so hi everybody thank you so much for coming here it’s really nice to be here
coming here it’s really nice to be here
coming here it’s really nice to be here and to see so many of you with an
and to see so many of you with an
and to see so many of you with an interest in these topics so did you know
interest in these topics so did you know
interest in these topics so did you know that the NHS carbon footprint is 20 2.8
that the NHS carbon footprint is 20 2.8
that the NHS carbon footprint is 20 2.8 million tons of carbon dioxide
million tons of carbon dioxide
million tons of carbon dioxide equivalents this is about 25% of Inglis
equivalents this is about 25% of Inglis
equivalents this is about 25% of Inglis England’s public sector emissions so in
England’s public sector emissions so in
England’s public sector emissions so in the pharmaceutical sector this could
the pharmaceutical sector this could
the pharmaceutical sector this could apply to carbon embodied in a particular
apply to carbon embodied in a particular
apply to carbon embodied in a particular drug to chemical waste that’s being
drug to chemical waste that’s being
drug to chemical waste that’s being disposed by a supplier or to the release
disposed by a supplier or to the release
disposed by a supplier or to the release of greenhouse gases from an inhaler used
of greenhouse gases from an inhaler used
of greenhouse gases from an inhaler used my patients and this is important
my patients and this is important
my patients and this is important because the NHS estimates that about 60%
because the NHS estimates that about 60%
because the NHS estimates that about 60% of emissions is due to people using or
of emissions is due to people using or
of emissions is due to people using or buying prescribed drugs the point I want
buying prescribed drugs the point I want
buying prescribed drugs the point I want to make is this excessive
to make is this excessive
to make is this excessive over-diagnosing of mental health
over-diagnosing of mental health
over-diagnosing of mental health disorders may lead to an increase in
disorders may lead to an increase in
disorders may lead to an increase in prescription of all sorts of medicines
prescription of all sorts of medicines
prescription of all sorts of medicines thereby increasing the ecological
thereby increasing the ecological
thereby increasing the ecological footprint of our NHS substantially so
footprint of our NHS substantially so
footprint of our NHS substantially so I’m a psychologist and we use this book
I’m a psychologist and we use this book
I’m a psychologist and we use this book called the DSM and in this book all the
called the DSM and in this book all the
called the DSM and in this book all the mental health disorders are listed then
mental health disorders are listed then
mental health disorders are listed then we use it for diagnosis so some time ago
we use it for diagnosis so some time ago
we use it for diagnosis so some time ago Ellen the Francis and his task force
Ellen the Francis and his task force
Ellen the Francis and his task force we’re working on a new version of this
we’re working on a new version of this
we’re working on a new version of this book because it’s constantly being
book because it’s constantly being
book because it’s constantly being updated so we’re now at its fifth
updated so we’re now at its fifth
updated so we’re now at its fifth version but the example I want to talk
version but the example I want to talk
version but the example I want to talk to you about is about ADHD and about the
to you about is about ADHD and about the
to you about is about ADHD and about the move from the DSM 3 to the DSM 4 so this
move from the DSM 3 to the DSM 4 so this
move from the DSM 3 to the DSM 4 so this taskforce was working on a new version
taskforce was working on a new version
taskforce was working on a new version of the DSM and they wanted to make this
of the DSM and they wanted to make this
of the DSM and they wanted to make this minor change to the criteria for ADHD
minor change to the criteria for ADHD
minor change to the criteria for ADHD attention deficit hyperactivity disorder
attention deficit hyperactivity disorder
attention deficit hyperactivity disorder and they estimated that this minor
and they estimated that this minor
and they estimated that this minor change would lead to an increase of
change would lead to an increase of
change would lead to an increase of about 15 percent of people being dike
about 15 percent of people being dike
about 15 percent of people being dike with ADHD and they consider that to be
with ADHD and they consider that to be
with ADHD and they consider that to be okay it would just mean that the system
okay it would just mean that the system
okay it would just mean that the system would become a bit more sensitive to
would become a bit more sensitive to
would become a bit more sensitive to detect people who were clearly suffering
detect people who were clearly suffering
detect people who were clearly suffering in important life areas so DSM 4 was
in important life areas so DSM 4 was
in important life areas so DSM 4 was published including this change but at
published including this change but at
published including this change but at the same time in the u.s. the
the same time in the u.s. the
the same time in the u.s. the pharmaceutical industry got approval
pharmaceutical industry got approval
pharmaceutical industry got approval from the government for making adverts
from the government for making adverts
from the government for making adverts for registered pills so from that moment
for registered pills so from that moment
for registered pills so from that moment there were commercials on TV and adverts
there were commercials on TV and adverts
there were commercials on TV and adverts everywhere and they might look something
everywhere and they might look something
everywhere and they might look something like this so you might see a poster with
