Gargoyles, tarantulas, bloodied children: Research begins into mystery syndrome where people see visions of horror

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anxiety, blindness, charles bonnet syndrome, Depression, hallucinations, isolation, mental health issues, neuroscience, stress, treatment, visions, visually impaired

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Gargoyles, tarantulas, bloodied children: Research begins into mystery syndrome where people see visions of horror

Estimated one million visually impaired people in UK are thought to experience bizarre ultra-lifelike hallucinations – including spiders crawling from books and Victorian families appearing in crowds.

The first time Dr Amit Patel saw the girl in his home he was so astonished he fell down the stairs.

“She was so vivid,” he remembers today. “I could see the detail on her dress. There was blood smeared on her face.”

A month earlier, in November 2012, the former A&E medic had gone suddenly blind after catastrophic haemorrhaging in both eyes.

As he attempted to negotiate a world without sight, the girl – or rather a crystal-clear vision of one; white dress, black hair, bloodied and bruised – appeared without warning. And she has been doing so ever since.

“I can be working, walking down the street, with the kids, and she’ll suddenly be there,” the 40-year-old father-of-two says. “She once watched me change my daughter’s nappy. She’s always on trains.”

This is Charles Bonnet Syndrome – and an estimated 1 million partially sighted and blind people in the UK are believed to live with it.

They see – often on a near daily basis – intensely real, hyper-detailed visions. Sometimes these are benign: flowers sprouting, musical notes hanging in the air or rainbows forming.

But for many – for reasons which nobody understands – the scenes come tinged with horror. Tarantulas crawl out of books, gargoyles appear amid friends, zombies turn up in homes. In an online post, one UK sufferer, describes seeing a person crumble to dust in front of them. Dr Patel likens his visitor to the girl in The Ring. “Used to love that film,” he says today. Now, he’s less enamoured.

“Something I hear a lot is it’s like being inside a horror movie,” says Judith Potts, founder of Esme’s Umbrella, the UK’s only charity dedicated to the condition. “People know it’s not real but they can’t switch it off. There is no cure. They cannot escape.”

A major study being carried out by neuroscientists at the University of Oxford will this summer begin investigating what might cause CBS. In doing so, they hope to, firstly, destigmatise an illness which many are believed to suffer with silently for fear their sanity may be questioned, and, secondly, lay the groundwork for finding an eventual treatment.

Crucially, while it has long been established that the syndrome is to do with the eye’s interaction with the brain – as opposed to being a form of psychosis or dementia – the research will aim to establish what exactly is happening within that process.

“It is so important,” says Ms Potts. “This affects every part of people’s lives. If you wake up in a morning and see a tiger in your doorway that’s so real you can see the saliva on its teeth – that’s just one example of someone I spoke to recently – if you see that, it is so terrifying that, even though you know it’s not real, the anxiety puts huge stress on your life.

“Some people won’t go out as much because they don’t want to have these visions in public, or they become depressed. They have accidents. You can imagine it’s rather distracting suddenly being confronted by a Victorian family as you walk down the street.”

She herself founded Esme’s Umbrella in 2015 because her mother – the Esme in question – had suffered with the condition but found nowhere to turn: “A wonderful lucid woman who did the cryptic crossword everyday but who also happened to see gargoyles jumping around her kitchen,” notes Ms Potts.

Charles Bonnet Syndrome itself was first identified in 1760 by the Swiss naturalist and philosopher whose grandfather – a sane and cogent man – confided in his grandson that he had started seeing birds he knew could not possibly be there.

Yet, perhaps, because the condition appears to cause no apparent physical or mental deterioration, research has been sparse and wider knowledge of it remains hugely limited.

Despite estimates that half of all visually impaired people in the UK suffer – a figure put forward by the King’s College London neuroscientist Dr Dominic Ffytche – most have never heard of it until they are diagnosed. It was only four years ago, indeed, that the Royal College of Ophthalmologists started advising its doctors they should ask patients as a matter of routine if they experienced hallucinations in a bid to better understand the syndrome.

The fact the visions are so often characterised by something vaguely dreadful is, one expert told The Independent, “beyond the current limit” of scientific understanding.

Stress, isolation and anxiety may spark the visions, some believe. But even this is open to interpretation – because the visions probably increase stress and anxiety levels.

“The first time it happened I thought I was losing my mind,” says Arthur Anston, a 71-year-old retired sales director, as he describes an unknown person suddenly appearing as he travelled in a car with his wife.

“They started very modern-looking, then their appearance went back in time – Victorian, Roman – until I had a prehistoric man looking at me,” he adds.

So scared was he that his son-in-law immediately took him to hospital. “No one ever told me when I started losing my sight this might happen,” the grandfather-of-two from Manchester says. “I’d never heard of CBS. All I knew was I was seeing something that no one else was. It was disturbing.”

It is a word commonly used by many of those diagnosed with the condition.

For Nina Chesworth, the first time she saw visions was just days after suffering the trauma of losing her sight during a home accident in 2018. Kaleidoscopic rainbows and coloured patterns suddenly appeared as she lay in hospital, eventually progressing, over the next few weeks, into unicorns.

“I’m a graphic designer by training,” the 38-year-old mother-of-one says. “So, I was a bit like, ‘Well, this is interesting’. I would observe all these colours and patterns. I found them comforting in a way. I still do sometimes.”

At one point she saw Danger Mouse. “I loved Danger Mouse,” she says. “That was lovely.”

Then, however, came the zombies and snarling dogs.

“I was sat on the sofa at home the first time,” the mother-of-one from Manchester recalls. “I was too scared to move for hours. It’s not like you can shut your eyes and stop seeing it. It stays right there in front of you.”

Now she has got used to the strange mix of visitors she is less concerned – “sometimes I sit studying them” – but they have caused her accidents, led to plans being cancelled and can make the world feel overwhelming.

“As a blind person you rely on all your other senses but when the visions start, they can take over,” she says. “They are incapacitating, even when it’s not bad stuff you’re seeing.”

It is for this exact reason that Esme’s Unbrella and the Fight For Sight charity are now funding the new research.

Pertinently, with 4 million people in the UK set to have some form of visual impairment by 2050 – a number which would result in a possible 2 million people with CBS – experts say it is more crucial than ever to get a grip on the syndrome.

