Andrew Marshall

An Overview of South London and Maudsley NHS Foundation Trust

Published on 02/22/202302/22/2023 by Andrew MarshallLeave a comment

Introduction

South London and Maudsley NHS Foundation Trust (also known as SLaM), is an NHS foundation trust based in London, England, which specialises in mental health. It comprises:

Three psychiatric hospitals:
The Ladywell Unit Unit based at University Hospital Lewisham.
Over 100 community sites and 300 clinical teams.

SLaM forms part of the institutions that make up King’s Health Partners, an academic health science centre. In its most recent inspection of the Trust, the CQC gave SLaM a ‘good’ rating overall, but a ‘requires improvement’ rating in area of safety. In 2019, Southwark Coroner’s Court ruled that SLaM was guilty of “neglect and serious failures” in relation to the death of a patient in 2018. In 2020, a further investigation into the Trust’s conduct was opened following the death of a patient in its care.

Overview

Each year the South London and Maudsley NHS Foundation Trust provides about 5,000 people with hospital treatment and about 40,000 people with community services. In partnership with King’s College London, the Trust has major research activities. This academic partnership enables the Trust to develop new treatments and to provide specialist services to people from across the UK such as the National Psychosis Unit at Bethlem Royal Hospital. The Trust forms part of the King’s Health Partners academic health science centre and together with the Institute of Psychiatry, Psychology and Neuroscience at King’s College London and University College London is host to the UK’s only specialist National Institute for Health Research Biomedical Research Centre for mental health. In 2009/10 the Trust had a turnover of £370 million.

The Trust’s work on promoting mental health and well-being, developed in partnership with the new economics foundation, has featured in the national media.

It was named by the Health Service Journal as one of the top hundred NHS trusts to work for in 2015. At that time it had 4218 full-time equivalent staff and a sickness absence rate of 3.74%. 58% of staff recommend it as a place for treatment and 59% recommended it as a place to work.

As of 2018, the trust employed 5,328 staff.

Select Chronology

The following are some important historical dates:

The Priory of St Mary of Bethlehem, Bishopsgate, was founded on land given by Alderman Simon Fitzmary. It later became a place of refuge for the sick and infirm. The names ‘Bethlem’ and ‘Bedlam’, by which it came to be known, are early variants of ‘Bethlehem’. It is first referred to as a hospital for ‘insane’ patients in 1403, after which it has a continuous history of caring for people with mental distress.
In 1867, the Southern Districts Hospital (or Stockwell Fever Hospital as it became known) opened on the site which is today known as Lambeth Hospital.
Henry Maudsley wrote to the London County Council offering to contribute £30k towards the costs of establishing a “fitly equipped hospital for mental diseases.” The Maudsley initially opened as a military hospital in 1915 to treat cases of shell shock and became a psychiatric hospital for the people of London in 1923.
Bethlem Royal Hospital moved to a new site at Monks Orchard, where it has been situated to this day.
With the introduction of the National Health Service in 1948, the Bethlem Royal Hospital and Maudsley Hospital were merged to form a postgraduate psychiatric teaching hospital. The Maudsley’s medical school became the Institute of Psychiatry.
Sister Lena Peat and Reginald Bowen became the first community psychiatric nurses, following up patients at home who had been discharged from Warlingham Park Hospital in Croydon.
The Ladywell Unit, located at University Hospital Lewisham, was refurbished for use by adult inpatient mental health services. The development brought together inpatient services which had previously been spread across other hospital sites (Hither Green, Guy’s and Bexley).
South London and Maudsley NHS Trust was formed – providing mental health and substance misuse services across Croydon, Lambeth, Lewisham and Southwark; substance misuse services in Bexley Greenwich and Bromley; and national specialist services for people from across the UK.
South London and Maudsley became the 50th NHS Foundation Trust in the UK under the Health and Social Care [Community Health and Standards] Act 2003.
2007 The Maudsley Hospital closed its 24-hour emergency mental health clinic, amidst protest from patient groups and politicians who continued campaigning for several years for a promised replacement at nearby KCL Hospital.
South London and Maudsley is part of one of the five Academic Health Sciences Centres (AHSCs) in the UK to be accredited by the Department of Health. King’s Health Partners AHSC consists of SLaM, King’s College London, and Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts.
South London and Maudsley is fined by the Parliamentary and Health Service Ombudsman for its failure to properly assess mental capacity.

Governance

The Chief Executive appointed in 2013 is Matthew Patrick, a psychiatrist with a background in psychoanalysis who was formerly head of the Tavistock and Portman NHS Foundation Trust.

Former Member of Parliament Sir Norman Lamb was appointed chair of the trust in December 2019.

Services

The Trust provides a wide range of mental health and substance misuse services. The Trust provides care and treatment for a local population of 1.3 million people in south London, as well as specialist services for people from across the country. The Trust provides mental health services for people of all ages from over 100 community sites in south London, three psychiatric hospitals (the Bethlem Royal Hospital, Lambeth Hospital and the Maudsley Hospital) and specialist units based at other hospitals.

In March 2016 it established a joint venture with the Macani Medical Centre in Abu Dhabi to provide child and adolescent services with specialisms in autism, Obsessive Compulsive Disorder and eating disorders. Maudsley International also signed an agreement with the Ministry of Public Health in Qatar for expert advice to help advance Qatar’s national mental health strategy.

It established a joint venture limited liability partnership with Northumbria Healthcare Facilities Management, run by Northumbria Healthcare NHS Foundation Trust in 2019. This will run its private and international work, develop its capital assets and employ its facilities staff. It will initially employ 192 existing staff. It plans rapid growth in the United Arab Emirates (UAE) and China.

Performance

255 patients were injured in 2016-17 through use of restraints on psychiatric patients in South London and Maudsley NHS Foundation Trust. This was the third largest number in England, There were more injuries in Southern Health NHS Foundation Trust and Mersey Care NHS Foundation Trust. Critics say restraints are potentially traumatic even life threatening for patients.

Research

The Trust’s research activities take place in close partnership with the Institute of Psychiatry, King’s College London and University College London. In the 2008 Research Assessment Exercise the Institute was judged to have the highest research power of any UK institution within the areas of psychiatry, neuroscience and clinical psychology.

Biomedical Research Centre

The Trust manages the NIHR Maudsley Biomedical Research Centre, the UK’s only Specialist Mental Health Biomedical Research Centre, in partnership with the Institute of Psychiatry at King’s College London. The Centre, which is based on the Maudsley Hospital campus, is funded by the National Institute for Health and Care Research (NIHR). Its aim is to speed up the pace that latest medical research findings are turned into improved clinical care and services.