like this so you might see a poster with
like this so you might see a poster with a bit of a theatrical child’s drawing
a bit of a theatrical child’s drawing
a bit of a theatrical child’s drawing and it might have some slogans on there
and it might have some slogans on there
and it might have some slogans on there saying ADHD affects more than your
saying ADHD affects more than your
saying ADHD affects more than your grades or ADHD medication can improve
grades or ADHD medication can improve
grades or ADHD medication can improve your academic performance and most of
your academic performance and most of
your academic performance and most of these posters were aimed to sensitize
these posters were aimed to sensitize
these posters were aimed to sensitize parents uncertainties regarding their
parents uncertainties regarding their
parents uncertainties regarding their their children for instance being
their children for instance being
their children for instance being worried that they were not finishing
worried that they were not finishing
worried that they were not finishing their homework or were acting overly
their homework or were acting overly
their homework or were acting overly playful and the message that all of
playful and the message that all of
playful and the message that all of these commercials had was basically if
these commercials had was basically if
these commercials had was basically if you think your child has ADHD please go
you think your child has ADHD please go
you think your child has ADHD please go to see your GP
to see your GP
to see your GP we have ADHD medication that can solve
we have ADHD medication that can solve
we have ADHD medication that can solve the problem so what do you think
the problem so what do you think
the problem so what do you think happened to that estimated 15 percent
happened to that estimated 15 percent
happened to that estimated 15 percent increase of ADHD diagnosis does anybody
increase of ADHD diagnosis does anybody
increase of ADHD diagnosis does anybody dare to give an estimate how much do you
dare to give an estimate how much do you
dare to give an estimate how much do you think the percentage change really was
think the percentage change really was
think the percentage change really was 30 right
30 right
30 right actually it was 300 percent and a reason
actually it was 300 percent and a reason
actually it was 300 percent and a reason that this can happen is because we have
that this can happen is because we have
that this can happen is because we have so few biomarkers and with biomarkers I
so few biomarkers and with biomarkers I
so few biomarkers and with biomarkers I mean there’s no blood or urine tests we
mean there’s no blood or urine tests we
mean there’s no blood or urine tests we can do or brain scan we can observe to
can do or brain scan we can observe to
can do or brain scan we can observe to test whether we are suffering from a
test whether we are suffering from a
test whether we are suffering from a mental health disorder which makes that
mental health disorder which makes that
mental health disorder which makes that label in nearly all cases quite
label in nearly all cases quite
label in nearly all cases quite subjective so my area of expertise is
subjective so my area of expertise is
subjective so my area of expertise is about dissociation and
about dissociation and
about dissociation and relation with sleep and I’ve been
relation with sleep and I’ve been
relation with sleep and I’ve been studying this topic for over seven years
studying this topic for over seven years
studying this topic for over seven years now both in the Netherlands and here in
now both in the Netherlands and here in
now both in the Netherlands and here in Oxford dissociation is about feeling
Oxford dissociation is about feeling
Oxford dissociation is about feeling detached from yourself or your
detached from yourself or your
detached from yourself or your surroundings and it happens to most of
surroundings and it happens to most of
surroundings and it happens to most of us from time to time in mild forms at
us from time to time in mild forms at
us from time to time in mild forms at least so I think most of you will
least so I think most of you will
least so I think most of you will recognize the feeling of driving home
recognize the feeling of driving home
recognize the feeling of driving home from work the same route you drive every
from work the same route you drive every
from work the same route you drive every day and then suddenly realizing that you
day and then suddenly realizing that you
day and then suddenly realizing that you have no recollection for some parts of
have no recollection for some parts of
have no recollection for some parts of your journey right
your journey right
your journey right you didn’t miss any traffic lights
you didn’t miss any traffic lights
you didn’t miss any traffic lights though you didn’t crash your car it’s
though you didn’t crash your car it’s
though you didn’t crash your car it’s just kind of when to an automatic pilot
just kind of when to an automatic pilot
just kind of when to an automatic pilot does anybody recognize this yeah so this
does anybody recognize this yeah so this
does anybody recognize this yeah so this is a mild form of dissociation that we
is a mild form of dissociation that we
is a mild form of dissociation that we call absorption people are suffering
call absorption people are suffering
call absorption people are suffering from more severe forms of dissociation
from more severe forms of dissociation
from more severe forms of dissociation might have trouble recognizing
might have trouble recognizing
might have trouble recognizing themselves in the mirror okay again some
themselves in the mirror okay again some
themselves in the mirror okay again some of you may recognize this after having a
of you may recognize this after having a
of you may recognize this after having a late night out and coming across your