“So much more needs to be done to understand this,” says Sherine Krause, chief executive of Fight For Sight. “With a better understanding of the causes, we will be one step closer to developing a treatment and a cure.”

The study will see some 20 people – 10 with CBS and 10 without – have certain chemicals in their brains measured and monitored over a period of time.

“By looking at that, we can see if there may be an imbalance in chemistry in the visional system that may be a cause of these really weird visions,” says Holly Bridge, a professor of neuroscience leading the study. “If we can establish that, then it can become possible lead to treatment because you could look to develop ways of changing those chemical balances. In the very long term, it may well be that you could develop an appropriate drug to keep those chemical levels in proportion.”

Early results will come within 12 months and a fully published paper within 18 – but a treatment, of course, might not arrive for years.

All the same, back with Amit in London – flanked by trusty guide dog Kika – he longs for the day when the girl from The Ring is no longer a regular visitor. He would not, it is safe to say, miss her.

“I was thinking the other day,” he says, “she’s been in my life longer than my children. It would be nice now to be rid of her”.

How mental distress can cause physical pain

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anxiety, Depression, depressive symptoms, diagnosis, distress, emotional distress, emotions, gastrointestinal issues, mental health issues, nausea, numbness, palpitations, panic, panic attacks, physical aches, physical pain, physical symptoms, psychological symptoms, stomach pains, stress

How mental distress can cause physical pain

It took Gemma* years to realise why she vomiting three of four times a week. She wasn’t suffering from some mysterious stomach illness. Instead, it was her mental health deteriorating.

“I have generalised anxiety disorder and panic disorder. I actually had physical symptoms first, long before I even knew what panic attacks or anxiety were,” the 24-year-old student based in London tells The Independent. “I suffer particularly badly from gastrointestinal issues. I spent years throwing up three or four times a week, ending up in hospital, with no real discernible ‘physical’ cause. The cause was anxiety, expressed physically.”

Gemma believes that her condition went undiagnosed for so long because of how mental and physical conditions are too often treated as mutually exclusive, when they are in fact inextricably linked.

“I think people very much misunderstand the link between physical and mental health,” she goes on. “I was one of those people. I didn’t even realise they could be connected when I was a teenager. I thought I was relaxed. Anxiety was the last thing I thought I was suffering from. But I was ignoring a lot of stress and was poor at acknowledging my own emotions. That stress had to come out somewhere, and I almost feel like it was my body trying to get me to listen.”

Now, Gemma knows that anxiety can cause her severe stomach pains. Or that panic attacks are what most often fill her stomach with nausea, cause her arms and legs to go numb, and her heart to palpitate.

Similarly, Courtney*, a 25-year-old publicist based in London, says her depression causes her to feel lethargic and sluggish and her bones and joints stiff and achy.

“The bigger problem with physical symptoms is for the anxiety side of things. Outside of panic attacks, a bad flare up of anxiety gives me absolutely stunning headaches with blurred or double vision, which often makes it hard to work – especially at a computer screen,” she tellsThe Independent.

And as the stigma of suffering from mental illness is talked about more widely, these comparatively nuanced aspects of understanding health are what need to be tackled next, say experts.

“The idea that mental illness is ‘all in your head’ is not only outdated, but can make us blind to the physical symptoms that can be a sign of mental health problems,” Rethink Mental Illness spokeswoman Nia Charpentier tells The Independent.

“For example, if you have anxiety, you may experience a fast heart rate and sweating; or for someone living with Post Traumatic Stress Disorder, the flashbacks can cause aches and pains, or make you feel sick. Similarly, depression can affect your appetite, causing you to either lose or gain weight.

Eating disorders such as bulimia and anorexia are perhaps the most obvious ways that serious mental illness can affect a person’s physical health.

“In the case of eating disorders, these illnesses may well involve physical symptoms that can become increasingly obvious over time, depending on the specific illness. However, it’s very important to remember that these are mental illnesses at their root, and changes to behaviour and mood will probably be noticeable long before any physical signs,” a spokesperson for the eating disorder charity B-Eat stresses. “It’s vital that people are aware of these psychological symptoms as well as the physical ones, as the sooner someone enters treatment for an eating disorder, the better their chance of recovery.”

It is erasing this confusing that spurs the Mental Health Foundation on to campaign for health check to include mental health screenings.

“Men in their forties are routinely screened for their blood pressure and cholesterol levels, when they are more at risk of ending their life by suicide,” points out Dr Antonis Kousoulis at the Mental Health Foundation, adding: “It’s crucial that health screening cover the health of our minds as well as the health of our bodies.”

*Name has been changed

Doctors’ new prescription: ‘Don’t just exercise, do it outside’

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'park prescriptions', activities, environment, Exercise, exercise regime, health, health initiative, nature, obesity, outdoors, park, physically active, prescriptions, scenery, sedentary, stress, trail, wellness

Doctors’ new prescription: ‘Don’t just exercise, do it outside’

It’s become commonplace for San Francisco physician Daphne Miller to write prescriptions that look like this:

Drug: Exercise in Glen Canyon Park
Dose: 45 minutes of walking or running
Directions: Monday, Wednesday, Friday and Saturday at 7am
Refills: Unlimited

She estimates she has now written hundreds of prescriptions for outdoor activity. “For some reason, it is much easier to keep up a movement or exercise regimen when it’s outdoors,” Miller says.

Perhaps it’s because of the varying scenery, the fact that monthly dues and expensive Spandex outfits aren’t required, or even because of what she calls “the camaraderie of the trail”.

Miller’s not alone. Faced with mounting obesity rates and a stubbornly sedentary population, physicians – especially pediatricians – are refining their exhortations that patients need to get more exercise.

Nationwide, they are dispensing thousands of prescriptions with specific instructions – not just going to a gym, but exercising in nature, at a park, along a trail. They’re literally telling their patients to take a hike.

“This is a lot more than getting people physically active. This is about getting them outdoors,” says Zarnaaz Bashir, director of health initiatives for the National Recreation and Park Association, a group that melds parks, recreation, the environment and now, health.

When terms like “park prescriptions” began popping up in 2008 or so, many experts viewed it as a niche idea.