The team at the Centre are working towards ‘personalised medicine’ – developing treatments based on individual need. The aim is to diagnose illness more effectively and much earlier, assess which treatments will work best for an individual and then tailor the care they receive accordingly.

The BRC’s development of an advanced computer programme to accurately detect the early signs of Alzheimer’s disease from a routine clinical brain scan was reported in the media in 2011. The ‘Automated MRI’ software automatically compares or benchmarks someone’s brain scan image against 1200 others, each showing varying stages of Alzheimer’s disease. Another study has concerned the reduced life expectancies of people diagnosed with different mental illnesses.

In 2011 the Department of Health announced that the Trust and the Institute of Psychiatry, King’s College London would receive a further £48.8m to continue running the Biomedical Research Centre for Mental Health for a further five years from 01 April 2012. An additional £4.5m was awarded to the Trust to launch for a new NIHR Biomedical Research Unit for Dementia.

King’s Health Partners

The Trust is a member of the King’s Health Partners academic health sciences centre, together with King’s College London, Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust.

In December 2013 it was announced that a proposed merger with Guy’s and St Thomas’ and King’s College Hospitals had been suspended because of doubts about the reaction of the Competition Commission.

National Addiction Centre

In partnership with the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, the Trust runs the National Addiction Centre (NAC), which aims to develop new treatment services for alcohol, smoking and drug problems. This work ranges from trials of new therapies and preventative treatments, to studies seeking to understand the genetic and biological basis of addictive behaviour. An example of research conducted is the Randomised Injecting Opioid Treatment Trial (RIOTT).

Media

The services provided by the Trust feature in a four-part observational television documentary to be broadcast on Channel Four in Autumn 2013. Produced by the makers of 24 Hours in A&E, Bedlam focuses on the work of the Anxiety Disorders Residential Unit at Bethlem Royal Hospital, the Triage ward at Lambeth Hospital, adult community mental health services in Lewisham and services for people over the age of 65.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/South_London_and_Maudsley_NHS_Foundation_Trust >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Claybury Hospital

Published on 02/21/2023 by Andrew MarshallLeave a comment

Introduction

Claybury Hospital was a psychiatric hospital in Woodford Bridge, London. It was built to a design by the English architect George Thomas Hine who was a prolific Victorian architect of hospital buildings. It was opened in 1893 making it the Fifth Middlesex County Asylum. Historic England identified the hospital as being “the most important asylum built in England after 1875”.

Since the closure of the hospital, the site was redeveloped as housing and a gymnasium under the name Repton Park. The hospital block, tower, and chapel, which is now a swimming complex, were designated as a Grade II listed building in 1990.

Brief History

The Project

The building of Claybury Hospital was commissioned by the Middlesex Court of Magistrates in 1887 and would eventually become the fifth Middlesex County Asylum. It was built to a design by the English architect George Thomas Hine who was a prolific, late-Victorian architect of mainly hospital buildings and asylums for the mentally insane. It was the first asylum to successfully use the echelon plan upon which all later asylums were based.

The site was situated on the brow of a hill and was surrounded by 50 acres (200,000 m²) of ancient woodland and 95 acres (380,000 m²) of open parkland, ponds, pasture and historic gardens. These had been designed in 1789 by the landscape architect Humphry Repton.

Early Years

In 1889 the uncompleted building passed to the newly created London County Council which opened it in 1893 as the Claybury Lunatic Asylum.

By 1896, the hospital had 2,500 patients. The first Medical Superintendent and directing genius was Robert Armstrong-Jones. By the first decade of the twentieth century, Claybury had become a major centre of psychiatric learning. It was internationally admired for its research, its pioneering work in introducing new forms of treatment and the high standard of care provided for the mentally ill. Armstrong-Jones was knighted in 1917 for his exceptional work at Claybury and his general service to psychiatry.

Armstrong-Jones held progressive views on community care, advocating in 1906 that city hospitals should have out-patient departments where patients could seek help for mental symptoms without loss of liberty. Each asylum should be a centre for clinical instruction where all medical practitioners could refresh their understanding of insanity. People showing early signs of insanity should be free to seek advice and if necessary be admitted on a voluntary basis and not have to wait until they became certifiable. The first voluntary patients could not admitted until 1930 when the Mental Treatment Act was passed.

In 1895, the London County Council appointed Frederick Mott as director for their new research laboratory at Claybury. Over the next 19 years he carried out vast research, documented in his Archives of Neurology and Psychiatry published between 1903 and 1922. He was knighted in 1919 and is particularly remembered for helping to establish that ‘general paralysis of the insane (GPI) was due to syphilis.

Helen Boyle was appointed as an Assistant Medical Officer in 1895, one of the first women to be employed as a doctor in an asylum. She became a pioneer of early treatment for the mentally ill and went on to found the Lady Chichester Hospital. In 1939 she became the first female president of the Royal Medico-Psychological Association (now the Royal College of Psychiatrists). In Pryor’s words: “The work of this ‘lady doctor’ formed part of the pale new dawn of community care for the mentally ill.”

The asylum was renamed Claybury Mental Hospital in 1930 and simplified to Claybury Hospital in 1959

A Patient Experience in the 1930s

The English artist, Thomas Hennell, published an account of his personal experience of schizophrenia in his book, The Witnesses, in 1938. Sectioned and detained at St John’s Hospital, Stone, Buckinghamshire in 1935, he was then moved to the Maudsley Hospital in London, and finally, to Claybury. He disliked his treatment at the first two, and satirised the Maudsley psychiatrists, but he enjoyed the humane therapy at Claybury (though there is a signed drawing by him in the Tate of staff stealing from a patient in Claybury). In the course of his illness he produced several pictures that depicted his mental state. Before leaving Claybury in 1938, the medical superintendent, Guy Barham, agreed to him painting a large mural covering three walls of the canteen. A photograph of this painting was rediscovered circa 2015. He became an official war artist during World War II.

Post-War Years

Claybury became part of the National Health Service in 1948. The introduction of new drugs, the phenothiazines in 1955 and 1956, and the anti-depressant drugs in 1959, dramatically altered the treatment of the major psychoses, reducing the severity and duration of many conditions and creating a setting where normalisation could flourish.

