Tag Archives: Depression



Have you ever yearned after being a ballet dancer – that is often the case in growing up and mothers often dutifully take their children to ballet classes as I did for my three children until the tummy aches occur before lessons or with competing interests they can’t fit it into their busy schedules.

But there are some children who feel they have missed out  Or feel they want to rekindle that yearning and as adults they find a studio to reconnect or even start as a beginner.  Moreover, there are significant number of middle – aged adults who decide to join ballet classes and reap the physical and mental benefits of this challenging dance form.

I remember my daughter and friends who dance at any opportunity  often attended a well known studio ‘Pineapple’ in Convent Garden. They have classes for a wide variety of different types of dance classes.

women who do ballet over 50

L to R These women are all keen ballet dancers, or use ballet movements to stay fit and active –-these ladies are aged 50-68yrs

Subsequently  I came across an ex-ballerina from Sadlers Wells Ballet company in an acupuncture class as she wanted to learn to treat common injuries. She was teaching middle – aged pupils at Pineapple and was proud of the fact that she had a pupil of 76yrs!

Isabel McMeekan was principal dance at the Royal Ballet now runs classes for adults including Assoluta class for the over 60’s.  This is a unique class specifically created for 60 year olds and over, involving gentle stretching, core work, barre work and centre practice.



Hence, I was not shocked when a professional colleague told me she had just enrolled for regular ballet classes. As we talked I could appreciate the positive health benefits of maintaining flexibility and bone density well into your later years to stall the onset of osteoporosis and could also ward off dementia. That’s as well as improving your figure, looks and confidence, relieving stress — and maybe even helping your love life.

We know that about 9 percent of adults age 65 and older report having problems with balance. Poor balance can be a contributing factor to falling, which can result in broken bones and hospital admissions.

Hence, because it is well recognised that:-

The single most serious threat that older people face is falling

Good balance is essential to being able to control and maintain your body’s position while moving and remaining still. Good balance helps you:

• Walk without staggering
• Arise from chairs without falling
• Climb stairs without tripping

You need good balance to help you stay independent and carry out daily chores and activities. Problems with sense of balance are experienced by many people as they age.

Inevitably practising ballet is going to be invaluable in addressing maintaining good balance.

My story of joining an adult ballet class

I did ballet as a child until about the age of 12 when transitioning to secondary school and puberty meant focussing on other things in life. It wasn’t until 9 years ago, in my late 30s, when I joined an adult ballet class, that my love of ballet was reignited! The combination of dance to classical music is unique to ballet, and though I have tried and have enjoyed many other activities (yoga, ballroom, Zumba and flamenco amongst many other things), ballet is what I have stuck at with a passion for the last 9 years! Certainly the movements and positions we get into remind me of my childhood, and the music makes me feel nostalgic and emotional. Perhaps it is all this emotion combined with the fact that I’ve had a seriously good work out keeps me so addicted to ballet!
Music is an essential part of ballet, and through ballet I have learnt to love the piano again too. I found I was enjoying the music so much at the class, I would go home to bang out the tune immediately on the piano! Memories of my old piano teacher came flooding back…and I have since made contact with her through email. These two pastimes have brought me much joy and satisfaction in recent years, I feel my childhood has returned to me in middle age!



You may feel this is something you thought was too late to start but there is a chance out there and with the added bonus of physical and mental health benefits.










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Posted by on February 9, 2017 in Training and Advice


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imageRecently I had an email from a patient asking if I would  support them in attending a course with MindFood. I had to admit I didn’t know what this was about and emailed Ed Harkness from MindFood to let me know what this was all about. After reading about it on the website I asked if I could blog about as not only was I interested in this venture but I would like to promote it.​

MindFood has a vision to see people with mental health issues recover, find healing and go on to achieve their potential through growing and selling food.

They run a sensory market garden in Ealing West London
They offer people with a wide range of mental health issues a therapeutic environment where those attending can learn to sow, plant and grow a variety of fruit and vegetables.
They then go on to sell ‘food that’s good for your mood’ into local communities.

I have to say I am a keen gardener and have been all my life- I have never been  far from a garden and if is no coincidence that the consulting room looks out on a garden. I remember as a small child having a patch to grow vegetables and there was nothing more thrilling than watching things grow and even  more exciting tasting the crops . I always enjoyed growing kale, spinach and sprouting purple broccoli as they all guarantee a good productive harvest from a small packet of seeds. It amuses me now to hear my children telling me now to buy them because they are today’s superfoods! Kale chips are a strong favourite- simply bake prepared kale with olive oil or even better coconut oil at 180F  for about 15 minutes and sprinkle some chilli and paprika and sea salt on them –  delicious family favourite.

My dear uncle was a gardener for the Council and had been brain damaged after a very traumatic birth but he had a major influence on my love for gardening. He could barely read or write but he knew how to garden. He could make frozen peas grow – nothing better than his homegrown Birds Eye peas! He could tell you the colour of a tulip by the bulb and prune a tree skillfully. I loved being with him in the garden and learnt so much from him but most of all I loved the peaceful atmosphere that I felt as we chatted and worked together.

