cornertree_admin

Videogames and Mental Health Nintendo Figurines (This post includes material published in MindCafe.)www.mindcafe.com.au Videogames and mental health. In psychiatry there are certain cultures that may pass us by, that nevertheless are of significant impact to our profession, and vice versa. One of these is the culture of those who identify as “gamers” – individuals with a shared enjoyment of videogames, that becomes more than a hobby and more linked to a shared social identity. It should be of no surprise, therefore, that DSM-V’s proposition of “Internet Gaming Disorder” was associated with more than some angst from this subgroup. There was the standard accusations of pathologising normal behaviour, alongside DSM-V not going far enough to formalise the diagnosis, but there was and remains a considerable amoung of debate regarding this issue. The APA Taskforce commissioned in 2015 reviewed 170 studies, and the outcome was telling – finding inconclusive results between the studies, it was nevertheless published with a conclusion section suggesting a link between aggression and videogaming, shortly being followed by letters published by members of the very taskforce claiming improper internal conduct and biased reporting by other members. On the other side, gamers themselves have taken the surprising task of advocating the use of games for mental health itself. Charities such as Child’s Play and Checkpoint support the provision of games for sick children, as well as directly for improving the mental health of gamers. How can this be possible? There are interesting components within gaming itself that can potentially be harnessed for good. 1.) Fun Games (good games, anyway) are fun, and doing fun things reduces stress. This does not indicate that all stress is negative, naturally, however a common feature of all mental health issues is the presence of stress, by means of impairment in psychosocial functioning. Whether this represents a temporary diversion or a neurotic escape fantasy, is a bit more of an issue for debate. However, ironically both of these elements are part of the second key issue of gaming. 2.) Flow theory. The game design extension of behaviourism, with components rooted in operant conditioning. I once had a colleague describe flow theory to me as “brainwashing”, which was a nuanced approach to the concept. However, it simply refers to the issue of reaching an optimal state of immersion with an activity matched to their skill level. How is this achieved? By having escalating levels of difficulty that encourage stabilisation towards a state of regular engagement. Gamers like progression, and completing an activity with associated reward encourages further action. Why is this relevant to mental health? Because of the issue of progression. Completing an activity is usually associated with a reward, however failure to complete the activity often requires penalty. The problem with penalty is that it robs one’s sense of progression and greatly increases stress associated with the event. Notably, different games deal with this mechanic in different ways – “casual games” often incur no penalty for negative activity. Penalty is often based on nonprogression – which is frustrating, however much less penalty than if one were to lose their previous achievements. 3.) Philosophy. Games now exhibit suprising levels of maturity, and have evolved into a storytelling medium in many cases. Games involve an interactive experience as their base. Within this, there are several other options – incorporating a story is commonest, and greatly adds to the experience, but is not essential. What is fascinating, is that many games attempt to introduce philosophical concepts to gamers, with potential longstanding benefits. The game “Braid” introduces considerable existentialist meditations into what superficially is a straightforward platformer. The Bioshock series is an excellent example of exploration of a deviant philosophy – the only problem is their interpretation of objectivism is more accurately ethical egoism, but I digress. Either way, the purpose of bringing a philosophical background to the game experience is that it encourages gamer to rethink circumstances – characters, motivations, etc. By doing so, this firstly teaches a level of psychological mindedness (being more aware of the thoughts of others and building empathy), but it also encourages self-exploration (reassessing how one makes decisions in their own life). Is it better to be the Ubermensch or the everyman? The favourite hero or the quiet champion? Philosophy also does not even require dialog, but merely a quiet opportunity to introduce shades of grey to a normally uncomplicated world. There is the intense moral ambiguity of Shadow of the Colossus, with a disdain for your own actions despite not a word being uttered. The Legend of Zelda series has as an essential underlying theme of the key concept of growing up – in all of the games, the player faces obstacles, and then you learn from them so that you can deal with bigger obstacles later, very slowly growing stronger without even realising it. There is a reason why it has had such lasting intergenerational appeal. 4.) Psychoeducation. Some games have attempted direct psychoeducation. There are several games that deal with the plight of the individual’s descent into a deteriorating world – such as Game Lab’s Elude, or Depression Quest. These seek to evoke the experience of a mental health issue, in order to raise awareness and encourage people to seek help. They either use highly evocative imagery to create the experience of what it would be like to have a mental health issue, or have explicit textual references to the experience and information about things such as sleep, abnormal cognitions and so on. However, it’s a fine line to tread between raising awareness and piecemeal interventions within broader exploitation. We would not consider reading a book on depression to be sufficient treatment for same, although amongst us there are certainly advocates for bibliotherapy. When I’ve tried these games, as a mental health professional they appear either trite or alarmingly celebratory of negative thought patterns. There is probably more to be done, however, to refine the medium to meet better aims. 4.) Look left, look right. One notices a