From the mid-1950s Claybury again attracted widespread attention as, led by consultants Denis Martin and John Pippard, it pioneered a controversial therapeutic community approach to an entire institution of over 2,700 people. In 1968, Martin described the development of Claybury’s therapeutic community in Adventure in Psychiatry. In 1972 a collection of essays by staff members and edited by Elizabeth Shoenberg were published under the title, A Hospital Looks at Itself:

The three pronged attack of therapeutic community techniques, use of new drugs and minimal use of the physical treatments, led to a reduction of the patient population from 2,332 in 1950 to 1,537 in 1970. However, lack of community care resulted in the ‘revolving door syndrome’ with over half admissions being re-admissions.

From the late 1940s it became increasingly difficult to recruit student nurses and other support staff from the UK. Many, with little English, were recruited from Europe and given English language tuition. In 1962, Enoch Powell, then Minister of Health, proposed that hospitals should seek recruits from the West Indies and Pakistan. By 1968 there were 47 nationalities represented at Claybury with different ethnic, religious and linguistic backgrounds, all part of the therapeutic community diversity.

Developments in Community Care

Enoch Powell had predicted in 1961 that all psychiatric hospitals would be closed within 15 years. In reality, the first, Banstead, closed in 1986. In 1983 the North East Thames Regional Health Authority (NETRHA) committed itself to a 10-year plan for the re-provision of care currently provided by Friern and Claybury hospitals. The number of patients on Claybury’s statuary books at the year end in 1980 was 1,057 and in 1990 was 429.

For some long-stay patients, thoroughly institutionalised, Claybury had been both home and local village for decades, in some cases for over 40 years. The challenge to manage their rehabilitation in a new environment, that they had never experienced and might well treat them with suspicion, was immense. In 1988 the Health and Social Services Research Unit at South Bank Polytechnic published a research paper detailing the post-discharge experience of a group of former long-stay Claybury patients.

Closure

To mark its centenary in 1993, the Forest Healthcare Trust published a comprehensive and well documented history of the hospital entitled, Claybury, A Century of Caring, written by Eric Pryor who had been a member of the nursing staff since 1948.

With the Care in the Community Programme and the planned decline in patient numbers, the Claybury site faced a difficult future. The NHS pressed for extensive demolition and maximum new build, whereas the Local Planning Authority and English Heritage argued for maximum retention of the historic buildings and restriction of new build to the existing footprint, in accordance with the Green Belt allocation in the Unitary Development Plan. The hospital was closed in 1997.

Historic England identified the hospital as being “the most important asylum built in England after 1875… [it was] the first asylum to successfully use the echelon plan, upon which all later asylums were based.” The hospital block was designated as a Grade II listed building in 1990, as was the stable block, which is located to the north west of the main building.

Repton Park

After the hospital was shut down in 1997 it was converted into gated housing by Crest Nicholson (working closely with English Heritage and the London Wildlife Trust) and renamed Repton Park.

The hospital chapel was converted into a swimming pool and health centre for the use of Repton Park residents. Former residents of Repton Park include singers V V Brown and Simon Webbe and actress Patsy Palmer. Properties have also attracted professional footballers from Arsenal and Spurs.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Claybury_Hospital >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Cassel Hospital

Published on 02/21/2023 by Andrew Marshall1 Comment

Introduction

The Cassel Hospital is a psychiatric facility in a Grade II listed building at 1 Ham Common, Richmond, Ham in the London Borough of Richmond upon Thames. It is run by the West London NHS Trust.

Brief History

The Hospital

The hospital was founded and endowed by Ernest Cassel in England in 1919. It was initially for the treatment of “shell shock” victims (aka combat stress reaction). Originally at Swaylands in Penshurst, Kent, it moved to Stoke-on-Trent during the Second World War. In 1948 it relocated to its present site at No. 1 Ham Common, Ham.

The Building

The present hospital was originally a late 18th-century house known as Morgan House after its owner, philanthropist and writer, John Minter Morgan. Morgan died in 1854 and is buried in nearby St Andrew’s Church, Ham. In 1863 it became home to the newly married Duc de Chartres. In 1879 it became West Heath Girls’ School. The school moved to its present site in Sevenoaks, Kent in the 1930s, and the building became the Lawrence Hall Hotel until its purchase by the Cassel Foundation in 1947. The building was Grade II listed in 1950.

Facilities

The hospital developed approaches informed by psychoanalytic thinking alongside medicinal interventions, techniques of group and individual psychotherapy. It was here that Tom Main along with Doreen Wedell pioneered the concept of a therapeutic community in the late 1940s. Together they pioneered & developed the concept of psychosocial nursing. By promoting and being proud of the role of the nurse – rather than try to imitate therapists; working alongside the patient in everyday activities, Weddell & Main developed a whole new way of working that reduced dependence upon services and fostered patient’s working collaboratively. Nurses were supported and taught to understand their reparative need, to challenge their sense of omnipotence and to rely on the patient group as the most useful resource. In 1948 Eileen Skellern came for her training and joined the staff in 1949.

The hospital formally established a research department in 1995 and has collaborative relationships with University College London, Imperial College and the Centre for the Economics of Mental Health at the Institute of Psychiatry, London. It is now a psychotherapeutic community which provides day, residential, and outreach services for young people and adults with severe and enduring personality disorders.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Cassel_Hospital >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 21 February [2023]

Published on 02/21/202302/15/2023 by Andrew MarshallLeave a comment

Events

1971 – The Convention on Psychotropic Substances is signed at Vienna.

People (Births)

1892 – Harry Stack Sullivan, American psychiatrist and psychoanalyst (d. 1949)
1914 – Jean Tatlock, American psychiatrist and physician (d. 1944)
1961 – Elliot Hirshman, American psychologist and academic

Harry Stack Sullivan

Herbert “Harry” Stack Sullivan (21 February 1892 to 14 January 1949, Paris, France) was an American Neo-Freudian psychiatrist and psychoanalyst who held that “personality can never be isolated from the complex interpersonal relationships in which [a] person lives” and that “[t]he field of psychiatry is the field of interpersonal relations under any and all circumstances in which [such] relations exist”. Having studied therapists Sigmund Freud, Adolf Meyer, and William Alanson White, he devoted years of clinical and research work to helping people with psychotic illness.

Jean Tatlock

Jean Frances Tatlock (21 February 1914 to 04 January 1944) was an American psychiatrist and physician. She was a member of the Communist Party of the United States of America and was a reporter and writer for the party’s publication Western Worker. She is also known for her romantic relationship with J. Robert Oppenheimer, the director of the Manhattan Project’s Los Alamos Laboratory during World War II.

