Last weekend I watched the first episode of Bedlam, a four-part series on mental health/mental illness on Channel 4, which -according to the programme information- seeks to ‘boldly challenge myths and taboos about mental illness, as well as promote better awareness and understanding of mental health issues, through unprecedented access to the patients and staff of the South London and Maudsley NHS Foundation Trust (SLaM) – the world’s oldest psychiatric institution’ (http://www.channel4.com/info/press/programme-information/bedlam).
The first episode of Bedlam focussed on acute anxiety which takes the form of what is known as ‘Obsessive Compulsive Disorder’ (OCD). We learned that at the Bethlem Royal Hospital in south London, a specialist anxiety unit treats some of the most extreme cases of acute anxiety/OCD in Britain – the top 1 per cent. The unit is residential, one of only two in the country.
I found watching the Bedlam episode on OCD acutely painful…the pain I felt had to do with seeing intelligent, creative and eloquent individuals – the majority of them fairly young…individuals full of potential being tormented and paralysed by acute anxiety that renders them unable to function on a day to day basis, hold down a job, attend a University course they are interested in or maintain relationships. Even though I have never had a diagnosis of OCD, acute anxiety has always been a critical part of my mental health difficulties. And I have often found myself paralysed by such anxiety – with catastrophic effects on all aspects of my life. Hence, my strong identification with the OCD sufferers in Bedlam and the deep sadness I felt whilst watching the programme…
Sorrowing Old Man (‘At Eternity’s Gate’) – Vincent van Gogh
One of the patients in the specialist anxiety unit in the Bethlem Royal Hospital in south London is 23-year-old James who has a profound fear that he will lose control of his bowel movements in public. Consequently, he spends up to seven hours a day in the toilet, too scared to leave his house in case he has an ‘accident’. He has been in and out of psychiatric institutions since he was a teenager and last year had to drop out of his drama course at university because his OCD got so bad.
Helen, another patient in the unit, is a librarian at the British Museum. She has what she describes as ‘an irrational’ fear of harming strangers – she believes that somehow she is responsible for killing them in road traffic accidents or putting them in rubbish bins. For the last two years she has lived the life of a recluse, too worried to leave her house or go to work. Her long-term relationship has also broken down.
The Head of the Anxiety Disorders Residential Unit (ADRU), Simon Darnley, indicated that the rituals and behaviours of people like James and Helen are driven by a less well known aspect of OCD, ie intrusive thoughts. Simon Darnley explained that we all have unwanted, involuntary, fleeting thoughts and we are able to dismiss them. His patients, however, become extremely worried and obsess about them. The more they try to ignore the thought, the stronger it becomes. The key to getting better, said Simon, lies in confronting the thoughts head on in practical, reality checking ‘experiments’. Apparently, the unit runs a 12-week therapy programme with a success rate of 3 in 4. The therapy follows a cognitive – behavioural approach to OCD.
Whilst watching the first episode of Bedlam I was increasingly astounded by how dominant the Cognitive Behavioural Therapy (CBT) model seems to be nowadays when it comes to dealing with acute anxiety/OCD…12 weeks of therapy that follows a cognitive-behavioural approach and people with severe OCD are supposed to get a handle on their paralysing difficulties…I am not convinced here…cognitive-behavioural techniques do have their place and can be helpful, I think, but only after you have worked with somebody’s life history and emotional experiences…it seemed to me that people in the first episode of Bedlam were not helped in any way (no time!!!) to understand their excruciatingly intrusive and suspicious thoughts and their meaning in the context of their life histories…and intrusive thoughts were apparently talked about in the episode in question as something ‘irrational’ that you get at random and you can combat through practical, reality checking ‘experiments’…‘Just dealing with symptoms and the surface’, I could not help thinking throughout the episode…but how meaningful and helpful is that for people’s healing in the long-term?
I wonder why I needed 20 years of intensive psychotherapy (of various kinds) to get where I am today, if I could have done it in just 12 weeks?