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So you have Alzheimer’s… Dementia Australia National Dementia Helpline 1800 100 500 Hi, I understand you have Alzheimer’s. It’s important first of all that you let someone know that you’re reading this; because in about 30 seconds you will forget it. It doesn’t mean that it’s not worth reading though. I’m probably biased, but I think it is. The thing is that, if you’re reading this, what’s happening is that the part of your brain that’s involved in what’s called “encoding” is damaged, and not working properly. It interferes with your creation of new memories. But you’re still able to read this, aren’t you? So if you’re not able to make new memories, how is it that you can understand a whole sentence, made of individual words? The answer is called “Registration” – you actually are able to remember things, it’s just that that kind of memory lasts for a very short time, about 30 seconds or so. I mentioned it at the beginning of this article; if you don’t remember, feel free to head back there and read it again. Now, if you’ve read this a couple of times, even if you can’t remember the details of it, you’ve got a bit of a “feeling” regarding the article, don’t you? It’s got a sort of lighthearted feel, with a bit of technical information in it. The more often you read it, the more often you’ll remember some details. And that’s because although you’ve got damage in the part of the brain that’s doing the ‘encoding’, there are other parts of your brain still active. It _is_ possible for you to form new memories – it just requires a great deal more work for you. Fortunately I’m patient – in fact, I’m precisely as patient as you are. This by the way works for other things – if there’s something you need to remember, have someone write it down so that you can read it over and over again. It will eventually go in, usually when you get frustrated. Not a joke! Because earlier I said something about the “feeling” of the article. Here comes another strange way your memory is affected, or rather not affected – you have difficulty forming new memories, with details like words and events. But your emotional memory is much less affected. You will remember feeling happy, or bemused, or even discombobulated. You probably won’t remember why you feel those things, but they’ll be there anyway. By the way, this is why when people tell you bad news, you may remember feeling awful, but not know why. Make sure they give you something written, you may not want to read it, but it will help. So, to recap – if your brain’s a warehouse, the guy doing the paperwork at front isn’t doing that great a job. You’re able to hold things in your head for about 30 seconds, but no really after. If you’ve got something emotional to go in, he does a much better job, even if the labelling’s terrible. Know what else he’s still good at? Getting stuff out. The stuff that was in there before you got Alzheimer’s is still there. The memories from your childhood, the embarassing thing that happened to you as a teenager that you would be mortified if anyone found out – they’re all still there. From the time that the Alzheimer’s started to hit, your ability to put stuff in has gotten worse and worse – apart from emotional stuff. For some people, all they remember is that they’re upset that they can’t remember things. Comical to others, tragic for them. So don’t be one of those people. There is a very narrow thing that you are impaired in – you have difficulty with forming new memories, but you have emotional responses, and emotional memories, and incredible, fantastic biographical memories. You might not be able to enjoy a good book, but you’ll be able to enjoy poems. Stuff that you can hold in your head for 30 seconds will still be meaningful for you – and after you forget the details, the way it felt will still stay in your soul. That which really makes you human – the ability to laugh, to love, to cry, and to enjoy life, to enjoy a moving opera and spit out an offensive grape, they’ll still be there, and they’ll be there for a very long time. What you’re going to miss is all the distractions – all of them. If there’s something that’s really so important you need to think about it for more than 30 seconds, keep a notepad next to you and write it down. And if other people really need you to know stuff, they can write it down too. But in the meantime, your job as a human being is to live, and to feel. Share Author: Neil R Jeyasingam Date: 18 June, 2016 Posted By: Profectus-Admin

Suicidality can exist without depression Gachet Lifeline Australia 13 11 14 The Chairman of Lifeline Australia, John Brogden, shared an important message recently in the Sydney Morning Herald with “The national emergency we can no longer ignore”. As a suicide attempt survivor himself, he grimly noted that 2500 Australians still take their lives every year – seven deaths per day. He has rightly called for it to be seen as warranting a national campaign, and the need to improve how we understand suicide. That last point may not appear to be particularly significant, particularly as there is something that should be self-evident about suicide. “The unfortunate few people with mental health issues are obviously at risk of suicide, which is due to them becoming too depressed”. What’s interesting about that sentence, is that none of those components are true. Firstly, with regards to the unfortunate few – we are now more aware that mental illness is extremely common. As much as a quarter of the population will suffer from depression at some point in their lives – not sadness, not bereavement or grief, but a clinical situation where their capacity to process emotions becomes damaged and requires intervention. The commonest mental illness is still anxiety – not a fear of spiders or avoiding black cats, but a pathological inability to control how they respond to the normal world. Our very reasonable skepticism then intervenes. 