The daughter of John Strong Perry Tatlock, a prominent Old English philologist and an expert on Geoffrey Chaucer, Tatlock was a graduate of Vassar College and the Stanford Medical School, where she studied to become a psychiatrist. Tatlock began seeing Oppenheimer in 1936, when she was a graduate student at Stanford and Oppenheimer was a professor of physics at the University of California, Berkeley. As a result of their relationship and her membership of the Communist Party, she was placed under surveillance by the FBI and her phone was tapped.

She suffered from clinical depression and died by suicide on 04 January 1944.

Elliot Hirshman

Elliot Lee Hirshman (born 21 February 1961) is an American psychologist and academic who is the president of Stevenson University in Owings Mills, Maryland since 03 July 2017. Prior to Stevenson University he served as president at San Diego State University and served as the provost and senior vice president of the University of Maryland, Baltimore County.

What is Milieu Therapy?

Published on 02/20/202302/21/2023 by Andrew Marshall1 Comment

Introduction

Milieu therapy is a form of psychotherapy that involves the use of therapeutic communities.

Outline

Patients join a group of around 30, for between 9 and 18 months. During their stay, patients are encouraged to take responsibility for themselves and the others within the unit, based upon a hierarchy of collective consequences. Patients are expected to hold one another to following rules, with more senior patients expected to model appropriate behavior for newer patients. If one patient violates the rules, others who were aware of the violation but did not intervene may also be punished to varying extents based upon their involvement.

Milieu therapy is thought to be of value in treating personality disorders and behavioural problems, and can also be used with a goal of stimulating the patient’s remaining cognitive-communicative abilities.

Organisations known to use milieu therapy include:

Cassel Hospital, in London, UK.
Forest Heights Lodge in Evergreen, Colorado, US.
The United States Veteran’s Administration, US.
The Kansas Industrial School for Girls in Beloit, Kansas, US.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Milieu_therapy >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is a Therapeutic Community?

Published on 02/20/202302/21/2023 by Andrew Marshall1 Comment

Introduction

Therapeutic community is a participative, group-based approach to long-term mental illness, personality disorders and drug addiction. The approach was usually residential, with the clients and therapists living together, but increasingly residential units have been superseded by day units. It is based on milieu therapy principles, and includes group psychotherapy as well as practical activities.

Therapeutic communities have gained some reputation for success in rehabilitation and patient satisfaction in the UK and abroad. In the UK, ‘democratic analytic’ therapeutic communities have tended to specialise in the treatment of moderate to severe personality disorders and complex emotional and interpersonal problems. The evolution of therapeutic communities in the US has followed a different path with hierarchically arranged communities (or concept houses) specialising in the treatment of drug and alcohol dependence.

Brief History

Antecedents

There are several antecedents to the therapeutic community movement. One of the earliest is the change in treatment of institutionalised patients in the late 18th century, continuing throughout the 19th century. A major contributor to this change is Philippe Pinel, a French physician who advocated for a more humane treatment of psychiatric patients. In the UK William Tuke founded the Retreat where patients were treated according to humanitarian principles, called moral treatment. Tuke based the treatment of mentally ill people partly on the Quaker ideology. The influence of Quaker principles continues through out the development of the therapeutic community.

Moral treatment focused on a more humane treatment of patients and a stimulating environment that engages them in healthy behaviour. An important distinction between the later therapeutic community is the strong hierarchy in moral treatment facilities. The superintendent had authority over and responsibility of the patients. The patients followed a strict schedule to promote obedience and self-control.

After the First World War, multiple varieties of living-and-learning communities for young adults were established. Examples are the Little Commonwealth school run by Homer Lane and the Q camps initiated by Marjorie Franklin. The Q camps were based on Planned Environmental Therapy, which focused on normally functioning parts of a patient’s personality and use them to deal with difficult social situations. These projects all emphasized shared responsibility and decision-making and participation in the community. What influenced the establishment of these projects were, among others, the developments in psychoanalytic theory in the UK.

United Kingdom

The work conducted by pioneering NZ plastic surgeon Archibald McIndoe at Queen Victoria Hospital and others at Northfield Military Hospital during World War II is considered by many psychiatrists to have been the first example of an intentional therapeutic community. But this story is prone to adopt a origin myth approach. The principles developed at Northfield were also developed and adapted at Civil Resettlement Units established at the end of the war to help returning prisoners of war to adapt back to civilian society and for civilians to adapt to having these men back amongst them.

The term was coined by Thomas Main in his 1946 paper, “The hospital as a therapeutic institution”, and subsequently developed by others including Maxwell Jones, R.D. Laing at the Philadelphia Association, David Cooper at Villa 21, and Joshua Bierer.

Under the influence of Maxwell Jones, Main, Wilmer and others (Caudill 1958; Rapoport 1960), combined with the publications of critiques of the existing mental health system (Greenblatt et al. 1957, Stanton and Schwartz 1954) and the sociopolitical influences that permeated the psychiatric world towards the end of and following the Second World War, the concept of the therapeutic community and its attenuated form – the therapeutic milieu – caught on and dominated the field of inpatient psychiatry throughout the 1960s.

The first development of therapeutic community in a large institution took place at Claybury Hospital under the guidance of Denis Martin and John Pippard. Beginning in 1955 it involved over 2,000 patients and hundreds of staff. The aim of therapeutic communities was a more democratic, user-led form of therapeutic environment, avoiding the authoritarian and demeaning practices of many psychiatric establishments of the time. The central philosophy is that clients are active participants in their own and each other’s mental health treatment and that responsibility for the daily running of the community is shared among the clients and the staff. One phrase commonly used to summarise this treatment philosophy is ‘the Community as Doctor’. ‘TC’s have sometimes eschewed or limited medication in favour of group-based therapies.

The Henderson Hospital first established in 1947 by Maxwell Jones and named after David Henderson evolved the specific concept of Democratic Therapeutic Community (DTC). Admission to and early discharge from the one year of residential treatment was by majority vote and residents of the DTC always held the majority in these votes. No psychotropic medication or one to one therapy sessions were available and so all the work of the DTC was pursued, on the one hand, in small or larger therapy groups or work groups and community meetings, which could be called (by the residents) day or night; and on the other hand, in the unstructured time in between these more formal spaces, in which belonging in and membership of a living community could become in itself a healing experience. The Henderson Hospital DTC became an international centre of excellence for the care of survivors of severe trauma who did not fall under conventional psychiatric classifications and towards the end of the twentieth century it was funded to replicate the treatment model in two other DTCs: Main House in Birmingham and Webb House in Crewe.