late night out and coming across your
late night out and coming across your mirror image in the morning but that’s
mirror image in the morning but that’s
mirror image in the morning but that’s more about maybe not wanting to
more about maybe not wanting to
more about maybe not wanting to recognize yourself so the problem with
recognize yourself so the problem with
recognize yourself so the problem with diagnosing these mental health disorders
diagnosing these mental health disorders
diagnosing these mental health disorders whether we’re talking about ADHD or
whether we’re talking about ADHD or
whether we’re talking about ADHD or dissociative disorders is that they’re a
dissociative disorders is that they’re a
dissociative disorders is that they’re a dimensional problem so they arranged on
dimensional problem so they arranged on
dimensional problem so they arranged on a continuum from mild to severe but
a continuum from mild to severe but
a continuum from mild to severe but we’re using a categorical approach to do
we’re using a categorical approach to do
we’re using a categorical approach to do this because you either have it or you
this because you either have it or you
this because you either have it or you don’t and we use this book the DSM where
don’t and we use this book the DSM where
don’t and we use this book the DSM where all these criteria are listed and if you
all these criteria are listed and if you
all these criteria are listed and if you take enough symptoms of the list then
take enough symptoms of the list then
take enough symptoms of the list then that means you’re suffering from the
that means you’re suffering from the
that means you’re suffering from the disorder
disorder
disorder take for example post-traumatic stress
take for example post-traumatic stress
take for example post-traumatic stress disorder
disorder
disorder the DSM states that you need to suffer
the DSM states that you need to suffer
the DSM states that you need to suffer from at least 8 out of 19 symptoms in
from at least 8 out of 19 symptoms in
from at least 8 out of 19 symptoms in order to be diagnosed with this disorder
order to be diagnosed with this disorder
order to be diagnosed with this disorder if you then do this really complicated
if you then do this really complicated
if you then do this really complicated mathematical formula it quickly shows
mathematical formula it quickly shows
mathematical formula it quickly shows that there are six hundred and thirty
that there are six hundred and thirty
that there are six hundred and thirty six thousand a hundred and twenty waist
six thousand a hundred and twenty waist
six thousand a hundred and twenty waist have post-traumatic stress disorder can
have post-traumatic stress disorder can
have post-traumatic stress disorder can you imagine the consequences for
you imagine the consequences for
you imagine the consequences for prescribing anti-anxiety medication so
prescribing anti-anxiety medication so
prescribing anti-anxiety medication so let’s consider this problem of the
let’s consider this problem of the
let’s consider this problem of the carbon footprints again one we are over
carbon footprints again one we are over
carbon footprints again one we are over prescribing drugs and too many drugs are
prescribing drugs and too many drugs are
prescribing drugs and too many drugs are being sold and to our system for
being sold and to our system for
being sold and to our system for classifying and labeling mental health
classifying and labeling mental health
classifying and labeling mental health disorders might not be the best approach
disorders might not be the best approach
disorders might not be the best approach and it might lead to over diagnosis of
and it might lead to over diagnosis of
and it might lead to over diagnosis of disorders thereby increasing the
disorders thereby increasing the
disorders thereby increasing the ecological footprint substantially so
ecological footprint substantially so
ecological footprint substantially so mind you talking about these labels
mind you talking about these labels
mind you talking about these labels we’re not just doing this in the mental
we’re not just doing this in the mental
we’re not just doing this in the mental health sector it seems like we are using
health sector it seems like we are using
health sector it seems like we are using all these psychopathological terms in
all these psychopathological terms in
all these psychopathological terms in our everyday language so nowadays people
our everyday language so nowadays people
our everyday language so nowadays people can come out with these these statements
can come out with these these statements
can come out with these these statements such as oh you almost gave me a panic
such as oh you almost gave me a panic
such as oh you almost gave me a panic attack or I’m feeling a bit bipolar
attack or I’m feeling a bit bipolar
attack or I’m feeling a bit bipolar today yeah it seems like we’re labeling
today yeah it seems like we’re labeling
today yeah it seems like we’re labeling everything so what can we do to improve
everything so what can we do to improve
everything so what can we do to improve sustainability and mental health because
sustainability and mental health because
sustainability and mental health because I think it’s time for a change now let’s
I think it’s time for a change now let’s
I think it’s time for a change now let’s consider these dissociative disorders
consider these dissociative disorders
consider these dissociative disorders again although it is really marvelous
again although it is really marvelous
again although it is really marvelous that we have all these brilliant minds
that we have all these brilliant minds
that we have all these brilliant minds working on improving medication all of
working on improving medication all of
working on improving medication all of the time
the time
the time unfortunately for dissociative disorders
unfortunately for dissociative disorders