When I was in Wales as a GP it was not unusual for me to be summoned from the garden, toss of my wellies to visit a patient when I was on all each weekend. Patients knew of my interest and when they came with their various complaints would also be asking about the state of the garden or pass on tips to get rid of blight, slugs or the like.

It has been my greatest joy since I have partially retired to do more gardening. I am aware of the hours of pleasure gardening has  given me over many years,  a chance to unwind, get rid of inner frustrations by digging and a sense of achievement after weeding an overrun flowerbed or harvesting crops. I am writing this after a day in the garden – trimming the conservation hedge I planted a 3 years ago and now well established providing food and homes for several families of birds. I planted my spinach and purple sprouting broccoli along with other vegetables and will look forward again to gathering the crops later this year and weeded my herb garden.

My garden last year – summer 2014. I have created this over the past 3 years since my partial retirement and it has become my Paradise.


I was delighted when my half Danish grandson decided to call me ‘Drangma’  which is the Danish for ‘ big digger’. He obviously felt it was appropriate as one of our main activities together has been digging in the garden.

It is not surprising that I was so pleased to hear about this project which supports all that I would say about gardening.


I strongly commend this course to anyone who has had moderate or severe depression and for anyone else to either look at the website or visit the site to consider volunteering to help support ythisworthwhile project.

MindFood CIC
Cleveley Crescent,
W5 1DZ

MindFood is launching a new ‘Growing Wellbeing’ 6 week course that focuses on the 5 ways to wellbeing in a food growing environment. The course is designed to be a fun balance of learning how to grow a wide range of fruit and vegetables whilst becoming more mindful of ways to improve our wellbeing.

The course is action orientated so each week we’ll discuss and commit to a specific action that will help improve our wellbeing between each session and ongoing after the course.

The five ways to wellbeing are 5 simple and practical steps that we can all take to improve our levels of wellbeing. The graphic below is an outline of the 5 ways to wellbeing and an indication of how this course will help you to engage with each one. s the course right for me?

Do you feel that poor mental health is having a negative impact on your quality of life? This course is aimed at people who experience mild to moderate depression, anxiety and other common mental health problems. The course is also for people who want to help prevent the onset of mental ill health e.g. an episode of depression.

When does the course run?

Our courses runs on Monday mornings and Friday afternoons. The next course starts on the 12th June. (Please note lunch is not provided)

Where is the course based?

We are based in Ealing, West London on a group of allotments which are a 5 minute walk from Hanger Lane Tube station or on bus routes 83, 112, 226, 95, 487. A map of our location can be found here.

What is the cost of the course?

The 6-week course costs £30 (£5 per session). The course is subsidised through the support of MindFood’s funders.

How do I sign up?

Please register your interest or direct any queries by emailing
Alternatively you can complete the referral form and send to Ed so that we can assess whether this course would be suitable for your needs.

How many people will be on the course?

The course is limited to 6 places.

Are there other courses or opportunities that MindFood offers?

Upon completion of the 6-week course you will have the opportunity to join MindFood’s Plot to Plate programme that offers longer-term opportunities to be part of our ecotherapy social enterprise.


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We have all been introduced to singing since we were born and most parents we will be delighted when they hear their child sing a familiar song for the first time and leap to record the moment. It is just as delightful when you hear your grandchild sing and singing to your grandchild even if your singing voice is limited is always appreciated and met with the  words ‘again, again’ !

As a schoolgirl  I associated  singing with warbling, middle aged women with blue rinses and clearly remember having learn to sing ‘Blow the wind Southerly’ by Kathleen Ferrier as an 8 year old !  I was in the school choir because I liked singing not because I had any musical talent!  Then there was the evolution of pop music And musical shows and then the doors opened wide and  singing for pleasure in the home took on a new light. After all I followed the generation where families used to sing around the piano at home but now it was singing with the radio or TV.

My children have known pop music since an early age and sing-a-longs with the radio on the school run were an important start to the day,  amusing many a commuter as they sidled up alongside us on the Great West Road. Now there are an overwhelming number of genres of music,  which has led to a wider range of choirs than ever before – gospel, rock, church, barbershop, beatbox  to name a few. You can find choirs who do popular chart hits arranged for choir, songs from the shows, or traditional folk music so that singing in choirs has become more popular.

In previous blogs I have alluded to the benefits of singing for patients with dementia and  the feel-good effects of singing in helping in depression. However, experts now believe that joining a choir could improve the symptoms of a range of health problems including Parkinson’s, depression and lung disease.