How does mental health feel about the secularisation of Christmas? Tea Light Candles How does mental health feel about the secularisation of Christmas? Share Author: Neil R Jeyasingam Date: 16 January, 2018 Posted By: Profectus-Admin

Psychosis and Video Games Super Mario Bros Game What can videogames teach us about psychosis? Why don’t people with schizophrenia take their medications? And how can psychosis possibly be regarded as beneficial? Share Author: Neil R Jeyasingam Date: 23 August, 2017 Posted By: Profectus-Admin

Euthanasia – the problem of capacity Power of Words Lifeline Australia 13 11 14 I once had a 70 year old patient with recurrent serious depressive episodes leading to suicide attempts. She was a “professional suicider”, in that she subscribed to an organisation that clandestinely posted out kits to help people kill themselves. I saw her after yet another attempt, wherein she drank a large amount of whisky and then attempted to use the kit. She was discovered on the floor a day later with some muscle damage and semi-comatose, but revivable to an almost full level of functioning. She explained to me a few weeks later that she now had a purpose to live – she realised her mistake was attempting to kill herself using the device whilst intoxicated, and that “thousands” of people around the world must be trying to do the same thing and failing. With a renewed mission in life, she decided that she would cease attempting to kill herself and would now play a more active role in the organisation, particularly in online messageboards, so as to assist other people to kill themselves more efficiently and help others to avoid the mistakes she made. It was one of the more confusing risk assessments I’ve ever had to make. A problem that psychiatrists often have is the management of suicidal tendencies in patients with mental health vulnerabilities is that they often find support with the euthanasia movements to support their plight. In June 2015, a 24 year old Belgian woman known as “Laura” was granted the right to die for longstanding suicidal tendencies only. Like my patient, she did not have a life-threatening physical illness, only a persistent belief that life was not for her. Fortunately most psychiatrists do not see a wish to die per se as being a mental illness, provided that there are sufficient insoluble stressors causing the decision – such as a terminal or severely incapacitating physical illness. But we are stuck with the person who decides that they need to die, and our ability to override that need. And we override that need by deciding on whether they have capacity. Capacity is defined as the ability that a person has to make a decision, and it is contingent on an unimpaired mind to reasonably take into account the context and implications of a decision. A person who is depressed, or delirious, or demented, may lack capacity with a particular decision. The doctors who tend to be guardians of capacity determinations are psychiatrists, mostly because we spend most of our time talking to patients. One of the best decisions made by the British was the establishment of the UK Capacity Act in 2005, which laid down the means for a determination of an individual’s capacity in a brilliantly objective fashion that not only removed the need for psychiatrists, but even doctors. Any individual within the health system now had a framework that they could call upon to determine a patient’s ability to decide on matters – built into the framework were also contingencies to protect patients in the event that they were determined to lack capacity. Australia does not have a capacity act – in practice, many of us use principles located within the Guardianship Act, but the determination can be subjective, and exploited. I recall a busy intensive care unit where the director of the unit shouted across to the psychiatrist on call “just document that she lacks capacity to do anything and we’ll do the rest.” There are reasonable mental health principles that assist us with maintaining and protecting vulnerable patients from poor choices, and these are a world away from the suffering terminally ill patients for which the majority of the euthanasia debates run. In order to appropriately separate the two, the question of capacity must be determined – in the event of euthanasia being approved, the mechanism by which one decides they have capacity must be legislatively backed – and I suspect that this would be better done if taken out of the hands of the doctors, as the British have done. Issues of life and death boil down to the freedom to choose. It is a caring society that allows choice to some. It is a callous society that allows choice to all. Share Author: Neil R Jeyasingam Date: 28 November, 2015 Posted By: Profectus-Admin

Does the President have Narcissistic Personality Disorder? Three psychiatry professors called for a formal evaluation. Psychologists and other mental health professionals worldwide are of surprising consistency in their interpretations. We have to ask – does the President of the United States have Narcissistic Personality Disorder? Share Author: Neil R Jeyasingam Date: 31 January, 2017 Posted By: Profectus-Admin

