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Back to School

 

I went back to school myself yesterday, starting an MA in Victorian Studies at Birkbeck College, part of the University of London. This follows on from my last blog piece, because quite a few other “Dickens obsessives” have done this course, and some of those teaching on it seem to acknowledge similar afflictions…

Many of my patients, especially those with ADD / ADHD, have thought about picking up where things went wrong in their own education. This may mean going back to do a similar course to the one which they dropped out of; or deciding that was the wrong choice anyway, and studying something quite different.

Although I have dropped out of a couple of courses myself in the past, I’m pretty sure it won’t happen this time. To some extent this is because I believe that I understand my own mild ADD tendencies better (1): my nineteenth-century interest is not an “obsession” in the clinical sense of being related to obsessive-compulsive disorder (OCD), but more of a recurrent ADD / ADHD “hyperfocus”.

 

 

(1) See https://drnmblog.wordpress.com/2010/04/16/how-mentally-healthy-should-mental-health-professionals-be/

Another Nobel for Cambridge University

 

One of my past teachers is to be awarded the Nobel Prize for Medicine today.

Professor Robert Edwards, who developed In-Vitro Fertilization, gave an annual series of seminars on embryology to about a dozen Cambridge students specialising in physiology. I was a member of the 1982-3 class, when Edwards was a prominent public figure; not only as a scientist, but also because of his decision to publicly discuss the ethical aspects of IVF in a very proactive way.

Unlike other aspects of the course, where we did experiments on rats, pigs, cats, and ourselves, there were no “practicals” in embryology. So the seminars were, to be honest, a bit dry and theoretical. The realities of fertility only became apparent when I was a clinical student in obstetrics and gynaecology, a couple of years later.

But on one occasion, Professor Edwards’ partner, the pioneering obstetrician Patrick Steptoe, came to tell us about the early days of IVF in Oldham, and we heard also about how they overcame opposition from the various establishment bodies of the day. The scientist and the clinician both loosened up and brought the subject, appropriately enough, to life.

 

 

Published at www.DrNM.org.uk on 10th December 2010; transferred to DrNMblog.wordpress.com on 9th October 2011

The Call of the Bottle

 

Books “should, like alcohol, dissolve barriers”, according to the literary academic and journalist John Sutherland, who explored the early history of Alcoholics Anonymous (AA) in a short programme last week on Radio 4 (1).

But for some people (including Professor Sutherland himself, sober only through two decades of attendance at AA meetings) alcohol has the opposite effect: “drinking recreated the conditions of childhood. Solitude; myself alone” (2).

Of these two apparently contradictory explanations for excessive drinking (alcohol dissolves interpersonal barriers; alcohol creates an interpersonal barrier), the first has been widely held for decades. “Social anxiety” was seen as a cause of alcoholism (3), and a problem in itself, well before pharmaceutical companies supposedly invented it in the 1990’s (4).

Anyone with the slightest interest in English Literature is likely to have read at least one of Sutherland’s reviews, books, or introductions to classics by authors such as Wilkie Collins and Anthony Trollope. They are invariably well-organised and structured, with a light touch but not at all “dumbed-down”, so achieving their aim of engaging academics and the general reader.

Alcoholics Anonymous has the reputation of having a rather black-and-white view of addiction. This is probably helpful, even necessary, for many people with severe problems, especially those in the early stages of “recovery”.

But this academic abstainer is not afraid to explore complexity or uncertainty. For example, in his Introduction to Jack London’s ‘Alcoholic Memoirs’, he suggests that the “chronic boozer” London later brought his own alcohol intake under control “easily enough”, and then continued to drink in part “socially”, but also because of the creative possibilities gained from alcohol withdrawal (not intoxication) (5).

Therefore, for anyone looking to remove or reduce moderate or mild addictions, a period of solitude spent reading Sutherland’s extensive works is highly recommended, and is unlikely in my view to have any harmful effects.

 
(1) Available on the BBC’s iPlayer only until 14th November: http://www.bbc.co.uk/iplayer/episode/b00vr78f/The_AA_Bible/

(2) Both quotations are from Professor Sutherland’s British Council Biography: http://www.contemporarywriters.com/authors/?p=auth519D1A75056591DEA5JxLj47A89F

(3) http://www.ncbi.nlm.nih.gov/pubmed/4394734

(4) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60470-5/fulltext

(5) The whole Introduction can be read with Amazon’s “Look Inside” facility. The book’s full title is John Barleycorn: ‘Alcoholic Memoirs’.

This post was published at www.DrNM.org.uk on 12th November 2010, and transferred to DrNMblog.wordpress.com on 7th October 2011

Playing the game

 

A boy who had to leave a “big sporty” independent school because of ADHD, was so good at rugby that he helped his team to win a match by scoring a try on his last day, according to an account written anonymously by his mother in last Friday’s Daily Telegraph (1).