At a conference of the Royal Society for Public Health, Grenville Hancox, professor of music at The Sidney De Haan Research Centre for Arts and Health, Canterbury, described the changes that can take place through singing together as “extraordinary”.
He told how he and colleagues have witnessed people with respiratory problems learning to breathe more easily, those with depression beating the blues and patients with Parkinson’s disease standing tall and singing loudly.
Prof Hancox is the founder of Skylarks, a new choir for people with Parkinson’s. This disorder of the central nervous system makes normal movements difficult and weakens the voice as the muscles in the face and vocal chords deteriorate. Prof Hancox and his colleague Stephen Clift, the centre’s professor of health education, are undertaking research to find out if choral singing can help with Parkinson’s symptoms, especially those affecting the voice, with choir members undergoing computer-assisted acoustical voice analysis at the start and finish of the study.


Ian MacDonald, voice specialist with the British Association for Performing Arts Medicine, reported to have said that it is logical that singing can help in this way. “The vocal cords are muscles,” he says. “By exercising them, you increase tone and restrict tremor, and the voice is less jittery. Singing warms the muscles up – just as athletes warm up theirs.” Being required to stand tall when performing may also improve core strength and benefit these patients.

As Professor Hancox and his colleagues have claimed they have witnessed people with COPD , a debilitating respiratory disease  learn to breathe more easily.  Around the world an estimated 64 million people are struggling to breathe on a daily basis.  The World Health Organization expects COPD to be the third leading cause  could potentially help so many people 

Sonia Page, the specialist respiratory nurse who is leading the current Singing for Breathing choir at the Royal Brompton Hospital, London says it has helped people with COPD “gain greater control of their breathlessness instead of being at the mercy of it.”

Patients have also reported improved respiratory stamina, reduced impact of chest infections and improvements in sleep apnoea (a condition that causes interrupted breathing during sleep). Dr Nicholas Hopkinson, a consultant chest physician at the Royal Brompton Hospital in London, notes that singing cannot reverse the lung damage caused by COPD, but it can still be of benefit.
COPD patients have difficulty emptying the air from their lungs (known as gas trapping), he says, which is why they suffer from shortness of breath – a problem made worse if they panic and start to hyperventilate.
“Singing may help these patients to improve their posture and learn techniques to help control their breathing. In particular, by breathing out more slowly they give their lungs more time to empty, reducing gas trapping,” says Dr Hopkinson.

The free weekly singing classes held at both Royal Brompton and Harefield hospitals are open to all respiratory  at Royal Brompton & Harefield NHS Foundation Trust to help them relax and learn new breathing techniques.

The sessions are organised by the arts team at the hospital and are funded by charitable donations. The course leaders hope to enhance existing support for respiratory patients with an enjoyable, informal exercise, that teaches a better understanding of breath control through the use of the voice.
Two of the longest-standing members of the singing groups are Harold Dearing, who has asthma and has had several operations on his heart, and John Turner who has COPD. John has been coming once a week to the Brompton Hospital since 2010 and is passionate about the benefits of singing.
“It helps us feel much, much better. Although singing therapy can’t cure the lung damage caused by acute respiratory conditions such as COPD, the combination of breathing exercises and song can help people with breathing difficulties cope better with their disability.”
“Doing everyday ordinary activities becomes increasingly difficult for people with lung problems,” says John. “I find singing gets your lungs working better, you get out of the house, you meet people and you become a social animal again.”
“Way back in 2002 when I was diagnosed with emphysema, it was suggested I would soon need oxygen. Well I haven’t yet needed it and I think this is very largely due to singing.”
Singing to build confidence
Harold Dearing has been with a singing group for three years. As a teenager, he’d sung in a choir, so when he saw the Harefield course advertised he decided to give it a go.
“Every time I go it’s beneficial. I enjoy the exercises, but it’s especially nice to be together singing. It’s confidence-building. The teachers make it fun and make sure you’re in your comfort zone.”

Angela Reith, a music therapist who runs the sessions at the Harefield hospital says she sees several benefits.
“Some find that by the end of the session they breathe more easily. Others benefit especially on a social level. They have a good time and if you’re happy with yourself you can cope better with your condition,” says Angela.
Singing’s feel-good factor
Joanna Foster who runs the sessions at Royal Brompton agrees about the feel-good factor of singing in a group. “Singing together is not just exercises. It’s fun and it releases endorphins.”
Each of the sessions involves breathing exercises and singing. Starting with gentle upper body stretches, the group then practice making different sounds as they exhale such as sighs and fake laughter.
“It’s the same techniques that actors and professional singers use to warm up their voices and overcome nerves,” says Joanna.
This then leads into singing whole songs, learning them in chunks and eventually – depending on the size of the group – singing rounds and harmonies.
A survey of 500 patients taking part in the singing workshops at Royal Brompton and Harefield found that 70% felt markedly physically better after the workshops.

Joining a choir is by no means a conventional solution for such a serious illness.

The research team from Canterbury Christ Church University in Kent felt they had good reason to investigate the effects  on COPD and singing and showed that the benefits are real. Dr Ian Morrison, a senior research fellow and one of the project’s authors, said: “Lung function improved dramatically, particularly after about five months, once people had got used to what they were doing and changed their breathing habits.