“It was a quirky, fun play on words. I don’t think a lot of people thought there was going to be much substance,” says Kristin Wheeler, program director at the nonprofit parks advocacy group, Institute at the Golden Gate, in San Francisco. “Now, it’s been validated.”

The number of programs has risen steadily. Officials have identified at least 50 specific programs in the US, Wheeler says, but smaller ones may be under their radar, and new programs are popping up all the time.

The trend is spreading to other countries as well – including Australia, where a conference was recently held to discuss the health and medical benefits the country’s natural parks can offer.

In the UK, doctors are prescribing visits to Green Gyms, outdoor sessions run by a conservation group. The idea is to not only improve health and stamina through exercise and activities, such as planting trees, but also to benefit local green spaces.

A result of the green-prescriptions movement has been the unlikely teaming up of otherwise unrelated groups. The Appalachian Mountain Club, for example, forged a partnership in 2013 with MassGeneral Hospital for Children to prescribe regular outdoor physical activity for children.

“With so many proven benefits to getting active outdoors, AMC can help families take the first step in trying out new activities, finding places to explore, and making these outings fun for kids,” club CEO John Judge says.

An early proponent was Robert Zarr, a physician with Unity Health Care in Washington DC who quizzes patients about their interests, checks a searchable database for information on parks in or near their zip code, and then writes a script for specific activities. He told one obese teen to skip one of the two buses she takes to school and walk through a park instead. She ended up losing weight and feeling happier.

“We’ve really got this down,” he told attendees at a conference last year in Philadelphia. “I see this as no different from prescribing medicine for asthma or an ear infection.”

Across the continent in San Francisco, Miller says she has learned that formalizing her recommendation to get out in nature by writing it as a prescription is highly effective. “Well over 80% of patients try it, and many stick to it,” she says.

Mounting evidence shows benefits of being out and active in green spaces: less tension and stress, lower blood pressure, improved immune system responses, and milder ADHD symptoms in children. Japanese researchers have found that adherents to Shinrin-yoku – “forest bathing” – have lower levels of the stress hormone cortisol than study subjects who walk the same distance in a lab.

Beyond that, simply spending more time outdoors – versus in front of the TV screen or computer monitor – equates to an overall increase in physical activity.

Proponents say the nature prescriptions shift the focus of medicine from illness to wellness, leading to the potential for widespread changes in medical care.

Diana Allen, chief of the US National Park Service’s “Healthy Parks, Healthy People” initiative, is seeing mergers of medical schools and parks programs. “That’s wild,” she said. “I think there are going to be some new fields of practice.”

She acknowledges possible opposition from traditional practitioners and drug companies – “this goes against the money machine.” And patients who simply want to pop pills for whatever ails them also may balk.

Other than the doubtless eye-rolling of some physicians who may view the programs as gimmicky, participants in the Philadelphia conference had more practical concerns. Were the parks they would send children to safe? Would weather be an issue? Would lack of transportation be a barrier?

While early adopters of the philosophy simply leapt in without much of plan – it made intuitive sense, after all – organizers now aim to standardize programs so other communities can basically plug and play.

In Philadelphia, more than two dozen partners, including The Children’s Hospital of Philadelphia, are developing Nature Rx, a comprehensive plan aimed at ensuring that when kids show up at a park to “fill” their prescriptions, the staff is ready to welcome them with specific activities.

Gail Farmer, director of education for the 340-acre Schuylkill Center for Environmental Education and one of the organizers, says park audits will start this spring and physicians will begin writing prescriptions come summer.

Adopting standards also will help researchers who are moving to the data-gathering stage. Is it really working? Do people follow the prescriptions? And does their health improve as a result?

Wheeler has just finished an economic benefits analysis for the parks of San Francisco, which put the figure at $1bn a year.

“A piece of it is what we’ve known for a long time. People prefer liveable, walkable communities,” she says. “The big new piece is health benefits.” Those, they pegged at $50m in avoided health care costs.

Self-harm is not just attention-seeking: it’s time to talk openly about the issue

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attention-seeking, Bullying, causes, emotional distress, emotional pain, emotions, isolation, obsessions, pain, physical pain, professional help, relief, secret, self-harm, stress, teenagers, young people

Self-harm is not just attention-seeking: it’s time to talk openly about the issue

Three years ago, with her parents and sisters out for dinner, then-13-year-old Lucy found herself alone in her family’s Lincolnshire home. Dressed in her pink Tinker Bell pyjamas, she began to make herself a cup of tea. Then she spotted an object on the kitchen counter that immediately diverted her attention. “Shall I do it?” Lucy asked herself. “Will it stop the pain?”

For Lucy, now 17, that evening marked the start of a two-and-a-half year struggle with self-harm. Two weeks before, she had been brutally attacked and raped (which she now describes as “the incident”). At the time, anxious they wouldn’t believe her, Lucy never fully revealed to anyone what had happened. In her mind, she tried to repress the rape. She began shutting herself in her bedroom. She told her parents she was feeling unwell. Physical pain, she decided, was the only way to purge her pent-up emotional pain.

“When you keep all your problems in, it feels like you’re screaming inside,” Lucy says. “But when you cut or burn yourself, the pain is more physical. You feel like you’re releasing that scream. After a few months, self-harming became part of my daily routine.”

Eventually, both at school or at home, Lucy was self-harming four times a day. She wore black jeans, black tops and even black gloves to conceal her scars. “I pushed everyone everyone away” Lucy says. “I stopped caring about school. My grades suffered. Self-harm became a real obsession. It took over my life.”

Today, having made a huge effort to stop, Lucy has not self-harmed for more than six months. But self-harm is still on the rise among the UK’s young population. Data published last year by a collaborate study from England Health Behaviour in School Aged Children (HBSC) revealed that up to one in five 15-year-olds across the country self-harm. During the past decade, according to the same study, there has been a three-fold increase in the total number of UK teenagers self-harming.

What drives young people to self-harm? Therapist Jenna Mutlick, who has a personal experience of it, says it is usually some form of “self-punishment”. People believe they have done something wrong – even when they haven’t – and then feel they deserve the pain. “I know a few people who self-harm because they are bullied and eventually come to believe that they then deserve to be bullied,” she says. “When you self-harm, it is so hard to escape from the [mental] space that you are in.”