The availability of the treatment on the National Health Service in the UK came under threat because of changes in funding systems. Researchers at the University of Oxford and King’s College London studied one of these national Democratic Therapeutic Community services over four years and found external policy ‘steering’ by officials eroded the community’s democratic model of care, which in turn destabilised its well established approach to clinical risk management (this had been jointly developed by clients and staff). Fischer (2012), who studied this community’s development at first hand, described how an ‘intractable conflict’ between embedded and externally imposed management models led to escalating organisational ‘turbulence’, producing an interorganisational crisis which led to the unit’s forced closure. The three ‘Henderson’ DTCs had all closed their doors by 2008.

However, development of ‘mini’ therapeutic communities, meeting for three or fewer days each week and supported out of hours by various forms of ‘service user led informal networks of care’ (for example telephone, texting and physical support), now offers a more resource and cost effective alternative to traditional inpatient therapeutic communities. The most recent exponent, the North Cumbria model, uses a dedicated out of hours website moderated by service users according to therapeutic community principles. This extends the community beyond the face to face ‘therapeutic days’. The website guarantees a safe group-based response not always possible with other systems. The use of ‘starter’ groups as a preparation for entry into therapeutic communities has lowered attrition rates and they now represent a cost-effective model still aimed at producing durable personal and intergenerational effects; this is at odds with the current trend towards the defensive needs of service providers, rather than service users, for less intensive treatments and management of pathways to control risk.

United States

In the late 1960s within the US correctional system, the Asklepion Foundation initiated therapeutic communities in the Marion Federal Penitentiary and other institutions that included clinical intervention based upon Transactional Analysis, the Synanon Game, internal twelve-step programmes and other therapeutic modalities. Some of these programmes lasted into the mid-1980s, such as the House of Thought in the Virginia Correctional system, and were able to demonstrate a reduction of 17% in recidivism in a matched-pair study of drug-abusing felons and sex offenders who participated in the program for one year or more.

Modified therapeutic communities are currently used for substance abuse treatment in correctional facilities of several US states including Pennsylvania, Washington, Colorado, Texas, Delaware, and New York. In New York City, a programme for men is located in the Arthur Kill Correctional Facility on Staten Island and the women’s programme is part of the Bayview Correctional Facility in Manhattan.

Main Ideas

The therapeutic community approach aims to help patients deal with social situations and to change perceptions they have about themselves. Difficult situations are re-enacted and experienced and patients are encouraged to examine and try to learn from them with the help of group and individual therapy. The communities function as a living-and-learning situations, where every interaction can serve as a learning moment.

There is no encompassing definition of what a therapeutic community should be. Some have therefore also argued that it follows a family resemblance. A common conception of therapeutic community is a group of people living together in a non-hierarchical, democratic way that brings psychological awareness of individual as well as group processes. Furthermore, the community has clear boundaries of place, time and roles of the participants. They are democratic because the patients are involved in decision-making to encourage a sense of responsibility. This is fostered by the non-hierarchical structure that tries to minimise dependency on the staff.

A key principle is the creation of a culture of enquiry. Everyone within the community is encouraged to reflect and ask question about themselves and others. In this way the participants are supported by continuous feedback to create better self-awareness.

The therapeutic community approach is informed by systems theory, organisation theory and psychoanalytic practice.

Effectiveness

As an intervention model for drug-using offenders with co-occurring mental health disorders, therapeutic communities may help people reduce drug use and subsequent criminal activity. Research evidence for the effectiveness of therapeutic community treatment is substantial and a demonstration of the cost efficacy of a year of residential therapeutic community treatment was instrumental in funding being granted in the late 1990s for the replication of the Henderson Hospital DTC.

In Popular Culture

The Alfred Hitchcock film Spellbound takes place within a therapeutic community called Green Manors.
Leonard Cohen and his touring band The Army gave an impromptu concert at the Henderson Hospital DTC in August 1970, just before the Isle of Wight Festival, after being invited by one of the residents.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Therapeutic_community >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 20 February [2023]

Published on 02/20/202302/15/2023 by Andrew MarshallLeave a comment

People (Births)

1893 – Elizabeth Holloway Marston, American psychologist and author (d. 1993)

People (Deaths)

1996 – Solomon Asch, American psychologist and academic (b. 1907)

Elizabeth Holloway Marston

Sarah Elizabeth Marston (née Holloway; 20 February 1893 to 27 March 1993) was an American attorney and psychologist. She is credited, with her husband William Moulton Marston, with the development of the systolic blood pressure measurement used to detect deception; the predecessor to the polygraph.

She is also credited as the inspiration for her husband’s comic book creation Wonder Woman, a character fashioned on their polyamorous life partner, Olive Byrne.

Solomon Asch

Solomon Eliot Asch (14 September 1907 to 20 February 1996) was a Polish-American Gestalt psychologist and pioneer in social psychology. He created seminal pieces of work in impression formation, prestige suggestion, conformity, and many other topics. His work follows a common theme of Gestalt psychology that the whole is not only greater than the sum of its parts, but the nature of the whole fundamentally alters the parts. Asch stated: “Most social acts have to be understood in their setting, and lose meaning if isolated. No error in thinking about social facts is more serious than the failure to see their place and function” (Asch, 1952, p.61). Asch is most well known for his conformity experiments, in which he demonstrated the influence of group pressure on opinions. A Review of General Psychology survey, published in 2002, ranked Asch as the 41st most cited psychologist of the 20th century.

What is Social Psychiatry?

Published on 02/15/202302/15/2023 by Andrew MarshallLeave a comment

Introduction

Social psychiatry is a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental wellbeing.

It involves a sometimes disparate set of theories and approaches, with work stretching from epidemiological survey research on the one hand, to an indistinct boundary with individual or group psychotherapy on the other. Social psychiatry combines a medical training and perspective with fields such as social anthropology, social psychology, cultural psychiatry, sociology and other disciplines relating to mental distress and disorder. Social psychiatry has been particularly associated with the development of therapeutic communities, and to highlighting the effect of socioeconomic factors on mental illness. Social psychiatry can be contrasted with biopsychiatry, with the latter focused on genetics, brain neurochemistry and medication. Social psychiatry was the dominant form of psychiatry for periods of the 20th century but is currently less visible than biopsychiatry.