It has been observed that people with breathing problems tend to develop a lot of anxiety about the very process of inhaling.  The tendency is to do ‘gaspy’ breathing so they’re taking short little breaths. This actually fills up the lungs without clearing them, making it even more difficult to breathe. Due to their obstructed airways, many people with COPD already find emptying their lungs a challenge.Gasping makes the problem worse and can, in the most serious cases, lead to a build-up of carbon dioxide in the blood, which can result in respiratory failure.

In contrast, the techniques used in singing encourage people to breathe in a much deeper, more controlled manner.The whole musculature around the lungs, throat and the upper chest improve with time,” says Dr Morrison. They use what they have much better and you really see a difference in the skill of actually breathing.”

To test its effects, Morrison and his colleagues asked over 100 COPD patients – ranging from mild to severely affected – to attend weekly singing sessions over a 12-month period.They measured their lung capacity with a device known as a spirometer – which looks a bit like a giant breathalyser – and asked participants to fill in a questionnaire to find out on a qualitative level how they were feeling. One of the tests involved measuring how much air a person could force out in a rapid puff. ( Peak Flow Meter)


On average the people in our study had 50% of expected lung function,” said Prof Stephen Clift, the study’s lead author. “That means about 1.5 litres of air in a one second puff. For healthy lungs, we would expect something more like 3 litres.” Without treatment, people with COPD can expect to see the size of their puff decrease by around 40ml a year.The very best the team had hoped for was that after singing regularly for one year, the size of that puff would stay the same.

Instead we got an increase of 30ml,” says Prof Clift.

“Although the changes are small, the progressive nature of COPD means that any loss of function year-on-year is going to be more significant for them.

“In our study, we not only appeared to halt the decline but people showed a small improvement.”

Dr Morrison added: “There’s also the social and psychological side, because any long term condition is isolating.

A recent Swedish study published in the journal Integrative Physiological and Behavioural Science suggested that it not only increases oxygen levels in the blood but triggers the release of “happy” hormones such as oxytocin, which is thought to help lower stress levels and blood pressure.

Singing has all the benefits mentioned so far and can also be very helpful in improving speech which has become slurred and unclear as a result of Parkinson’s. These same breathing exercises can prevent decline and marginally improve lung function in serious lung disease.

Breathing exercises and vocal techniques used when singing can help with:

  • sustaining the voice
  • increasing and controlling volume
  • varying pitch and expression
  • improving diction
  • controlling vocal speed
  • increasing the fluidity of diction
  • improving Posture

Not surprisingly there are a growing number of informal singing groups for people with Parkinson’s or other illnesses, such as Alzheimer’s. The opportunity to work on vocal and breathing techniques in an informal setting with people who share similar difficulties can be a valuable social activity and can help with self-confidence and overcoming Depression. And you don’t generally need to be able to sing to participate because such groups are not usually choirs and most do not give performances.

Typical singing activities which can help with improving posture, breath work and diction include:

  • taking your voice ‘for a walk’ up and down in pitch
  • lifting the tongue to the roof of the mouth
  • practicing trills (rapid alternation between two adjacent notes of a scale) with lip and tongue
  • making different types of sighs
  • humming
  • echoing tunes
  • singing in rounds (one voice starts and others join in one after another until all are singing different parts of the same song at the same time)
  • experimenting with a variety of pitch, pace and mood in songs.

Singing techniques have also been used to aid fluidity of speech and combat stuttering: Melodic Intonation Therapy (MIT) uses song phrases to retrieve speech when this has been lost or weakened. Group singing can give a social outlet and boost self-confidence in people who tend to withdraw socially due to slurred speech and weakening articulation

Prof Clift and Prof Hancox believe the health benefits of belonging to a choir, for some chronic conditions will become indisputable. “There are examples of arts on prescription and gym on prescription,” argues Prof Hancox. “How about singing on prescription, too?”

If after reading this you want to have singing lessons or join a choir try your local church, community centre or school. I have listed some ideas below of various choirs in and around Ealing.


Ealing Choral Society,

This is one of London’s best choirs: they are an amateur choir, performing with world-class orchestras and soloists in Ealing, as well as Central London and occasionally abroad.


Questors Theatre Choir

imageAnd for more information about joining, read the Why not sing with us? section.

Contact us here or phone 020 8816 7734 / 07802 720333

We are a 60-strong mixed voice choir based in West London, England, and affiliated to Questors Theatre.


Ealing Common Choir

imageThis was formerly Ealing Common Choir. Singers are welcome and ideally  can read music and sight-read a simple line. You’ve probably sung on and off all your life. Contact us or just come along to a rehearsal on a Thursdays at St Matthews Church, Ealing Common. Further details:-


Gospel choir/Singology


Singology is a vocal coaching company setup by Mark De-Lisser in 2000 to provide singing opportunities and tuition to people of all ages. With a strong tradition of choral singing, Singology has now launched ‘Singology Choirs’ to encourage more and more people to get involved in community singing, which has been proven to increase confidence, social cohesion and can also be used as a diversionary activity for young people in the community.