25% of the population? Where are all the people falling off office buildings on a daily basis? We should be having fulltime Monty Pythonesque “bring out your dead” carriers operating the streets. Then comes the rather unusual reality that, in the world of mental health, suicide is actually rather rare. Multiple international studies confirm that there are two spikes in lifetime risks of suicide – the 18-25 age bracket, and the 80 years old and above bracket. I work fulltime as an old age and adult psychiatrist, covering both high-risk areas, and process approximately 800-1000 cases a year. Yet I encounter a completed suicide approximately once every 2 years. Whenever we get a case it is a tragedy for myself and my teams, but whilst I remember every patient we have lost, I often consider it strange that there are not more we have to remember. The reality is that, most patients with mental health issues merely suffer in silence and continue. Treatment can considerably improve their functioning, and perhaps explains why I can count on one hand the suicides that I am aware of after 12 years of clinical practice. Yet the most interesting – and novel – issue in this is the premise that depression and suicidality are two different things. Fairweather-Schmidt and colleagues of the University of Melbourne studied 7485 people and applied statistical analysis to query whether suicidal behaviour was a symptom of depression or an independent construct. What was fascinating, was that their research indicated that the data fitted a two-factor model of depression and suicidality better than a single-factor model – meaning that suicidality was distinguishable from depression. This fits a number of preceding studies looking at the effectiveness and roles of medication. We have known for a long time that there is a temporary increase in suicidality in the first few weeks of starting an antidepressant before the patient starts to improve in mood – which is why they require monitoring during this period. What has also been known is that there are interesting distinctly “antisuicidal” properties of certain medications – such as lithium and clozapine. What this all means is that if a person is distressed and feeling that life is not worthwhile, there may be a serious issue – and, most importantly, a reversible issue. They do not need to be otherwise depressed. They may have a mental illness – and if they do, it is not an unusual issue, about as common as having an elevated blood pressure. And they deserve help. Suicidality is never normal. The body’s self-preservation instincts are built into every cell. A person thrown into water will instinctively twist every muscle in their body in order to gasp for air. Something has to go seriously awry before the mind starts to override the body. The need to preserve life is built into all of us. We should have the same approach to our friends and relatives, regardless of how depressed we think they may – or may not – be. Share Author: Neil R Jeyasingam Date: 01 October, 2015 Posted By: Profectus-Admin

Gender, Sexuality, and Religion: The End. It was shortly after the second mission to Mars that society finally ceased. It was probably 2050, although the date is certainly in dispute, when sexual perversion was finally eradicated. It was, unsurprisingly if uncharitably, the Germans who were responsible, but with noble causes. In 2005 the Prevention Project Dunkelfeld took the unusual step of mass advertising to find those with pedophilic urges, for the purposes of encouraging them to step forward and receive treatment. There were parallels with the Americans, such as Professor Letorneau’s network of individuals all trying to suppress their urges. However, they were up against the same problems that the failed aversion therapists of the 1970s found – that pedophilia, and many sexual perversions, were in fact sexual orientations and fundamentally unchangeable, only repressible. Whilst this had been well known amongst academics, the mass recruitment of these individuals now brought them into the public eye, and the debates regarding sexual identity restarted. If these were socially unacceptable sexual orientations, what about bestiality? Bisexuality? Pansexuality? Who decided what was wrong or right? There was a powerful religious component, naturally. By then most once-powerful mainstream churches that had made the mistake of embracing homosexuality had since declined into minor grassroots movements, leaving congregations packing only the conservative churches. Those that remained were slight, and battled against a world that viewed their doctrine as immature and relics of a primitive society. This was their chance. We warned you, the message was, Sexual perversion is a sin, and denial of anything but a male or female identity is an Abomination. It was their time to shine, and the debate was simpler now as it was no longer about gender identity. That had been settled by John Hopkins University, which in the 1970s ceased offering sex-change surgery after determining that transgender identity was in fact a mental illness. It took several decades for the work of Professor McHugh to be embraced by the broader psychiatric community, but the poor outcomes for sexual reassignment surgeries, the persisting 50% suicide rate for transgendered individuals, and the disaster of the Oslo commune cemented the end of the debate. That was a curious experiment, and even attracted some cautious government funding, but the Norwegian initiative in 2030 was to establish a large residence for village-style