After reviewing the history and activities of social psychiatry, Vincenzo Di Nicola reviews three major questions for social psychiatry and concludes with a manifesto for a 21st-century social psychiatry:

What is social about psychiatry? This addresses definitional problems that arise, such as binary thinking, and the need for a common language.
What are the theory and practice of social psychiatry? Issues include social psychiatry’s core principles, values, and operational criteria; the social determinants of health and the Global Mental Health (GMH) Movement; and the need for translational research. This part of the review establishes the minimal criteria for a coherent theory of social psychiatry and the view of persons that emerges from such a theory, the social self.
Why the time has come for a manifesto for social psychiatry. This manifesto outlines the parameters for a theory of social psychiatry, based on both the social self and the social determinants of health, to offer an inclusive social definition of health, concluding with a call for action.

Brief History

The events of the first half of the 20th century brought the issue of the relationship between the individual and the community to the fore. Psychiatrists who showed a willingness to confront these issues at home, after the war, called themselves social psychiatrists. Psychoanalytic psychotherapy and all its offshoots were grounded in an approach to the patient that focused almost exclusively on the individual – the relational aspects of therapy were implicit in the relationship between therapist and patient, but the main source of problem and motivation for change was seen as being intrapsychic (within the individual). The social and political contexts were largely disregarded. Sarason observed in 1981, that:

“it is as though society does not exist for the psychologist. Society is a vague, amorphous background that can be disregarded in one’s efforts to fathom the laws of behavior” (Sarason 1981).

Early landmarks in social psychiatry included: Karen Horney, MD, who wrote about personality as it interacts with other people (1937); Erik Erikson, who discussed the influence of society on development (1950); Harry Stack Sullivan’s (1953) integration of sociological and psychodynamic concepts, and his work on the role of early interpersonal interactions in the development of the self; Cornell University’s Midtown Manhattan Study, which looked at the prevalence of mental illness in Manhattan; August Hollingshead, PhD, and Frederick Redlich, MD, looked at the influence of social class on psychiatric conditions (1958); Alexander H. Leighton, MD, looked at the relationship between social disintegration and mental illness (1959); Burrow was an early pioneer of the social causes of mental disorder and suggested “Sociatry” as the name for this new discipline.

Over the years many sociologists have contributed theories and research which has enlightened psychiatry in this area (e.g. Avison and Robins); The relationship between social factors and mental illness was demonstrated by the early work of Hollingshead and Readlich in Chicago in the 1930s, who found a high concentration of individuals diagnosed with schizophrenia in deprived areas of the city has been replicated numerous times throughout the world, although controversy still exists as to the extent of drift of vulnerable individuals to these areas or of a higher incidence of the disorder in the socially disadvantaged; the Midtown Manhattan Study conducted in the 1950s by Cornell University hinted at widespread psychopathology among the general population of New York City (Srole, Sanger, Michael, Opler, and Rennie, 1962); the Three Hospitals Study (Wing, J.K. and Brown, G.W. (1967) Social Treatments of Chronic Schizophrenia: a comparative survey of three mental hospitals. Journal of Mental Science. 107, pp.847-861) was a very influential work that has been replicated, that demonstrated forcefully that the poverty of the environment in poor mental hospitals lead to greater handicaps in the patients.

Social psychiatry was instrumental in the development of therapeutic communities. Under the influence of Maxwell Jones, Main, Wilmer and others (Caudill, 1958; Rapoport, 1960), combined with the publications of critiques of the existing mental health system (Greenblatt et al., 1957, Stanton and Schwartz, 1954) and the sociopolitical influences that permeated the psychiatric world, the concept of the therapeutic community and its attenuated form – the therapeutic milieu – caught on and dominated the field of inpatient psychiatry throughout the 1960s. The aim of therapeutic communities was a more democratic, user-led form of therapeutic environment, avoiding the authoritarian and demeaning practices of many psychiatric establishments of the time. The central philosophy is that clients are active participants in their own and each other’s mental health treatment and that responsibility for the daily running of the community is shared among the clients and the staff. “TCs” have often eschewed or limited medication in favour of psychoanalytically derived group-based insight therapies.

Current Work

Social psychiatry can be most effectively applied in helping to develop mental health promotion and prevent certain mental illnesses by educating individuals, families, and societies.

Social psychiatry has been important in developing the concept of major “life events” as precipitants of mental ill health, including, for example, bereavement, promotion, moving house, or having a child.

Originally inpatient centres, many therapeutic communities now operate as day centres, often focused on borderline personality disorder and run by psychotherapists or art therapists rather than psychiatrists.

Social psychiatrists help test the cross-cultural use of psychiatric diagnoses and assessments of need or disadvantage, showing particular links between mental illness and unemployment, overcrowding and single parent families.

Social psychiatrists also work to link concepts such as self-esteem and self-efficacy to mental health, and in turn to socioeconomic factors.

Social psychiatrists work on social firms in regard to people with mental health problems. These are regular businesses in the market that employ a significant number of people with disabilities, who are paid regular wages and work on the basis of regular work contracts. There are approximately 2,000 social firms in Europe and a large percentage of people with disabilities who work in social firms have a psychiatric disability. Some are specifically for people with psychiatric disabilities. (Schwarz, G., & Higgins, G, (1999) Marienthal the social firms network Supporting the Development of Social Firms in Europe, UK).

Social psychiatrists often focus on rehabilitation in a social context, rather than “treatment” per se. A related approach is community psychiatry.

Facilitating the social inclusion of people with mental health problems is a major focus of modern social psychiatry.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Social_psychiatry >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 15 February [2023]

Published on 02/15/202302/12/2023 by Andrew MarshallLeave a comment

People (Births)

1856 – Emil Kraepelin, German psychiatrist and academic (d. 1926)

Emil Kraepelin

Emil Wilhelm Georg Magnus Kraepelin (15 February 1856 to 07 October 1926) was a German psychiatrist.

H.J. Eysenck’s Encyclopaedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics.

Kraepelin believed the chief origin of psychiatric disease to be biological and genetic malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later psychodynamic influence of Sigmund Freud and his disciples, enjoyed a revival at century’s end. While he proclaimed his own high clinical standards of gathering information “by means of expert analysis of individual cases”, he also drew on reported observations of officials not trained in psychiatry.

His textbooks do not contain detailed case histories of individuals but mosaic-like compilations of typical statements and behaviours from patients with a specific diagnosis. He has been described as “a scientific manager” and “a political operator”, who developed “a large-scale, clinically oriented, epidemiological research programme”.

An Overview of Music as a Coping Strategy

Published on 02/14/2023 by Andrew MarshallLeave a comment

Introduction

Music as a coping strategy involves the use of music (through listening or playing music) in order to reduce stress, as well as many of the psychological and physical manifestations associated with it.