The End – a short story about the apocalypse Awarded a commendation by the KSP Writer’s Centre Short Fiction Awards, 2016 “So, how exactly did Australia save the world?” Bob stopped, the freshly opened homebrew just barely at his lips. “What, seriously, you still don’t get it?” Bill was tapping his drink against the side of his head for some goddamn reason. “I think I got it, but,” There was a pause. “You don’t, do you?” “Nope.” Bob clunked the bottle down clumsily on the patiobot, which recommenced chilling. There was a beautiful cold mist emanating from the mouth of the bottle, the kind that makes you know that the last three months of careful monitoring of the Hills system was worth it. The few lights on the side were isolated specks in the midst of the brilliant shades of yellow, purple and orange that the world was turning as the sun went down. Not a cloud overhead, but plenty in the distance filtering the last rays of the day. The weather was perfect, and the sun was just about to go down and provide what was definitely going to be an incredible sunset. Good brew, good view, and this dickhead seemed dedicated to ruining it. He sighed. “Fine, Bill, one more time.” “Right.” “So – world was ending, right? Climate change, world economy collapsing, refugee crises left right and centre,” Bill’s forehead crinkled. As it already was crinkled before, there were fairly impressive new valleys formed. “I dunno Bob, it was kinda before my time.” “God’s sake, Bill, you’re older than me.” “Yeah, but, you know, legalising cannabis an’ all, kinda screwed with my, you know, what’cha call,” “Short term memory.” “Yeah.” “See, that was part of it, Bill. You and the rest of the world. Your lot copied off Colorado, who copied off Holland, and everyone else copied you guys, and before you knew it the whole world – except for us, cause we’re slow like that – decided grass was legal. They started calling it grass again, by the way. Problem is, no one had determined what the safe limit for marijuana use was, and it turned out that-“ “There wasn’t?” “Yup.” “Oh, there was?” “No, I mean that there was no safe limit. So the rest of the world’s IQs dropped by, well, a lot. America got hit hardest. World’s greatest democracy started running around with a population that was quite a bit dumber. Voted in a few fairly impressive idiots. Rich Mormon bloke, Wife of someone or other, heck they even found another Bush.” Bill’s right index finger shot up. “That’s right! I voted for him!” “Who knew, right?” “Knew what?” Bob groaned, and dialled back his expectations further. “Right, so anyway, lots of idiots who decide to do everything possible to screw up the world. No more immigration, so all the minorities started rioting. No more climate change scientists, so the smart guys stopped being smart. Seas kept rising, temperatures kept rising, whole world boiling, all that.” “When do we get to Australia?” “Right, then a bunch of people worked out that we had to do something to cool the world down. Something big. Something urgent. But first principles – the stuff that worked, but on a bigger scale. Need to plant trees. Need to plant lotsa trees. Need a really big landmass that’s mostly desert, with good access to decent irrigation, to quickly turn into forest.” Bill stared, his brow locked in concentration. You could have planted potatoes in that forehead. Bob waited with a bit more patience than he actually had. Bill finally answered, “You mean the Saha-” “They tried, but didn’t work. No one around there, see? But lots of capital cities around here, with lots of people with ideas. Anyway, suddenly the whole world wanted to talk to us. We put our hands up once at the UN, and then, bang, it happened – we reforest Australia.” “Woah.” Bob leaned back, and took the opportunity to take a few swigs of his brew. He noticed it was a bit quiet, so he gave the patiobot a kick, which started it quietly humming again. He didn’t really need to, as it had shut off due to having chilled the beer perfectly to the right temperature, but it was more for the serenity. He was also enjoying the 140 seconds it took for Bill to process a new idea. He cleared his throat. “So, turns out you need a lot of stuff in order to plant trees. You need money. Good thing is, whole world was heating up, and every country in the world had money they wanted to splash on a climate project – any project. So we got, like,” “All the money?” Bob hesitated, and then shrugged his shoulders. “Sure, Bill, yeah. We got all the money. So, you need more than that. Technology – that was there, but there were always improvements. But what you really need is people – lots of people – in order to do the work. Not much time to save the world, you know, so all hands on deck. But, not many people want to actually work, apart from immigrants.” “Oh, I see where this is going.” Bob took a quick drink. “Right, so suddenly, the whole world’s in contact with Australia again. Talking to us, giving us money, uprooting their lives and coming here, sometimes all three (although those blokes were pretty confused but). All those refugees and people who didn’t have a place to live, suddenly we were sending them boats and bringing them over here. So long as you could handle a shovel, or a Mark III combined tiller, or executive task force, you were in, and you were paid. The Aboriginals were OK with it too – turns out the place originally had a lot more trees before anyway, and they kinda liked the idea of the country going back to what it used to look like.” “OK.” “It

Reducing Mental Health Stigma My interview with Wendy Harmer on ABC702 regarding Mental Health Month – in 2016, stigma is less than ever. The message is simple – that which we used to think untreatable, is now more likely than ever to respond to psychiatric intervention. Share Author: Neil R Jeyasingam Date: 20 October, 2016 Posted By: Profectus-Admin

We need to keep with the times when it comes to Mental Health Care At least 6 public awareness campaigns are currently running at the same time for mental health. This is a good thing. Share Author: Neil R Jeyasingam Date: 05 October, 2016 Posted By: Profectus-Admin