Monday Ealing 7:30pm – 9:30pm Ealing Town Hall, W5 2BY 12th Jan – 23rd Mar

Singology choirs throughout London are joining together to sing at the Royal Festival Hall.


The Ealing Rock Choir

image             Grange Primary School,
Church Gardens, Ealing, London, W5 4HN

The Ealing Rock Choir is led by singer/pianist Christina Clark. We have a great year lined up and we would like to invite you to join our choir and take part in the local Ealing and wider London community. We are the Ealing rehearsal of the trailblazing Rock Choir. We often team up with the other local London choirs to perform in much bigger choral groups. These inspirational moments are unique to the Rock Choir experience. It’s unbelievable and you can still join the choir. Just like a gym class or amateur dramatic society, your Rock Choir rehearsal provides an escape from everyday life. One evening a week during term time, your time is completely your own, to do nothing but sing your heart out with friends whilst enjoying our trailblazing formula of fun, friendship and feel-good music. Book a FREE singing taster session at the Ealing Rock Choir and see for yourself!

There’s no pressure to perform if you don’t want to – it’s all about having fun and enjoying some well-deserved ‘me time’. – See more at:

The Ealing Rock Choir singing at the Minack theatre, Cornwall. This is a fascinating outdoor theatre with an intriguing story.


Addison Singers

imageThe Addison Singers comprises two classical choirs – an auditioned Chamber Choir and larger non-auditioned Oratorio Choir; and two jazz choirs – an auditioned Jazz Ensemble and a larger non-auditioned all-female Jazz Choir. It also offers three different singing classes to meet the needs of beginners, intermediate and the more competent, experienced singer.


Or if or if all else fails try some Kareoke or sing- a – long with the TV or radio


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Posted by on February 8, 2015 in Training and Advice


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Candace also passed on this video as she found it helpful in describing the feelings she has gone through. It illustrates what anyone goes through when experiencing loss, albeit a serious illness, a bereavement or even the break up of a partnership. I am sure many people will identify with this giraffe and perhaps be able to raise a smile at the end!


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Have you ever felt that your mind is over full, cluttered with so many thoughts and worries that you almost feel your head is about to explode?

Moreover,have you developed techniques to deal with this?

This need has been recognised since the beginning of time and I feel as soon as we become aware of the world outside ourselves as a child we instinctively know how to do this. Unfortunately, children are not encouraged or nurtured to preserve this skill and many modern toys are brightly coloured and noisy and the opportunity to just ‘be’ and enjoy stillness and silence and the simple life around them is missed.

One of the best pieces of advice I was given when I had my first child was ‘if the baby cries remember she may just want to be put down’ and it often worked.

Several years ago I talked to a group of 5-6 year olds about being quiet and still and I was surprised when most of them revealed how this was something in their own way they found a way of practising. They then proceeded to tell me how they found space to do this. “I always go under my sisters bed,” said one child. “I go in the garden behind the shed” said another.” I sit under the stairs” said another.


I then sat with them and focused on a candle, which I allowed one of them to carry to the table. The child who was the noisiest and most active carried it with great care and placed it on the table. I spoke with these children on several occasions and on each occasion a child carried the candle a short distance to the table and we all sat in silence. Week by week the length of time they remained silent and still grew until they were able to sit quietly for up to 5 minutes. Following this they came out of the silence quieter and played together in a much calmer, friendlier manner.

Similarly, talking to children in a a quiet monotone causes absolute relaxation and puts them in a state of selfhypnosis. This technique I have used on many occasions to administer injections and take blood from children. On one occasion when I was a junior paediatrician and a child was admitted with an asthma attack. The nursing staff were lining up to hold him down to put up a intravenous infusion. The child was distressed and frightened. I asked the staff to leave the room and quietly spoke to him with full eye contact and gradually the child quiet ended and he cooperated fully to allow me to put up the infusion much to the surprise of the nursing staff.
On another occasion more recently I was working as a locum in a practise and a mother came to the surgery with 3yr old active twins. She was distraught as her husband had terminal cancer and she had no-one to look after the children and wanted to talk about her own problems. When I looked at the computer notes there were four entries from previous doctors recording that they were unable to have the consultation with the mother and she should return on her own. I started to talk to the twins and then gently massaged the centre of their scalp (a calming acupuncture point) and both children stood still for long enough for the mother to pour out her concerns. The children were then led calmly away by their much calmer mother.

image image

As an adult to achieve this level of relaxation we need to focus on a sound, a picture or simply your own breath sounds and may need help from another person.
Using techniques like this, meditation, breathing and yoga can help us pay attention to the present moment. It helps us become more aware of our thoughts and feelings so that instead of being overwhelmed by them, we’re better able to manage them.
This awareness of the present moment or Mindfulness as a psychological concept is based on the concept of mindfulness in Buddhist meditation. It has been popularised in the West by Jon Kabat-Zinn. Despite its roots in Buddhism, mindfulness is often taught independently of religion.
Mindfulness teaches individuals to be present in the moment rather than being distracted about the past or projectingd into the future. It doesn’t stop you feeling emotions per se, but it does allow you to deal with them more dispassionately.