unfortunately for dissociative disorders Moniz most drugs don’t seem to have much
Moniz most drugs don’t seem to have much
Moniz most drugs don’t seem to have much effect now my research has been about
effect now my research has been about
effect now my research has been about connecting dissociation to sleep
connecting dissociation to sleep
connecting dissociation to sleep disturbances because people who suffer
disturbances because people who suffer
disturbances because people who suffer from these disorders tend to sleep quite
from these disorders tend to sleep quite
from these disorders tend to sleep quite poorly and as it turns out by improving
poorly and as it turns out by improving
poorly and as it turns out by improving their sleep were able to reduce
their sleep were able to reduce
their sleep were able to reduce dissociation and I can hear what you’re
dissociation and I can hear what you’re
dissociation and I can hear what you’re thinking we can improve sleep by
thinking we can improve sleep by
thinking we can improve sleep by prescribing sleep medication right but
prescribing sleep medication right but
prescribing sleep medication right but what I’m pleading for is that we as
what I’m pleading for is that we as
what I’m pleading for is that we as mental health professionals could focus
mental health professionals could focus
mental health professionals could focus more on social prescriptions
more on social prescriptions
more on social prescriptions eco-friendly alternatives that have
eco-friendly alternatives that have
eco-friendly alternatives that have proven useful rather than drug
proven useful rather than drug
proven useful rather than drug prescriptions that leave a considerable
prescriptions that leave a considerable
prescriptions that leave a considerable footprint there are ways of improving
footprint there are ways of improving
footprint there are ways of improving sleep using sleep hygiene that have
sleep using sleep hygiene that have
sleep using sleep hygiene that have proven just as effective as sleep
proven just as effective as sleep
proven just as effective as sleep medication which by the way can be very
medication which by the way can be very
medication which by the way can be very addictive as well so sleep hygiene is
addictive as well so sleep hygiene is
addictive as well so sleep hygiene is all about employing these routines
all about employing these routines
all about employing these routines that’ll help us
that’ll help us
that’ll help us to sleep better so would you would
to sleep better so would you would
to sleep better so would you would advise people to not drink coffee and
advise people to not drink coffee and
advise people to not drink coffee and evening have plenty of exercise during
evening have plenty of exercise during
evening have plenty of exercise during the day preferably outside go to bed at
the day preferably outside go to bed at
the day preferably outside go to bed at the same time every night and perhaps
the same time every night and perhaps
the same time every night and perhaps most difficult refraining from alcohol
most difficult refraining from alcohol
most difficult refraining from alcohol and evening all of these combined will
and evening all of these combined will
and evening all of these combined will improve your sleep thereby reducing
improve your sleep thereby reducing
improve your sleep thereby reducing psychological symptoms or if we put it
psychological symptoms or if we put it
psychological symptoms or if we put it in the very wise words of Ronald Reagan
in the very wise words of Ronald Reagan
in the very wise words of Ronald Reagan who said I never drink coffee at lunch I
who said I never drink coffee at lunch I
who said I never drink coffee at lunch I find it keeps me awake for the afternoon
find it keeps me awake for the afternoon
find it keeps me awake for the afternoon so let’s also consider nature feeling
so let’s also consider nature feeling
so let’s also consider nature feeling connected with nature is related to
connected with nature is related to
connected with nature is related to mental wellness so going out for walk in
mental wellness so going out for walk in
mental wellness so going out for walk in the woods or joining a running group not
the woods or joining a running group not
the woods or joining a running group not only will benefit your sleep and your
only will benefit your sleep and your
only will benefit your sleep and your physical health
physical health
physical health but your mental well-being in general
one other example of where our natural
one other example of where our natural responses come in the mix is this
responses come in the mix is this
responses come in the mix is this suppose you have to go to the emergency
suppose you have to go to the emergency
suppose you have to go to the emergency department because you’ve been in an
department because you’ve been in an
department because you’ve been in an accident you’re physically alright but
accident you’re physically alright but
accident you’re physically alright but you you feel pretty shaken up that means
you you feel pretty shaken up that means
you you feel pretty shaken up that means you’re feeling restless and agitated so
you’re feeling restless and agitated so
you’re feeling restless and agitated so what do clinicians in a in A&E typically
what do clinicians in a in A&E typically
what do clinicians in a in A&E typically do they will prescribe you some sleep
do they will prescribe you some sleep
do they will prescribe you some sleep medication so that you can sleep and
medication so that you can sleep and
medication so that you can sleep and feel better in the morning
feel better in the morning
feel better in the morning however recent studies we conducted here
however recent studies we conducted here
however recent studies we conducted here in Oxford actually show that if you are
in Oxford actually show that if you are