“It’s a very heterogeneous group of people who self-harm, and there are a variety of reasons why people might start,” says Professor Glyn Lewis, head of psychiatry at University College London. “Clearly, there are people who self-harm because they want to take their own lives, but there are also people who want to self-harm because they are in difficult situations or want to relieve stress.

“As a long-term strategy, of course, self-harm is not very effective,” he adds, “but people do report that they get some form of relief from upsetting thoughts or emotions. Some forms of self-harm are obviously very dangerous, but there’s a continuum. Some people may only scratch themselves very superficially, for example, which won’t do any long-lasting damage.”

The causes of self-harm are likely to be complex, even if the person harming does not see the issues in that way. Kieran, from Glasgow, began self-harming after five years of “constant” physical and verbal bullying at school. His parents split up when he was seven, though he says it was the bullying – which still torments him today – that incited his self-harming. “The bullying made me feel really unbalanced,” says Kieran, now 23. “I started to self-harm when I was aged 11, and it kind of just snowballed from there. I stopped eating. I isolated myself from a lot of my friends and family. I kept it a secret for almost a decade.”

Like Lucy, Kieran says that self-harming became a secret obsession. The bullying made him feel “physically and mentally numb”. Self-harm, by contrast, made Kieran feel more alive, and he would regularly self-harm in his bedroom at night. “It brought me out of my slumber,” he says. “It made me feel normal, and I became addicted to doing it for that reason.” He says that the self-harm was like an “adrenaline shot” that brings everything back into focus.”

Kieran admits that he still has a “daily battle” with self-harm. He is significantly better than he was a few years ago, though, when he would harm himself up to 400 times in one evening. “It’s a high level of emotional distress that causes people to resort to self-harming,” he says. “People sometimes feel like they can’t cope with their emotion. It’s how they cope with life’s daily stresses.”

Chris Leaman, from the UK mental health charity YoungMinds, says it is still very much a taboo subject in British society. “Every year, we work with Childline, YouthNet and selfharmUK to try and combat these sort of stigmas for Self-Harm Awareness Day,” he says. “There is a definite problem around young men not feeling like they can talk about their issues, which can make self-harm quite a common issue among them.”

“Some people do talk about self-harm quite openly, but that’s relatively unusual,” says Professor Glyn Lewis. “A lot of people conceal self-harming behaviour from their friends and family. There are not necessarily signs to look out for; it’s more a case of often asking people how they are feeling, and keeping communication open with them. As a rule, families and friends concerned about someone self-harming always should talk to the person themselves and encourage them to seek professional help.”

Statistically, teenage girls are still more than twice as likely to self-harm than young males, and this has helped create another gender-based stigma: that self-harming girls are simply seeking attention. Fiona Brooks, professor of adolescent and child health at the University of Hertfordshire, who led the investigations for last year’s HBSC report, identifies this as a prevalent problem. “Nowadays, young people are in a much more uncertain world than before,” she says. “Instead of self-harming just being dismissed as attention seeking, it’s something that needs to be taken seriously. Equally, if young girls are self-harming for attention, that’s a different matter that needs to be taken just as seriously.”

Lucy thinks back on that evening she started self-harming, and wishes that she could tell herself to stop – and talk to someone. Talking, like with most former self-harmers, has been a significant part of Lucy’s recovery, but she also credits her own determination as a decisive factor. “If you don’t want to stop, you won’t,” she says. “In the end, a lot of it comes down to how you see yourself. I used to feel people were always judging me, but now I feel I don’t care what they think. Why should I let them control my happiness?”

When intensive care is just too intense

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critical care, delusions, Depression, discomfort, disorientated, distress, drugs, early intervention, fears, flashbacks, hallucinations, intensive care, intrusive memories, nightmares, psychological difficulties, stress, techniques, threat, treatment

When intensive care is just too intense

I still remember the first patient I saw in intensive care. A naked man, covered by a white sheet, was plugged into banks of machines through cables that radiated from his body. His face was covered by a breathing mask, his blood connected to bags of fluids. Muted and voluntarily immobile, so as not to break the fragile web that kept him alive, his eyes tracked me as I entered the cubicle. Intensive care can be a disconcerting place.

As a treatment, it is remarkably successful. Perhaps the greatest tribute to the people who work in critical care is this simple fact: most people leave intensive care alive – despite being dangerously close to death when they arrive. Through a combination of dedication, decision-making and technology, critical care staff ensure that most people pull through. This is the result of years of careful research that has focused clinical practice on restoring the body’s functioning as quickly and efficiently as possible.

But recently there has been a dawning realisation that the impact of intensive care extends beyond the survival of the body. Dorothy Wade is based at University College Hospital in London and is one of the country’s few intensive care psychologists. She led a recent study which found that more than half of patients assessed at follow-up had marked psychological difficulties. “We learned that patients were suffering from serious depression or having frightening flashbacks and nightmares to their time in intensive care,” says Wade. “This badly affected their quality of life and also held back their physical recovery from their illness.”

In another study, recently submitted for publication, Wade interviewed patients about the hallucinations and delusions they experienced while in intensive care. One patient reported seeing puffins jumping out of the curtains firing blood from guns, another began to believe that the nurses were being paid to kill patients and zombify them. The descriptions seem faintly amusing at a distance, but both were terrifying at the time and led to distressing intrusive memories long after the patients had realised their experiences were illusory.

Many patients don’t mention these experiences while in hospital, either through fear of sounding mad, or through an inability to speak – often because of medical breathing aids, or because of fears generated by the delusions themselves. After all, who would you talk to in a zombie factory?

These experiences can be caused by the effect of serious illness on the brain, but painkilling and sedating drugs play a part and are now used only where there is no alternative. Stress also adds to the mix but is often caused inadvertently by the way intensive care wards are organised. “If you think about the sort of things used for torture,” says Hugh Montgomery, a professor of intensive care medicine at UCL, “you will experience most of them in intensive care. As a patient, you are often naked and exposed, you hear alarming noises at random times, your sleep-wake cycle is disrupted by being woken up for medical procedures through the night, you will be given drugs that could disorient you, and you will be regularly exposed to discomfort and feelings of threat.”