Practising mindfulness can give people more insight into their emotions, boost their attention and concentration and improve relationships. It’s proven to help with stress, anxiety, depression and addictive behaviours, and can even have a positive effect on physical problems like hypertension, heart disease and chronic pain.

Mindfulness practice, is increasingly being employed in psychology to alleviate a variety of mental and physical conditions.

I think that mindfulness is something many of us have done – have you ever sat looking out to sea and found yourself listening to the rhythmic sound of waves or watching the trees/ grass swaying in a breeze or listening to your favourite music and suddenly realised that time has passed and for a short time you were only aware of that present moment and following this you feel more at ease. Have you swum lengths in a swimming pool with gentle rhythmic arm and leg movements and your mind taking up by feeling of movement in the water and finished the swim feeling that problems have seemed less or gone. Jogging at a gentle rhythmic pace around the park in a similar vein can give the same effect. This is not overexerting the body but calming the mind in a similar way to yoga. However, the benefit is only appreciated by being aware of the present moment and your thoughts and emotions at the time.
This can be a start to achieving full awareness or mindfulness by zoning in on the feeling of relieving the mind of excessive, overwhelming clutter so that eventually you can reach mindfulness with perfect stillness of body and mind.


Although the practise of meditation is in no way a religion it may be it is part of your religious practise and you need to be aware of how it can be helpful physically and mentally; you may want to call it prayerfulness.

I have been surprised as to how many people from all walks of life benefit from regular meditation although it is now it can be referred to as mindfulness.

Mindfulness. If you’re not yet au fait with the concept, it might be a good idea to familiarise yourself with it now, because you’ll be hearing a lot about it in 2013; from business leaders, academics, politicians and educationalists they are all making it part of their lives.

It is also being introduced into some schools as part of the curriculum.
I read an account of a school that played music and instructed the schoolchildren that when played they were to stay still and think about themselves. After a while the head teacher only had to start the music and the whole school became quiet.
Mindfulness is being increasingly recognised as an incredibly effective way to cope with stress and also recognised by NICE and the NHS as the most effective way to prevent relapse into depression and anxiety states. It has been found to help with pain management and weight loss.

It has been discussed in Parliament as a therapy in relation to both unemployment and depression. But it isn’t about zoning out. If anything, it’s about zooming in; paying attention to the present and decluttering the brain to make room for creativity – and in business that means boosting the bottom line.

To that end, mindfulness training has been embraced by organisations as diverse as Google, Transport for London, PricewaterhouseCoopers and the Home Office, by way of an antidote to the relentless pressure and information overload common in many workplaces.


1) Make it a formal practice. You will only get to the next level in meditation by setting aside specific time (preferably two times a day) to be still. At first it maybe for only 3-4 minutes.

2) Start with the breath. Breathing deep slows the heart rate, relaxes the muscles, focuses the mind and is an ideal way to begin practice.

3) Stretch first. Stretching loosens the muscles and tendons allowing you to sit (or lie) more comfortably. Additionally, stretching starts the process of “going inward” and brings added attention to the body.

4) Meditate with Purpose. Beginners must understand that meditation is an ACTIVE process. The art of focusing your attention to a single point is hard work, and you have to be purposefully engaged!

5) Notice frustration creep up on you. This is very common for beginners as we think “hey, what am I doing here” or “why can’t I just quiet my mind already”. When this happens, really focus in on your breath and let the frustrated feelings go.

6) Experiment. Although many of us think of effective meditation as a Yogi sitting cross-legged beneath a Bonzi tree, beginners should be more experimental and try different types of meditation. Try sitting, lying, eyes open, eyes closed, etc.

7) Feel your body parts. A great practice for beginning meditators is to take notice of the body when a meditative state starts to take hold. Once the mind quiets, put all your attention to the feet and then slowly move your way up the body (include your internal organs). This is very healthy and an indicator that you are on the right path.

8) Pick a specific room in your home to meditate. Make sure it is not the same room where you do work, exercise, or sleep. I may help to use a candle and gentle music or sounds to help you o feel relaxed.

9) Read a book (or two) on meditation. Preferably an instructional guide AND one that describes the benefits of deep meditative states. This will get you motivated. John Kabat-Zinn’s Wherever You Go, There You terrific very  good for beginners.

10) Commit for the long haul. Meditation is a life-long practice, and you will benefit most by NOT examining the results of your daily practice. Just do the best you can every day, and then let it go!

