaud the creative use of such animals, as dogs can be a calming influence on individuals who are in need of comfort. It might also be the case that the dogs are able to gain comfort for the people whom they are helping, leading to a mutual benefit.

Moreover, there have been several case studies, alongside anecdotal evidence, demonstrating that engaging with dogs can help reduce stress and anxiety (Holder, 2013; O’Neill-Stephens, 2011; Wells, 2009). Also, many people, for one reason or another, are not in a situation that allows them to own dogs or simply interact with animals. So, just for a few hours, people can have the benefit of connecting with dogs, which contributes to health and well-being, helping people feel connected with a creature who makes no judgement. As long as a religious organisation is subtle rather than forceful in presenting their own beliefs, and are keeping compassion at the centre of their interactions, then it is easy to see the positives in this initiative.

As we rapidly push forward implementing using dogs in the courtroom, ‘comfort dogs’ provide food for thought about the many roles which dogs can potentially play in society.

To find out more about comfort dogs please follow this link to their website: Immanuel Lutheran Ministries

References

Holder, C. (2013) ‘All Dogs Go To Court: the Impact of Court Facility Dogs as Comfort for Child Witnesses on a Defendant’s Right to a Fair Trial’ Hous. L. Rev., 50, pp.1155.

O’Neill-Stephens, E. (2011) ‘Courthouse Facility Dogs.’ [Online] Available at: http://www.courthousedogs.com/starting_news.html (Accessed 14th Septemeber 2016)

Wells, D. (2009) ‘The effects of animals on human health and well‐being.’ Journal of social issues, 65(3), 523-543.

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