in Oxford actually show that if you are awake for that first night after having
awake for that first night after having
awake for that first night after having gone
gone
gone through a trauma it actually helps you
through a trauma it actually helps you
through a trauma it actually helps you in terms of having less intruding
in terms of having less intruding
in terms of having less intruding memories directly after so maybe this is
memories directly after so maybe this is
memories directly after so maybe this is our body’s way of telling us that we
our body’s way of telling us that we
our body’s way of telling us that we need to be agitated and perhaps we need
need to be agitated and perhaps we need
need to be agitated and perhaps we need to sleep poorly for a night in order for
to sleep poorly for a night in order for
to sleep poorly for a night in order for us to cope naturally with what with what
us to cope naturally with what with what
us to cope naturally with what with what has happened to us rather than trying to
has happened to us rather than trying to
has happened to us rather than trying to treat these symptoms with sleep
treat these symptoms with sleep
treat these symptoms with sleep medication so the point I want to make
medication so the point I want to make
medication so the point I want to make is this we need to normalize the way we
is this we need to normalize the way we
is this we need to normalize the way we view mental health we need to stop
view mental health we need to stop
view mental health we need to stop trying to categorize a dimensional
trying to categorize a dimensional
trying to categorize a dimensional problem we need to stop labeling mental
problem we need to stop labeling mental
problem we need to stop labeling mental health complaints into little boxes and
health complaints into little boxes and
health complaints into little boxes and we need to stop this trend of using all
we need to stop this trend of using all
we need to stop this trend of using all the psychological symptoms in our
the psychological symptoms in our
the psychological symptoms in our everyday language what we do need is
everyday language what we do need is
everyday language what we do need is stepped care starting with normalization
stepped care starting with normalization
stepped care starting with normalization of complaints than minor low-frequency
of complaints than minor low-frequency
of complaints than minor low-frequency interventions and only if necessary
interventions and only if necessary
interventions and only if necessary moving on to drug prescriptions try
moving on to drug prescriptions try
moving on to drug prescriptions try sleep hygiene interventions first before
sleep hygiene interventions first before
sleep hygiene interventions first before moving on to sleep medication in the
moving on to sleep medication in the
moving on to sleep medication in the social of disorders this linked with
social of disorders this linked with
social of disorders this linked with sleep has been well evidenced and it’s
sleep has been well evidenced and it’s
sleep has been well evidenced and it’s an avenue worth pursuing so the idea is
an avenue worth pursuing so the idea is
an avenue worth pursuing so the idea is that mental health should should be
that mental health should should be
that mental health should should be connected more to being connected with
connected more to being connected with
connected more to being connected with community and to be sustainable we could
community and to be sustainable we could
community and to be sustainable we could use the resources around us and in
use the resources around us and in
use the resources around us and in nature so for example having a dose of
nature so for example having a dose of
nature so for example having a dose of nature and therapy by joining a
nature and therapy by joining a
nature and therapy by joining a community garden group interventions
community garden group interventions
community garden group interventions like these have proven successful to
like these have proven successful to
like these have proven successful to reduce anxiety depression delusions and
reduce anxiety depression delusions and
reduce anxiety depression delusions and schizophrenia and aggression in dementia
so in summary spending time in nature
so in summary spending time in nature participating in developments that
participating in developments that
participating in developments that contribute to sustainable communities
contribute to sustainable communities
contribute to sustainable communities and making simple changes in your life
and making simple changes in your life
and making simple changes in your life such as employing a good sleep hygiene
such as employing a good sleep hygiene
such as employing a good sleep hygiene can all contribute to a positive mental
can all contribute to a positive mental
can all contribute to a positive mental health now I’ll be starting my own
health now I’ll be starting my own
health now I’ll be starting my own experiment in a couple weeks from now
experiment in a couple weeks from now
experiment in a couple weeks from now and I remember from when I had my first
and I remember from when I had my first
and I remember from when I had my first child and that I will get pretty
child and that I will get pretty
child and that I will get pretty sleep-deprived and there may be times
sleep-deprived and there may be times
sleep-deprived and there may be times where I don’t recognize myself in the
where I don’t recognize myself in the
where I don’t recognize myself in the mirror I guess people who say they sleep
mirror I guess people who say they sleep
mirror I guess people who say they sleep like a baby usually don’t have one thank
like a baby usually don’t have one thank
like a baby usually don’t have one thank you so much for your time good night
you so much for your time good night
you so much for your time good night [Applause]
”
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