11) Listen to instructional tapes and CDs.

12) Generate moments of awareness during the day. Finding your breath and “being present” while not in formal practice is a wonderful way to evolve your meditation habits.

13) Make sure you will not be disturbed. One of the biggest mistakes beginners make is not insuring peaceful practice conditions. If you have it in the back of your mind that the phone might ring, your children might wake, or an alarm is about to go off then you will not be able to attain a state of deep relaxation.

14) Notice small adjustments. For beginning meditators, the slightest physical movements can transform a meditative practice from one of frustration to one of renewal. These adjustments may be barely noticeable to an observer, but they can mean everything for your practice.

15) Use a candle. Meditating with eyes closed can be challenging for a beginner. Lighting a candle and using it as your point of focus allows you to strengthen your attention with a visual cue. This can be very powerful.

16) Do NOT Stress. This may be the most important tip for beginners, and the hardest to implement. No matter what happens during your meditation practice, do not stress about it. This includes being nervous before meditating and angry afterwards. Meditation is what it is, and just do the best you can at the time.

17) Do it together. Meditating with a partner or loved one can have many wonderful benefits, and can improve your practice. However, it is necessary to make sure that you set agreed-upon ground rules before you begin!

18) Meditate early in the morning. Without a doubt, early morning is an ideal time to practice: it is quieter, your mind is not filled with the usual clutter, and there is less chance you will be disturbed. Make it a habit to get up half an hour earlier to meditate.

19) Be Grateful at the end. Once your mediation is finished spend 2-3 minutes feeling appreciative of the opportunity to practice and your mind’s ability to focus.

20) Notice when your interest in meditation begins to wane. Meditation is hard work, and you will inevitably come to a point where it seemingly does not fit into the picture anymore. THIS is when you need your practice the most and I recommend you go back to the book(s) or the CD’s you listened to and become re-invigorated with the practice. Chances are that losing the ability to focus on meditation is parallel with your inability to focus in other areas of your life!


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Posted by on September 28, 2013 in Training and Advice


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When I see someone with depression at their lowest ebb when everything seems black and whatever I suggest is met with profound negativism. They present in many different ways and may have some insight or may be in total denial.
Churchill referred to his depressive episodes as ‘the black dog’ and it has been suspected that it was Churchill’s recurrent episodes of depression that allowed him to realistically assess the threat of Germany.
Psychiatrist Anthony Storr described how Churchill used his experiences of depression to inform his political decisions: “Only a man who knew what it was to discern a gleam of hope in a hopeless situation, whose courage was beyond reason and whose aggressive spirit burned at its fiercest when he was hemmed in and surrounded by enemies, could have given emotional reality to the words of defiance which rallied and sustained us in the menacing summer of 1940.”
The quote that I find illustrates what I want to say is:-
“A pearl is a beautiful thing that is produced by an injured life. It is the tear [that results] from the injury of the oyster. The treasure of our being in this world is also produced by an injured life. If we had not been wounded, if we had not been injured, then we will not produce the pearl.” Stephen Hoeller
Over the years I have seen a huge variety of people with depression, head teachers, lawyers, research scientists, doctors, infact people of all ages from all walks of life. They all present with hopelessness and dwindling lack of interest in life and I see it as my job to help them discover a gleam of hope in order to work themselves out of this painful state.
They usually claim they have tried everything but nothing works, they don’t trust anyone and they don’t see a way forward.
However, as I reflected on the different people I have seen over the years and followed them up I feel uplifted by the fact that most of them have emerged out of this state to be happier, more fulfilled people and have turned around their lives in a positive way and this empowers me to feel hopeful about true recovery.
Something that I have suggested on many occasions that has been a help to some people is a simple idea based on the fact that collecting lots a minute pieces of positive experiences that would normally go unnoticed can subtly create a gleam of hope.
These minute positive experiences could be some food that tasted pleasant, making a note of a random smile from someone, the sun shining or simply a ray of sunshine through a crack, a pleasing picture or piece of music, anything that Seems momentarily pleasing. Saving a bus ticket, wrapper or newspaper cutting or putting a word on a scrap of paper as a reminder and then saving them in a ‘ chocolate box’ or equivalent and putting the box in a drawer( I suggest an underwear drawer – somewhere private) and to get the box out on a black day and trawl through these personal items.It is surprising how these minute events mount up in a short time and the overall effect can make life seem less hopeless.
When this gleam of hope is found and this may take a variable length of time and may need several consultations to build up a mutual trust in working together then a patient can embark on the 7 steps of recovery.

1)firstly in depression aswell as other chronic illness,it is important to accept help from people who really want to help us, from people who are really interested in our problems and listen to us, not just because it is their duty as doctors, but because they really want to help, and those people prescribe us medication, give us advice, and cognitive therapy. Allow yourself to accept such help, as it is genuine.
2) that you have to understand yourself. Meditation, yoga, anything. And above all, ask yourself, why did this mental illness occur? If you can answer this question, and I am sure you can, then this is already a great step forward.
We are now talking about the concept of mindfulness which I will be writing a separate blog shortly.