This has led to a recent push to reorient treatment toward reducing patient stress, and long-term psychological problems, without sacrificing life-saving efficiency. Take this simple example: a study led by consultant critical care nurse John Welch at UCL found that the pitch or tone of alarms on intensive care equipment has no relation to how urgent the situation is. Many frightening-sounding alarms are just reminders – this bag needs refilling in the next hour; don’t forget to change the filter – and are often left until more important tasks are finished. But, to the uninitiated, it might sound as if death is imminent and no one is responding.

Some stress is simply an unavoidable part of necessary medical procedures. Breathing tubes inserted through the mouth or surgically implanted through the neck are notoriously uncomfortable. And, despite the survival rates, people die in intensive care. A daunting experience if you’re a patient in the same ward.

Helping patients with their intense emotional reactions, whether they arise from hallucination, misunderstanding or medical intervention, normally happens on an ad hoc basis and for many clinicians it is a relatively new situation that hasn’t been incorporated into standard training. In many intensive care units, the approach was to sedate patients for the whole of their admission. As this practice declined, for the first time, clinicians were faced with distressed, possibly hallucinating, awake patients.

Wade is currently working with clinicians to take a more systematic approach to detecting and reducing psychological distress. “There have always been experienced or just naturally empathetic nurses and doctors in intensive care,” she says. “We’re trying to build on that natural care and compassion by teaching nurses and doctors more about the causes and nature of psychological distress… and training them with simple psychological techniques that could help to reduce immediate and long-term distress.”

For his part, Montgomery is less convinced about early intervention. He feels intensive care needs to be reorganised to reduce stress but psychological problems are best dealt with in follow-up clinics.

The best time for treatment is the subject of an ongoing debate, but for the first time studies have been funded that will answer these questions. Intensive care is being rethought and may become, at least psychologically, less intense.

Why should teachers talk about mental health with students and colleagues?

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anxiety, Bullying, career, colleagues, Depression, harassment, management, mental health issues, recovery, secret, stigma, stress, support, teachers

Why should teachers talk about mental health with students and colleagues?

Clare can now talk with calm reflection about the moment she decided to end her life. She remembers feeling as if she were living in a sort of twilight zone where nothing made sense: she was being shunned by colleagues and faced losing her job as a teacher.

Things had spiralled out of control after Clare was signed off work with stress-related depression. When invited back to school to talk about when she might return, managers tried to renegotiate her contract. Clare immediately sought legal advice. “I felt isolated, bullied and harassed.

“My managers were asking other staff members about me and I was becoming increasingly anxious by what was happening. Instead of supporting me and making reasonable adjustments to the fact that I was off with stress, the school’s response was completely punitive.”

Part of the problem is that mental illness in teaching is stigmatised, says Clare. “If you reveal that you are stressed, it is seen as a great weakness – that you are just not up to the job.”

Figures published by the Association of Teachers and Lecturers (ATL) this year showed that more than a third of school and college staff have noticed a rise in mental health issues among colleagues in the past two years. Despite this, 68% kept their problems a secret from their bosses.

In a recent Teacher Support Network survey, the majority of teachers (89%) blamed excessive workloads for their mental health problems, and 40% wouldn’t talk to anyone at work about mental illness because was seen as “a sign of weakness”.

People worry about being seen as not good enough, says Tim, a teacher who retired early due to stress and anxiety. “If you are suffering from work-related stress you are especially reluctant to seek the support of senior management for fear that your complaints could be seen as an indictment of their management.”

David Ambler, ATL district secretary in Birmingham, says mental health problems are also stigmatised because of worries about how this will make a school look. “To reduce the stigmatisation of mental illness requires more than simply a change of attitude among headteachers and senior management in school. It requires a change of attitude among the general public and parents to understand that teaching is a stressful job and sometimes teachers go under or need treatment.”

When Michael was signed off with stress-related depression, he found that some colleagues were understanding but others were not. Teachers worry about the impact of admitting to a mental health problem on their career, he says. The headteacher who employed Michael in his current post said that she was taking a huge risk and put him on a six-month trial period. “Employers are not as sure about mental illness as they would be about physical illness,” he says. “If I broke my leg, for example, and came back to work I don’t think I would be trialled in the same way.”

But this needn’t be the case if the stigma around the issue of mental illness is tackled and the right support is put in place. Rachel, who has experienced depression for years but hasn’t taken time off work, puts her ability to keep teaching without taking any extensive leave down to the support of her senior leadership team and colleagues.

“I am able to talk to all my senior management team and have good friends on the staff who also know and are supportive. My experience of mental health, if anything, has done the opposite of holding me back. But if I had not received the understanding and support I did then I would almost certainly have ended up off sick and probably left teaching.”

Nor is this just an issue of doing the right thing and supporting people experiencing mental health problems – it’s also essential to their recovery. Alison Stark, a senior teacher at a Dutch secondary school, who is off sick with work-related burnout, says there is a more open culture to mental health in the Netherlands.

“The first step is admitting that you have a problem. I talked about my problems with a friend and just being able to say out loud that I am struggling helped me accept things,” she says.

Her school has been patient and supportive – rather than worrying about what to say, colleagues have sent her cards, flowers and message of support. “It is important that schools have a supportive management who are understanding. Headteachers need to support management and create an atmosphere in which teachers can talk about it [mental illness].”

For Stark, the most supportive person has been her deputy head, who has sought solutions by asking her what she needs and what would aid her recovery. “They say, ‘do you want me to allow you home access to email or not? Should I block it and protect you?’”

An openness about mental illness could also help students by ensuring they have positive role models. Kelly, who just started in a girls’ school, is recovering from an eating disorder and used to self-harm. She says stress from teaching can cause a flare-up in food-control behaviours and she has visible scars on her arm. “I am what you could call a normal weight so it’s not obvious I struggled with bulimia, anorexia and excessive exercising,” she says.

Kelly wants to share her experiences to show her pupils that no one should let mental health problems define them, but she worries about the repercussions. “I worry that my school would not be supportive of my talking about my experiences as they would be concerned about the potential backlash from parents. If students mis-reported the story at home some parents may be concerned about my capacity to cope.”

• Most of the names in this article have been changed to protect the teachers who shared their stories.

The Tackling mental health stigma in schools series is funded by Time to Change. All content is editorially independent except for pieces labelled advertisement feature. Find out more here.