living and an interesting sociological premise. In this society, people were free to choose any gender, free to express their sexuality however they wished, and there was shared responsibility for the upbringing of children. There was a massively decentralised system of government, world-class health care, and self-sufficient agriculture. It was certain to work, argued its proponents, as anthropological history was replete with similar examples. What about the hijras of India, or the mak nyahs of Malaysia? It was supposed to be a perfect utopia, but it didn’t take long for the horror stories to slowly filter through to the real world. Their defenders argued that the experiment was spoiled by a couple of narcissistic predators, but it was hard to hear their voices over the screams. So gender identity was now rewritten as Gender Dysphoria again, and the unfortunate situation that a person had a mind that didn’t fit with their body, required a change in the mind, not the body. One could not maintain a mind that did not have a rational connection to the real world. And all criminal behaviours – bestiality, bisexuality, asexuality, narcissism, excessive drinking, prodigious thought, paracetamol intake, beliefs in higher powers as opposed to biological determinism – these all had to be eradicated. And it was 2050, when they worked out how to do that. It was as an afterthought that Religion entered psychology textbooks as a listed immature defence mechanism – “supernatural preoccupation in order to avoid personal responsibility”. In the Diagnostic and Statistical Manual (Version 8), homosexuality quietly slipped back in as a listed mental illness, after it was removed in 1973. The war between religious doctrine and identity diversity was finally over, and there were no survivors. And with that, there was no further growth. Society stood still, forever and ever, as the seas rose. Share Author: Neil R Jeyasingam Date: 20 September, 2015 Posted By: Profectus-Admin

Tony Abbott’s Mental Health Legacy Farewell It is important to be seriously concerned regarding Mr Tony Abbott’s mental health at this stage. It has been long known that mental health crises have an association with major life events, such as recently losing one’s job. Kendler and colleages in 1999 studied 2000 pairs of individuals, and determined that the risk of major depression increased by as much as fivefold following a major life event. We still consider that depression is not caused by life events per se, but rather by vulnerable individuals being exposed to stress, however sudden unemployment leads to worrisome outcomes for Mr Abbott. If there is any consolation, in the event of developing depression he is likely to be in considerable company. For example, one of his earliest actions in September 2013 which blocked pay rises for aged care workers was part of a cascade of interventions that damaged aged care mental health. Although most research suggests that people should expect better mental health as they grow older, there is a significant disparity between community dwellers and those in residential facilities, with some studies finding rates of depression as high as 50%. Abolishing the Advisory Panel on Positive Ageing in 2013, following that up with December 2014’s removal of the Aged Care Reform Implementation Council, Aged Care Planning Advisory Committee, Minister’s Dementia Advisory Group and even the Aged Care Standards and Accreditation Agency will lead to many more vulnerable seniors never receiving the care they deserve. At present we still do not have anything approaching an organised approach to aged care residences that are mental health aware, despite considerable demand. However, he probably does not wish to relate to older adults, so the incredible mental health load of asylum seekers can be his next compatriates in suffering. Newman and Steel’s 2004 study identified threefold increases in psychiatric disorders in adults and tenfold increases in children, after detention. Australia even has the distinction of creating its own mental health diagnosis, with Associate Professor Sundram in May 2012 coining “Prolonged Asylum Seekers Syndrome” secondary to lengthy detainment with repeated rejections. Of course, now that the boats have been stopped there are less to worry about, as they’re not around here and therefore do not exist. Some consideration must however be given to his likely need for professional sympathy, and fortunately his consistent approach to climate change creates an admittedly smaller but interesting cohort of fellow patients. That is, climate change scientists themselves. Holmes commented on Richardson’s interviews of several climate scientists, finding that they suffered “ from ‘pre-traumatic stress,’ the overwhelming sense of anger, panic, and ‘obsessive-intrusive thoughts’ that results when your work every day is to chart a planetary future that looks increasingly apocalyptic” – particularly in the face on widespread denial from those who could potentially actually make a difference. The American Psychological Association’s task force on climate change – formed primarily to work out how to convince leaders of its significance – has also identified considerable impacts on the mental health of the general population. Now that we know that wind power is just plain ugly, and that awful female-unfriendly carbon tax has been abolished, this fortunately frees up many more for Mr Abbott to empathise with. It is remarkable to note that one man has done so much for mental health in such a short space of time. Mental illness is an important and dominant issue, and thanks to his efforts, there will soon be a lot more of it around. Share Author: Neil R Jeyasingam Date: 17 September, 2015 Posted By: Profectus-Admin