The use of music to cope with stress is an example of an emotion-focused, adaptive coping strategy. Rather than focusing on the stressor itself, music therapy is typically geared towards reducing or eliminating the emotions that arise in response to stress. In essence, advocates of this therapy claim that the use of music helps to lower stress levels in patients, as well as lower more biologically measurable quantities such as the levels of epinephrine and cortisol.

Additionally, music therapy programmes have been repeatedly demonstrated to reduce depression and anxiety symptoms in the long term.

Major Theories

In the context of psychology, a coping strategy is any technique or practice designed to reduce or manage the negative effects associated with stress. While stress is known to be a natural biological response, biologists and psychologists have repeatedly demonstrated that stress in excess can lead to negative effects on one’s physical and psychological well-being. Elevated stress levels can lead to conditions including mental illnesses, cardiovascular conditions, eating disorders, gastrointestinal complications, sexual dysfunction, and skin and hair problems. The variety and potential fatality from these conditions push the need for a coping mechanism to reduce the manifestations associated with stress.

While there are hundreds of different coping strategies, the use of music is one specific example of a coping strategy that is used to combat the negative effects of stress. Due to the substantially large number of strategies to choose from, psychologists break down coping strategies into three types:

Strategy	Outline
Appraisal-Based	Intended to modify the individual’s thought process Stress is typically eliminated through rationalisation, changes in values or thinking patterns, or with humour.
Problem-Based	Targets the cause of the stress. The process could either involve eliminating or adapting to a stressor in order to cope. An example of a problem based strategy is time management.
Emotion-Based	Geared towards influencing one’s emotional reactions when stressed. Meditation, distractions, or the release of emotion are all forms of emotion-based coping strategies. Mindfulness-based stress reduction is another example of this, as it is a more personal reflection based aspect of coping.

Since music-based coping is designed to modify an individual’s emotional reactions to a certain event, it is best classified as an emotion-based coping strategy. Rather than attempting to directly influence or eliminate a particular stressor, music-based coping relies on influencing an individual’s emotional and mental reaction to the stressor. Music assuages stress by either reducing or altering emotional response or alleviate some of the physiological effects of the stress response.

Major Empirical Findings

Psychologists and medical practitioners have recently focused more time and attention on the concept of music as a coping strategy and the effects of its use on patients. In literature linking music and stress, empirical findings are typically grouped together according to the method in which they are gathered. For example, some methods may include studies like survey questions or more invasive methods of study like invasive psychoacoustic observations. Despite the fact that different methods are used, most of these studies demonstrate the impact different types of music have on human emotions.

Patient Response-Based Findings

One of the more popular methods used to collect data on coping strategies involves the use of non-invasive, patient response-based methods. This method is directed more towards the psychological realm, in that the methods used to collect data were not very invasive but more of a “tell me how you feel” type of question/response system. Once the findings had been gathered, statistical analysis was performed in an effort to discover a correlation between the coping mechanism and its effect on the stress response. These non-invasive treatments are more popular among children and elderly patients, since they prevent the results from being altered due to the patient’s nervousness. Proponents of these methods claim that if children are prompted with general, unthreatening questions, they are much more comfortable and willing to provide accurate accounts of their levels of stress. In several studies using non-invasive methods, music has been documented as being effective in reducing the subject’s perceived level of stress.

Music and Effects on Psychological Trauma

Posttraumatic stress disorder (PTSD) is a psychological stress disorder that involves the experience of strong emotional reactions due to traumatic events in an individual’s past. PTSD is almost always a result of a traumatic experience. Certain triggers, such as images, sounds, or other significant sensory details associated with the experience can evoke extreme stress responses, panic attacks, or severe anxiety. PTSD is commonly experienced by veterans of armed conflicts, and can be frequently diagnosed in victims of rape or other violent assaults.

If an individual diagnosed with PTSD associates a certain song with a traumatic memory, it typically triggers a stronger stress/anxiety response than the individual would otherwise have otherwise experienced when listening to the song. While one cannot assume that music is the only factor that triggers PTSD-influenced stress and panic attacks, these can be especially memorable because of music’s rhythm, beat, and/or memorable lyrics. However, associating music with psychological responses is not necessarily guaranteed to bring up bad memories, because music can often hold psychological connotations to very happy memories. For example, it has been demonstrated that supplying the residents of nursing homes with iPods that feature nostalgic music is a means of reducing the stress of the elderly.

Music has been used to treat dementia patients by utilising methods similar to the treatments that are used in the management of PTSD. However, in the treatment of dementia, more emphasis is placed on providing the patient with music that triggers pleasant memories or feelings, rather than avoiding music that triggers negative emotions. After the music is listened to, one sees the change in mood and attitude from closed and distant to joyful, open and happy.

There is a wealth of anecdotal evidence demonstrating the effectiveness that music can have as a coping response in this regard. For example, if a patient of either PTSD or dementia were to have a loved one die, he or she might associate a certain song with the person being mourned for, and hearing that song could bring about feelings of happiness or deep sadness. In addition, if there was a certain connection between them, such as in marriage, and their wedding song came on, an overly powerful emotional reaction could occur. These overly emotional situations trigger memories and a stress response that anguishes the person remembering these hurtful memories. A certain song that pertains to that memory can trigger nearly any emotion.

Music’s effects on dementia patients have shown to bring them out of their shell, and engage them in singing and being happy, opposed to their usual closed and distant personalities. The patients have been shown to sing and perk up, even cry out of pure joy of the music that they loved in their youth. After the patients listen to their music they were interviewed and actually engaged, because of how happy the music had made them. The patients talked about how much they loved the music and the memories that the music invoked.

Stress and Music in the Medical Field

The use of music as a coping strategy also has applications in the medical field. For example, patients who listen to music during surgery or post-operative recovery have been shown to have less stress than their counterparts who do not listen to music. Studies have shown that the family members and parents of the patient had reduced stress levels when listening to music while waiting, and can even reduce their anxiety for the surgery results. The use of music has also been proven effective in paediatric oncology. Music therapy is mainly used in these cases as a diversion technique, play therapy, designed to distract the patient from the pain or stress experienced during these operations. The focus of the patient is directed at a more pleasurable activity and the mind shifts toward that activity creating a “numbing” effect founded on an “out of sight, out of mind” type approach. This can even transcend to elderly patients in nursing homes and adult day care centres. Music therapy in these places have shown reductions in elder aggression and agitated moods. However, because several of these studies rely mainly on patient responses, some concerns have been raised as to the strength of the correlation between music and stress reduction.