Mindfulness therapy comes at a high price for some, say experts

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anxiety, attention, breath, depersonalisation, Depression, health professionals, meditation, mindful living, mindfulness, mindfulness meditation, mindfulness therapy, mindfulness-based cognitive therapy (MBCT), NHS, side-effects, stress, teachers, training, trauma memories, vulnerability

Mindfulness therapy comes at a high price for some, say experts

In a first floor room above a gridlocked London street, 20 strangers shuffle on to mats and cushions. There’s an advertising executive, a personnel manager, a student and a pensioner. A gong sounds softly and a session of sitting meditation begins. This is one of more than 1,000 mindfulness courses proliferating across the UK as more and more people struggling with anxiety, depression and stress turn towards a practice adapted from a 2,400-year-old Buddhist tradition.

Enthusiasm is booming for such mindfulness-based cognitive therapy (MBCT) courses, which an Oxford University study has found can reduce relapses into depression by 44%. It is, say the researchers, as effective as taking antidepressants. It involves sitting still, focusing on your breath, noticing when your attention drifts and bringing it back to your breath – and it is surprisingly challenging.

Lifestyle magazines brim with mindfulness features and the global advertising giant JWT listed mindful living as one of its 10 trends to shape the world in 2014 as consumers develop “a quasi-Zen desire to experience everything in a more present, conscious way”.

But psychiatrists have now sounded a warning that as well as bringing benefits, mindfulness meditation can have troubling side-effects. Evidence is also emerging of underqualified teachers presenting themselves as mindfulness experts, including through the NHS.

The concern comes not from critics of mindfulness but from supporters, such as Dr Florian Ruths, consultant psychiatrist at the Maudsley hospital in south London. He has launched an investigation into adverse reactions to MBCT, which have included rare cases of “depersonalisation”, where people feel like they are watching themselves in a film.

“There is a lot of enthusiasm for mindfulness-based therapies and they are very powerful interventions,” Ruths said. “But they can also have side-effects. Mindfulness is delivered to potentially vulnerable people with mental illness, including depression and anxiety, so it needs to be taught by people who know the basics about those illnesses, and when to refer people for specialist help.”

His inquiry follows the “dark night” project at Brown University in the US, which has catalogued how some Buddhist meditators have been assailed by traumatic memories. Problems recorded by Professor Willoughby Britton, the lead psychiatrist, include “cognitive, perceptual and sensory aberrations”, changes in their sense of self and impairment in social relationships. One Buddhist monk, Shinzen Young, has described the “dark night” phenomenon as an “irreversible insight into emptiness” and “enlightenment’s evil twin”.

Mindfulness experts say such extreme adverse reactions are rare and are most likely to follow prolonged periods of meditation, such as weeks on a silent retreat. But the studies represent a new strain of critical thinking about mindfulness meditation amid an avalanche of hype.

MBCT is commonly taught in groups in an eight-week programme and courses sell out fast. Ed Halliwell, who teaches in London and West Sussex, said some of his courses fill up within 48 hours of their being announced.

“You can sometimes get the impression from the enthusiasm that is being shown about it helping with depression and anxiety that mindfulness is a magic pill you can apply without effort,” he said. “You start watching your breath and all your problems are solved. It is not like that at all. You are working with the heart of your experiences, learning to turn towards them, and that is difficult and can be uncomfortable.”

Mindfulness is spreading fast into village halls, schools and hospitals and even the offices of banks and internet giants such as Google. The online meditation app Headspace now has 523,000 users in the UK, a threefold increase in 12 months. But mounting public interest means more teachers are urgently needed and concern is growing about the adequacy of training. Several sources have told the Guardian that some NHS trusts are asking health professionals to teach mindfulness after only having completed a basic eight-week beginners’ course.

“It is worrying,” said Rebecca Crane, director of the Centre for Mindfulness Research and Practice in Bangor, which has trained 2,500 teachers in the past five years. “People come along to our week-long teacher training retreat and then are put under pressure to get teaching very quickly.”

Exeter University has launched an inquiry into how 43 NHS trusts across the UK are meeting the ballooning demand for MBCT.

Marie Johansson, clinical lead at Oxford University’s mindfulness centre, stressed the need for proper training of at least a year until health professionals can teach meditation, partly because on rare occasions it can throw up “extremely distressing experiences”.

“Taking the course is quite challenging,” she said. “You need to be reasonably stable and well. Noticing what is going on in your mind and body may be completely new and you may discover that there are patterns of thinking and acting and behaving that no longer serve you well. There might be patterns that interfere with living a healthy life and seeing those patterns can bring up lots of reactions and it can be too much to deal with. Unless it is handled well, the person could close down, go away with an increase in self-criticism and feeling they have failed.”

Finding the right teacher is often difficult for people approaching mindfulness for the first time. Leading mindfulness teaching organisations, including the universities of Oxford, Bangor and Exeter, are now considering establishing a register of course leaders who meet good practice guidelines. They expect mindfulness teachers to train for at least a year and to remain under supervision. Some Buddhists have opposed the idea, arguing it is unreasonable to regulate a practice rooted in a religion.

Lokhadi, a mindfulness meditation teacher in London for the past nine years, has regular experience of some of the difficulties mindfulness meditation can throw up.

“While mindfulness meditation doesn’t change people’s experience, things can feel worse before they feel better,” she said. “As awareness increases, your sensitivity to experiences increases. If someone is feeling vulnerable or is not well supported, it can be quite daunting. It can bring up grief and all kinds of emotions, which need to be capably held by an experienced and suitably trained teacher.

“When choosing a course you need to have a sense of the training of the teacher, whether they are supervised and whether they themselves practise meditation. Most reputable teacher training courses require a minimum of two years’ meditation practice and ensure that teachers meet other important criteria.”

The bizarre sleeping habits of Brits revealed: From sleep-walking to sleep-drawing

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anxiety, drawing, dreams, families, painting, sleep, sleep deprivation, sleep-talking, sleepwalking, somnambulists, stress, writing

The bizarre sleeping habits of Brits revealed: From sleep-walking to sleep-drawing

A new study of sleeping habits in the UK has shown Brits are a restless bunch, with over 40 per cent talking in their sleep, and more surprisingly almost 10 per cent getting creative by drawing, painting or writing while in the land of nod.

