Freudian Script Fortnight 10/04/17

What’s the buzz on mental health for the past two weeks? Let’s find out!


“The Trauma of Facing Deportation” (The New Yorker)


Photograph by Magnus Wennman for The New Yorker

Sixty children in Sweden entered a coma-like state last year and no one knows why! Except we have a pretty good idea why – they are refugees and their families were denied asylum.

This is a classic example of “medicine” v psychiatry, particularly neurology v psychiatry. Perhaps more than other specialities, neurologists love tests. They are infamous in the medical world for ordering 101 tests – and shrugging their shoulders when they all come back negative.

So, when professionals say this condition cannot be explained – and neither can the “cure” of granting asylum – they mean the tests don’t fit or are inconclusive.

Psychiatrists are used to working in this zone of uncertainty. Most conditions we manage do not have easy tests or narrowly-defined definitions. When I describe things like non-epileptic attack disorder (seizures that are not epilepsy) to people, I tell them that this might be their brain’s method of telling them to remove themselves from a stressful situation and that we have to convince their body it’s safe to function again.

Neurologists tend to favour a model where they simply haven’t found the right test yet and “you’re not crazy!”. One of the most well-known support sites for functional neurological disorders goes out of its way to tell people that their physical health is not linked to their mental health.

In fifty years, I anticipate we’ll understand more about the brain workings behind mental health conditions, but I doubt that will mean the end of talking therapy and socially-focused solutions like granting asylum.

(And can we just take a moment to appreciate the beauty of “trygghet”? A word that should be in every therapist’s vocabulary to describe that particular feeling of trust, belonging and security.)


The above tweet is the beginning of an excellent thread by Zoe Stavri on ketamine and depression. It uses a “big picture” view of why individual trial results may look great until the wider implications are considered. In this case, it’s that ketamine requires intravenous administration to be effective for depression. In the case of cannabis for sleep, for example, the problem is the risk of psychosis. With St John’s Wort and depression, the main difficulties are its interactions with dozens of other medications, including the oral contraceptive pill.

Showing that something works is the easy part. Showing that it’s viable in a wider reality is where it gets tough.


The World Health Organisation tweeted a series of infographics related to depression, after its stunning but sadly unsurprising revelation that depression now has the highest global disease burden.

The one regarding economic benefits of treating depression was perhaps the most controversial, as critics felt it reduced people to their work-potential and did not capture their life-potential or acknowledge that returning to work might be detrimental to mental health.

In motivational interviewing, one of the key techniques is using affirmations. Unlike a compliment, which conveys the receiver’s worth using the giver’s value system, an affirmation is praising a person using something they value. For example, a man who values his role as a father might appreciate being told “you really put your children first this week”, whereas someone who prizes meeting targets might embrace “you are really dedicated to your gym time”.

I feel affirmations have an important role in politics. They are ultimately tools of persuasion and that is why they have such a powerful effect in therapy for addictions. If a Tory government values productivity and a healthy economy over piffling little things like the wellbeing of the populace, lines of persuasion need to speak to productivity and economy.

Which is why this statistic is useful when trying to secure increased funding for the treatment of depression and other mental health conditions. And if, as a byproduct, we get health, wealth and happiness, all to the good.

Leave a Reply

Your email address will not be published. Required fields are marked *