Music as a form of coping has been used multiple times in cancer patients, with promising results. A study done on 113 patients going through stem cell transplants split the patients into two group; one group made their own lyrics about their journey and then produced a music video, and the other group listened to audiobooks. The results of the study showed that the music video group had better coping skills and better social interactions in comparison, by taking their mind of the pain and stress accompanying treatment, and giving them an outlet to express their feelings.

Another study done at UNC showed remarkable improvement in a young girl who was born without the ability to speak. A therapist would come in and sing with her, as the only thing she could do was sing. Miraculously, the singing allowed to her gain the ability of speech, as music and speech are similar in nature and help the brain form new connections. In the same hospital, the therapist visits children daily and plays music with them, singing and using instruments. The music fosters creativity and reduces stress associated with treatments, and takes the children’s minds off of their current surroundings.

It also cannot be ignored the importance of coping strategies in families and caregivers of those going through serious and even terminal illness. These family members are often responsible for a vast majority of the care of their loved ones, on top of the stress of seeing them struggle. Therapists have worked with these family members, singing and playing instruments, to help them take their minds off of the stress of helping their loved ones undergo treatment. Just like in the patients themselves, the music therapy has been shown to help them cope with the intense emotions and situations they deal with on a daily basis.

Physiological Findings

Other studies, which use more invasive techniques to measure the response of individuals to stress, demonstrate that the use of music can mitigate many of the physiological effects often associated with the stress response – such as a lowering of blood pressure or a decrease in heart rate. Most research associated with the use of music as a coping strategy makes use of empirical measurements through devices like an EKG or heart rate monitor in order to provide a stronger correlation between music and its proposed effects on the stress response. In these studies, subjects are typically exposed to a stressor and then assigned music to listen to, while the parties conducting the study measure changes in the subjects’ physiological status.

Some studies, using more invasive physiological research methods, have demonstrated that the use of sedative music or preferred sedative music cause a decrease in tension and state-anxiety levels of adult individuals. This decrease in tension or feeling of anxiety is more prevalent and noticeable in the attempt to return to homeostasis, and shows far less effectiveness during the actual stressful event. Other studies expose their subjects to an immediate physical stressor, such as running on a treadmill, while having them listen to different genres of music. These studies have shown that the respiratory rates of the participants are increased when they listen to faster, upbeat music while running in comparison to no music or sedative music. In addition to the raised respiratory frequency caused by the initial stressor “running” music still had a noticeable physiological effect on the participants.

By and large, a collective review of these studies shows that music can be effective in reducing physiological effects that stress has on the human body. This can be anywhere from changing pulse rates, breathing rates, to even decreasing the occurrence of fatigue. This can even be seen in different tempo’s and pitch, such as low pitch creates a relatively calming effect on the body whereas high pitch tends to generate stressors for the body. Furthermore, it has been suggested that if a patient can control the music that he or she listens to in the recovery process, then the return to normalcy happens at a much faster, more efficient rate than if the subject was assigned a music genre that he or she did not find appealing. With the use of the EKG monitor and other empirical methods of study, researchers are able to remove the superficial qualities associated with patient response-based findings and provide a more substantial correlation between the use of music and its effects on the human stress response.

Specific Techniques

One particular technique that uses music as a coping strategy is choosing and listening to music genres that have been shown to correlate with lower levels of stress. For example, it has been suggested that listening to classical music or self-selected music can lower stress levels in adult individuals. Music that is fast, heavy or even dark in nature may produce an increase in these same stress levels, however many people also find the cathartic effects of music to be intensified with the listening of music that is intense in such a way. Ambient music is a genre of music that is often associated with feelings of calmness or introspectiveness. While listening to self-selected genres, an individual is provided with a sense of control after choosing the type of music he or she would like to listen to. In certain situations, this choice can be one of the few moments where stressed and depressed individuals feel a locus of control over their respective lives. Introducing the feeling of control can be a valuable asset as the individual attempts to cope with his or her stress.

With that in mind, there are a few specific techniques specifically involving the use of music that have been suggested to aid in the reduction of stress and stress-related effects.

Listening to softer genres such as classical music.
Listening to music of one’s choice and introducing an element of control to one’s life.
Listening to music that reminds one of pleasant memories.
Avoiding music that reminds one of sad or depressing memories.
Listening to music as a way of bonding with a social group.

Another specific technique that can be used is the utilisation of music as a “memory time machine” of sorts. In this regard, music can allow one to escape to pleasant or unpleasant memories and trigger a coping response. It has been suggested that music can be closely tied to re-experiencing the psychological aspects of past memories, so selecting music with positive connotations is one possible way that music can reduce stress.

A technique that is starting to be employed more often is vibroacoustic therapy. During therapy the patient lies on his/her back on a mat with speakers within it that send out low frequency sound waves, essentially sitting on a subwoofer. This therapy has been found to help with Parkinson’s disease, fibromyalgia, and depression. Studies are also being conducted on patients with mild Alzheimer’s disease in hopes to identify possible benefits from vibroacoustic therapy. Vibroacoustic therapy can also be used as an alternative to music therapy for the deaf.

Controversies

Several of the empirical studies carried out to demonstrate the correlation between listening to music and the reduction in the human stress response have been criticised for relying too heavily on a small sample size. Another criticism of these studies is that they have been carried out in response to no stressor in particular. These critics claim that because no specific stressor is identified in many of these studies, it is somewhat difficult to identify whether the stress response was lessened by music or by some other means.

A more theoretical critique of this coping strategy is that the use of music in stress coping is largely a short-term coping response and therefore lacks long-term sustainability. These critics argue that while music may be effective in lowering perceived stress levels of patients, it is not necessarily making a difference on the actual cause of the stress response. Because the root cause of the stress is not affected, it is possible that the stress response may return shortly after therapy is ended. Those who hold this position advocate instead for a more problem-focused coping strategy that directly deals with the stressors affecting the patient.

Conclusion

The use of music as a stress coping strategy has a demonstrated effect on the human response to stress. The use of music has been proven to lower the perceived levels of stress in patients, while greatly reducing the physical manifestations of stress as well – such as heart rate, blood pressure, or levels of stress hormones. It seems as though different types of music have different effects on stress levels, with classical and self-selected genres being the most effective. However, despite demonstrated effectiveness in empirical studies, there are many who still question the effectiveness of this coping strategy. Nevertheless, it is still an attractive option for some patients who want an easy and inexpensive way to respond to stress.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Music_as_a_coping_strategy >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.