In a survey of 2,000 UK adults, overall 42 per cent spoke in their sleep, with almost half of 25 to 34-year-olds continuing to natter away. It also revealed that women are more prone to sleep-talking than men, as 46 per cent admitted to the behaviour, in comparison to 35 per cent of men.

The study also showed that one in 10 people are somnambulists, or sleep-walkers. Sleepwalking usually occurs in a period of deep sleep during the first few hours after falling asleep.

While the exact cause is unknown, it seems to run in families, according to the NHS. Sleep deprivation, stress and anxiety, and drinking too much alcohol, taking recreational are among the factors that can trigger sleep walking.

The research commissioned by Ibis Hotels also gave in an insight into the mysterious world of dreams, with some 16 per cent of adults convinced that they had dreamt something that they claim later came true. Meanwhile, a quarter of those surveyed reported having a recurring dream for six months.

The peculiarities of sleepers across the UK were also revealed, as people in the North East were more likely to have recurring dreams, while a quarter of people in the same region admitted to dream cheating on their partners. But the Scottish appear to be the most self-conscious about their behaviour, as a fifth have had a sexual dream about someone and felt embarrassed to see them the next day.

Meanwhile, Londoners were more prone to having the same dreams as their friends and families on the same night. Residents of the capital were also more likely to be able to get back into a dream after waking up.

Night terrors: In my wildest dreams

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adults, Children, night terror, nightmares, panic, reassurance, scream, shout, sleep, stress, terror

Night terrors: In my wildest dreams

The walls are closing in on me. The air is sucked out of my lungs and everything turns black. One thought pulses through my mind – to get out of the room, no matter how. I push open my window and start climbing out. Only when the fresh air hits me do I realise something’s not right. I fall backwards and crawl back into bed, confused and disorientated by my surroundings.

This was the most dangerous night terror I suffered during my final year at university. I initially forgot what had happened, until I saw the chaos the next morning – my desk and chair were overturned, my books had been knocked off my bedside table and my laptop’s screen had smashed. The window was still wide open.

Deep bruises came up a day after, with the right-hand side of my body turning black and blue. My GP practically laughed me out of the surgery when I went in for a consultation. “There’s nothing I can do about it, it happens in your sleep,” he said, smiling. It was only once I had moved to London and suffered a similar attack that left me bleeding that I decided I’d had enough. After a three-month wait, I finally managed to get a space in one of the UK’s busiest sleep clinics for an overnight study.

The technicians wired me up at the clinic at London Bridge. There were 10 sensors attached to my head alone, with countless cables running down my body. Lying on the bed, monitored by two cameras, I knew that I wouldn’t be having a night terror that night. But I was hopeful that the results might shed some light on my condition.

When someone suffers from a night terror, they can scream, shout and thrash around in extreme panic, sometimes jumping out of bed. It’s an unnerving experience for anyone to watch – the sufferer’s eyes will be open, but they’re not fully awake or aware of what they’re doing. Once the panic subsides, the person will fall back asleep, oblivious to the chaos.

Most people experience nightmares or night terrors growing up. Figures show that between 20 and 30 per cent of children between the ages of five and 12 have frequent nightmares, while night terrors affect 17 per cent of children. Once children reach adulthood, incidence rates are much lower, with only one in 20 of that 17 per cent still reporting night terrors in later life. But recent research has linked recurring night-time problems to more ominous long-term consequences. A study conducted by the University of Warwick followed nearly 6,800 children up to the age of 12. The results suggest that long-term sufferers of nightmares and night terrors have a higher risk of mental health problems as they enter adolescence. Those having nightmares aged 12 were three-and-a-half times more likely to have problems and the risk was nearly doubled by regular night terrors.

Psychology professor Dieter Wolke led the research at Warwick. He says that while children often experience night-time problems, in adults, it’s only around 1 to 2 per cent who still have night terrors. When they persist into adulthood, the physical risks also increase. “Night terrors become more dangerous, as you’re larger and more mobile. People are known to have fallen off balconies or thrown themselves out of windows,” says Professor Wolke.

From a young age, I have been a restless sleeper, but the night terrors only started happening when I entered my teens. It wasn’t until university that they became more severe. The more extreme ones saw me running around the house or frantically trying to open my bedroom window.

So why do night terrors occur? According to Dr Nicholas Oscroft, a respiratory physician at Papworth Hospital, genetics and not getting enough sleep could be to blame. “It does seem to run in families… From previous research it has become clear that night terrors happen more often if people don’t get enough sleep on a regular basis. Work or family-related stress also increases the risk.”

Another sufferer is 24-year-old Kevin Stone. He started having night terrors from the age of seven. He believes it’s because of having lived in South Africa, where his family experienced regular break-ins. His night terrors follow a repeated theme – someone is always trying to chase or kill him. “I once dreamt that people had broken into the house and were in my room. They made me get out of bed and kneel on the floor while I tried to convince them not to kill me. When I have a night terror, I act out everything. I can hear their voices, I can see them, I can even feel the gun against my head.”

Stone’s night terrors took a gruesome turn when he was 18. One night, he woke up and was convinced someone had broken into the house. As a result, he jumped out of his bedroom window and fractured his spine and broke both his ankles. “I realised what I was doing just before I hit the ground.” Terrified by what his sleeping mind was capable of, he sought treatment to stop his night terrors from happening. But he believes that his problems can’t be solved, because it’s all in his mind. “Doctors have said to keep a bedtime journal to clear my mind, but that hasn’t worked.” He also wasn’t happy with the option of being prescribed antidepressants.

So can night terrors be solved? Dr Oscroft seems unsure. “Adult patients who suffer from them need to try and reduce how often it happens. The best way to achieve this is by getting enough sleep. People should also optimise their sleeping environment, so that they won’t be woken up during the first two hours of sleep, which is when night terrors are most likely to occur.”

Night terrors can put a strain on relationships. Dr Oscroft says the best thing to do when someone is suffering from a night terror is to reassure them. “People who are having a night terror will be agitated, so the best thing to do is to calmly talk to them until they wake up. Don’t try to restrain them unless they are in danger of hurting themselves.”

