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.
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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.
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:
The Kansas Industrial School for Girls in Beloit, Kansas, US.
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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.
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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.
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.
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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”.
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.
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Emotions Anonymous (EA) is a twelve-step programme for recovery from mental and emotional illness. As of 2017 there were approximately 300 Emotions Anonymous groups active in the United States and another 300 around the world.
Brief History
Marion Flesch (24 July 1911 to 10 October 2004) is responsible for creating the groups that would become Emotions Anonymous. Marion was a graduate of St. Cloud State Teachers College (now St. Cloud State University) and at various times worked as a teacher, secretary, clerk, accountant, bookkeeper and office manager. Later in life she became a certified chemical dependency counsellor through the University of Minnesota and started work on a master’s degree, but stopped at age 80 due to health concerns. Marion originally went to Al-Anon meetings at the advice of a friend to help cope with panic attacks. Later Marion learned of another twelve-step programme, Neurotics Anonymous and she started the first such meeting in Minnesota held 13 April 1966, at the Merriam Park Community Centre in St. Paul. Neurotics Anonymous grew quickly in Minnesota, and by Fall of 1966 there were thirty active groups in the state.
Differences developed between the Minnesota groups and the central offices of Neurotics Anonymous. The Minnesota Intergroup Association separated from Neurotics Anonymous on 06 July 1971. After unsuccessful attempts to reconcile differences with Neurotics Anonymous, the Minnesota groups later adopted the name Emotions Anonymous. They wrote to Alcoholics Anonymous World Services for permission to use the Twelve Steps and Twelve Traditions. Permissions was granted. Emotions Anonymous officially filed Articles of Incorporation on 22 July 1971.
Misconceptions
Purpose
EA is not intended to be a replacement for psychotherapy, psychiatric medication, or any kind of professional mental health treatment. People may find useful as a complement to mental health treatment, as a personal means to better mental health in general, or when psychiatric treatment is not available or they have resistance to psychiatric treatment. EA does not attempt to coerce members into following anyone’s advice.
Intellectual Disabilities and Hospitalisation
Jim Voytilla of the Ramsey County, Minnesota, Human Services Department created EA groups for intellectually disabled substance abusers in 1979. Voytilla noted when this particular demographic of substance abusers attended AA meetings in the surrounding community, they felt uncomfortable and made others attending the meetings uncomfortable. Voytilla’s EA meetings were created to avoid these problems, and address the illnesses of his clients other than substance abuse. Since then, four articles have narrowly defined EA as a program specifically for mentally retarded or intellectually disabled substance abusers. In a similar way, EA has also been incorrectly described as an organisation either specifically or primarily for those who have been discharged from psychiatric hospitals.
EA does not discriminate against any demographic. All that is needed to join EA is a desire to become emotionally well. EA is not, and never has been, a programme specifically for people of any particular background or treatment history. It is not uncommon for individuals in recovery from addictions or former patients in psychiatric hospitals to seek help in EA after being discharged.
Processes
Emotions Anonymous views mental and emotional illness as chronic and progressive, like addiction. EA members find they “hit bottom” when the consequences of their mental and emotional illness cause complete despair. Twelve-step groups symbolically represent human structure in three dimensions: physical, mental, and spiritual. The illnesses the groups deal with are understood to manifest themselves in each dimension. The First Step in each twelve-step group states what members have been unable to control with their willpower. In some cases the emphasis is on the experience in the physical dimension; in AA the First Step suggests admitting powerlessness over alcohol, in Overeaters Anonymous (OA) it is powerlessness over food. In other groups the First Step emphasizes the experience in the mental dimension; in NA the First Step suggests admitting powerlessness over addiction, in EA (as well as Neurotics Anonymous), it is powerlessness over emotions. Emotions Anonymous focuses on deviant moods and emotions, not just a craving for mood alteration. The subjective experience of powerlessness over one’s emotions can generate multiple kinds of behavioural disorders, or it can be a cause of mental suffering with no consistent behavioural manifestation (such as affective disorders).
In the Third Step members surrender their will to a Higher Power, this should not be understood as encouraging passiveness, rather its purpose is to increase acceptance of reality. The process of working the Twelve Steps is intended to replace self-centredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action; this is known as a spiritual awakening, or religious experience.
Literature
Emotions Anonymous publishes three books approved for use in the organization. Emotions Anonymous is the primary book, the Today book contains 366 daily meditation readings related the EA programme, and It Works If You Work It discusses EA’s tools and guidelines in detail.
Emotions Anonymous (1996). Emotions Anonymous (Revised ed.). St. Paul, Minnesota: Emotions Anonymous International Services. ISBN 978-0-9607356-5-5. OCLC 49768287.
Emotions Anonymous (1987). Todays. St. Paul, Minnesota: Emotions Anonymous. ISBN 978-0-9607356-2-4. OCLC 19232484.
Emotions Anonymous (2003). It Works If You Work It. St. Paul, Minnesota: Emotions Anonymous. ISBN 978-0-9607356-9-3. OCLC 54625984.
Tools and Guidelines for Recovery
All twelve-step programs use the Twelve Steps and Twelve Traditions, but most have their own specialised tools and guidelines emphasizing the focus of their programme. EA developed the “Twelve Helpful Concepts,” and “What EA Is…and Is Not.” the “Just for Todays,” as well as a slightly modified version of AA’s Twelve Promises. The EA “Just For Todays” were adapted by a twelve-step organisation for female victims of domestic violence with substance abuse histories, Wisdom of Women (WOW).
This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Emotions_Anonymous >; 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.
1964 – Werner Heyde, German psychiatrist and academic (b. 1902)
Werner Heyde
Werner Heyde (aka Fritz Sawade) (25 April 1902 to 13 February 1964) was a German psychiatrist. He was one of the main organizers of Nazi Germany’s T-4 Euthanasia Programme.
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