Although I currently see teenagers only from eighteen years of age, a couple of years ago I saw some children in their mid-teens at independent schools, because of my association with Professor Peter Hill. Many of my adult patients have had non-state education.

It is clear that some schools in the private sector are more accepting of ADD / ADHD and other developmental problems than others. It seems surprising, though, that the school in the Telegraph article, which in 2008 apparently claimed to welcome children with special educational needs, was not more helpful in guiding the parents towards proper diagnosis and treatment at an earlier stage.

The story had a happy ending, with a good response to ADHD medication, and “…a course of therapy with a psychologist from our local authority’s Child and Adolescent Mental Health Service.” Enabling the boy’s settling in to another independent school.

The original school may well have changed its attitudes and procedures by now. But other parents in a similar situation may want to consider whether obtaining early external assessment and perhaps intervention can save the relationship with a school. It might have been the fear of the anonymous parents in the Telegraph article that the school would be antagonised, but that rarely seems to happen in practice.

 

 

(1) http://www.telegraph.co.uk/health/8081311/How-ADHD-forced-my-son-out-of-school.html

Published at www.DrNM.org.uk on 29th October 2010; transferred to DrNMblog.wordpress.com on 9th October 2011

Panorama’s bad news still buried

 

An article in Education Guardian this month (1) received some interesting online responses, two of which pointed out that Ritalin (methylphenidate) has been used clinically in ADD / ADHD for fifty years. There did not seem to be overwhelming agreement with The Guardian’s scourge of health misinformation Ben Goldacre, who has stated “Big Pharma is evil” (2).

There was, however, little picking up on the valid concern expressed in Are drugs the solution to the problem of ADHD among young people? that NHS specialists who diagnose and prescribe may be forced to cut corners in their assessments and monitoring (3). Just one parent with an ADD child, and a mixed experience of services, posted on this: “The best treatment involved regular visits to the psychologist (every 6 -8 weeks) with ALL the family so we could all work out what was working and what was not.”

Unlike the BBC, The Guardian is free to be opinionated. Even so, it is disappointing that all the paper’s print and online articles mentioning ADD / ADHD continue to avoid reference to Panorama’s two programmes on this topic, both of which had complaints upheld against them. The more recent one was found to be “unfair and not openminded”, resulting in a rare on-air apology (4). Given the BBC’s massive online and broadcasting influence, and Panorama’s “flagship” status, this seems to be essential context for understanding public and professional attitudes to ADD / ADHD.

I was also concerned that an academic educationalist who does not “acknowledge that ADHD is even a medical condition” because “You can’t do a blood test to check whether you’ve got ADHD” appeared to go unchallenged. Epilepsy, bipolar disorder, migraine, schizophrenia and depression all lack definitive physical tests, and may improve with psychological treatments, but does that mean no one should ever take medication for these conditions?

As the online responses to this article showed, Guardian readers should not be stereotyped as simply following the line that mental and behavioural disorders are, in general, just “marketing” tools for pharmaceutical companies.

 

 

(1) http://www.guardian.co.uk/education/2010/may/11/ritalin-adhd-drugs

(2) Bad Science (2009, paperback edition) page 201. From the context, Goldacre appears to be half-joking.

(3) See “Critical Psychiatry”, 2nd April 2010: https://drnmblog.wordpress.com/2010/04/02/%e2%80%9ccritical-psychiatry%e2%80%9d/

(4) See my postings on Panorama, 5th and 19th March, below

Published at www.DrNM.org.uk on 28th May 2010; transferred to DrNMblog.wordpress.com on 10th October 2011

Bright teenagers: at risk for what?

A recent study from Sweden, published in the British Journal of Psychiatry (1), appears to confirm a link between high ability and bipolar disorder. Over seven hundred thousand teenagers were followed up to see if they were admitted to psychiatric hospital in their twenties and thirties. Then their school examination grades at 16 years were compared with those of the other students who had not developed such severe mental and behavioural problems.

The adults with bipolar disorder had done better in exams as teenagers, especially in humanities subjects such as Swedish and History (but not Art). Those who had been good at Sport seemed to have a lower chance of developing bipolar disorder later.

This is an interesting study which is in keeping with the suggested link between bipolar disorder and creative ability. However, it does not mention the possibility that adult ADD / ADHD, which also can sometimes lead to hospital admission, may have been the real problem in many cases. Like much research of this kind, the diagnosis was made a long time ago (1988 – 1997), when there was even more scepticism about adult ADD / ADHD than there is now (2).

 

 

(1) Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. http://bjp.rcpsych.org/cgi/content/abstract/196/2/109  

(2) For an example of how creative ability may be linked to ADD / ADHD, see my Blog piece on Vincent Van Gogh: https://drnmblog.wordpress.com/2010/02/05/vincent-van-gogh-did-he-have-add-adhd/

Published at www.DrNM.org.uk on 14th May 2010; transferred to DrNMblog.wordpress.com on 7th October 2011

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