My results from the sleep clinic proved surprising. I had woken up four times during the night – flustered and disorientated. Even though there was no physical cause, I do suffer from slow wave arousal disorder, which is usually associated with sleepwalking and other sleeping disorders. Aside from the advice to sleep more or to take sleeping pills, my diagnosis remains unchanged. I suspect that it will be something I’ll have to deal with on a regular basis throughout my life. Until they stop completely, I’ll be keeping my bedroom window firmly locked.

Teachers left to pick up pieces from cuts to youth mental health services

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behavioural problems, CAMHs, Children, counselling, counsellors, early intervention, emotional difficulties, mental health issues, mental health services, school, stress, support, teachers, training, well-being, young people

Teachers left to pick up pieces from cuts to youth mental health services

As the headteacher of large primary school in the west of England, Joan Cunningham is accustomed to the demanding aspects of managing an intake from a mainly disadvantaged area. However, for the past couple of years, she says, one issue has escalated so dramatically that it is nearly at crisis point. “There is so much more pressure on schools and teachers to deal with children’s mental health and behavioural problems,” she says. “We provide as much support as we can but, with fewer resources available and a massive increase in need … the pressure has been incredible.”

Cuts to mental health and other services for young people mean teachers are increasingly having to fill the gap, even though schools do not always have the resources or training to provide the extra support pupils with mental or emotional issues may need.

“It was already hard to access the right services before cuts but its getting worse,” Cunningham says. “Teachers … are not mental health professionals, and now there is a vacuum in the services we have [traditionally] relied on. Social services departments are under more pressure due to cuts, Sure Starts … have vanished, [and] in many cases the voluntary organisations we used to be able to turn to are disappearing. Sign-posting families to where they can get help is much harder because of all of this.” At a time when families are under greater financial strain and “even very young children” are under pressure to achieve academically, she concludes, the need for support is “growing very fast”.

Child and adolescent mental health services (Camhs) have been particularly hard hit. These specialist services assess and treat children and young people with mental, emotional or behavioural difficulties. Typically, when schools cannot offer the support of their own counsellor, or when a child has especially serious difficulties, they will seek out their local Camhs for help.

In many cases, local authorities commission and fund these services, and the impact of council budget cuts on Camhs in some areas has been severe. According to research by the charity Young Minds, two-thirds of councils in England have reduced their Camhs budget since 2010. And when the charity asked NHS trusts and councils about other mental health spending targeted at children and young people, such as youth counselling or specific services for schools, more than half had cut budgets – some by as much as 30%.

The cuts mean local authorities’ Camhs spending is increasingly redirected towards more serious cases of mental ill-health, at the expense of early intervention services. “Draining money from early intervention services is short-sighted and just stores up problems for the future,” says Sarah Brennan, chief executive of Young Minds. “The result is Camhs feels it is being asked to respond to an enormous number of issues and schools feel Camhs has left them high and dry.”

Chris Harrison, national executive member and former president of the NAHT, says part of the problem until recently has been that targets in education have allowed children’s wellbeing to slip down the agenda. “The issue of mental health [in schools] has been coming to the fore over the past four or five years; there’s a real groundswell of interest, but it isn’t yet a priority in schools. We need to accept that preparation for life is about more than academic results.”

Research by the Teacher Support Network, a charity focusing on teachers’ wellbeing, shows around half of teachers feel pupil behaviour is worsening. Its survey of over 800 teachers also found almost two-thirds were stressed as a result.

The cuts to Camhs mean schools are struggling to provide professional support on site. Some have set aside cash from the Pupil Premium to pay for a regular counsellor. Andy Bell, deputy chief executive at the Centre for Mental Health, says that an “ad-hoc” system of support relies too heavily on the initiative of individual heads or teachers, and is undermined by unsatisfactory and arbitrary access to funds. “We see raising awareness of this issue as a major priority,” he says. “When we conducted research on child behavioural problems we found that three-quarters of parents asked teachers for help … However, some schools are better equipped than others. Many have virtually nothing by way of [professional] support, while others have full-time counsellors.”

Inadequate and underfunded services mean undue stress is being put on teaching staff, who may feel they are not trained or qualified to tackle many of the emotional or mental health problems that come up.

And with anecdotal evidence suggesting the number of young people experiencing mental health problems is rising, the crisis in Camhs is set to get worse. In 2004, the last year that government statistics were centrally collected on the prevalence of mental ill-health among children and young people, 1.3 million children were deemed to have a diagnosable mental illness. The economic downturn, coupled with government austerity and exam stress, means this figure is now probably much higher. And with NHS England estimating that only a quarter of children and young people with a problem are ever seen by mental health services, the figures are just the tip of the iceberg.

Politicians are becoming more aware of the scale of the problem. The health select committee has begun a parliamentary inquiry into Camhs, which campaigners hope will push mental health in schools higher up the agenda when it is published this year. “What we need is a consistent, national system that is accountable. What we need is for Camhs to be transformed.” says Bell.

Harrison says more needs to be done to ensure heads and schools have access to effective support services. “Schools and heads are battered at the moment. We want the government to look at the evidence. It’s common sense. There is overwhelming evidence that students learn better and are more effective in environments where they are supported and their teachers are supported.”

For now, charities and campaign groups are having to help schools themselves. Young Minds offers guidance on its website for teachers and is about to pilot a helpline for school staff, while the anti-stigma campaign Time to Change is running a project promoting pupil wellbeing and offering practical guidance for teaching staff. “Pupils are under much more stress these days and so are staff, yet teachers don’t have training in mental health – or spare time,” says Moira Clewes, lead teacher on health at Sandwich technology school, Kent, one of the schools piloting the project. “We are breaking down misconceptions around mental illness. Students are opening up. Teachers are grateful for advice. You’d be amazed at the impact this is having.”

A Department for Education spokesperson points to a range of initiatives, including the MindEd website, launched in March, designed to help people working with children, including teachers, “to recognise when a child needs help and how to make sure they get it”. The Department of Health says it has a “priority” focus on children’s mental health and, among other things, has put additional cash in to “talking therapies”, adding that it is liaising with the DfE to improve links between schools and Camhs.

For Cunningham, while any help is welcome, she is adamant that “nothing short of a clear, coherent and properly funded approach nationally will work for schools and for children”.

• Some names have been changed