3)Change your eating habits.
We know that omega-3 fatty acids have innumerable health benefits. Recently, scientists have revealed that a deficit of omega-3 fatty acids is associated with depression. In one study, researchers determined that societies that eat a small amount of omega-3 fatty acids have a higher prevalence of major depressive disorder than societies that get ample omega-3 fatty acids. Other studies show that people who infrequently eat fish, which is a rich source of omega-3 fatty acids, are more likely to suffer from depression.
Sources of omega-3 fatty acids: fatty fish (anchovy, mackerel, salmon, sardines, shad, and tuna), flaxseed, and nuts.
Sources alpha-linolenic acid (another type of omega-3 fatty acid): flaxseed, canola oil, soybean oil, walnuts, and dark green leafy vegetables.
Also it has been found that people with low Vitamin D and or folic acid (spinach and advocado) tend to be more depressed.

4) We also need to change the way we communicate with others.
As one psychiatrist quoted,
“When a patient tells me his wife nags him I tell him to turn the tables on her. When she says: ”look at you in front of the TV again watching too much TV Football leaving me to do the washing up once more”, stand up and say:«you are right dear, I will do the washing up today.”
I think she will feel weak at the knees and you will gain something, because you have surprised her and, by doing so you have gained, and become more charming because you reacted differently. When the patient comes to me the following week he says: ”I surprised her, but I didn’t do the washing up”.”
I have used this in consultations using personal situations. Many years ago I remember this series of consultations.
Mr T had been going on holiday by himself for a few years because his wife was too miserable and depressed and I suspected he was depressed but in denial. When she went in hospital he came to have a routine blood pressure and complained how his wife was in hospital and even more miserable. She had seen me before going into hospital and complained as to how unsympathetic and miserable he was and how glad he was going on holiday by himself. (As patient confidentiality is paramount in any consultation neither party knew I had consulted the other.)
When I saw Mr T I suggested that it would be good if he took her flowers when he went to see her although it was something he had not done in many years.
When I saw Mrs T after she was discharged I reviewed her and she then said with a smile on her face “guess what doctor, my husband visited me in hospital and he brought me flowers!” I replied ” how lovely, I hope you said ‘thank you’ ” she replied, ” oh dear, I don’t think I did”
When Mr T consulted again he said, ” I did what you said doctor and eventually she even said ‘thank you’!
When I consulted them a few months later each one in turn gave me a bar of chocolate from Spain and reported how they had had a nice holiday together.
On each occasion I just smiled and later shared the chocolate with my family when they greeted me in the evening with “late again for supper,mum”!

5)We all need to find a better balance between work and leisure, find another pattern. Some of us have a pattern of 20 hours to 4 hours. It would be much better to have a pattern of 20 minutes to 4 minutes. Or better still 4 hours: 1 hour. Changing the rhythm doesn’t mean that you have to work less, just change the rhythm. Otherwise you risk burnout.
I often suggest to those people, who adamantly claim that they have to work late every night, to choose one or preferably 2 days a week to leave ‘on time’. The first week colleagues will question this ‘leaving early are you?’ But hold the head up high and leave with no reason given. The second week on leaving ‘on time’ the comments may be ‘leaving early again’ and again leave with head held up high and no reason given. The third week as you linger dreading a comment it will probably be ‘isn’t it today you leave early?’ It works and can be a chance to develop space for leisure even a quiet undisturbed cup of tea or a walk in the park.

6)Change your interaction with nature. To those of you who enjoy being outdoors I say: ”What do you think about when you for a walk in the park . About your problems. Why? Why is this wrong? Because every muscle cell has a memory. When we do stomach exercises, all our stomach cells are attuned to work with us . When we do push-ups, all our cells do push-ups. If we think about our problems every time we run uphill, then our cells will be full of problems whenever we run uphill. So, when we get depressed, somatisation causes pain in all those cells. It’s very simple. Every cell has a memory. I suggest that it is a good idea to change – go to Tai Chi before going for a run or alternatively concentrate on something else. When you run, imagine yourself in an ideal situation with the perfect partner, the perfect job or in a dream location.
Change your interaction with nature. If you used to go mountaineering take up caving, jogging take up rambling.

Take a trip to ‘Lammas Park or Walpole Park instead of Pitshanger Park. In short: make a change, because by doing this you will move from West Ealing to another place. Even if only for half an hour a day.
“Trying something new alters the levels of dopamine, which is associated with pleasure, enjoyment, and learning.”

7)What is most important?

For me the most important thing is to change your attitude towards music and dance. Listen to music for fun, sing or hum along with it with ear phones or in the shower if you don’t want to upset the neighbours. Sing in the car on your own, with your partner or children with feeling and passion!! Great on the school run…

Dance on you own, with your partner or children or your imaginary partner!
Dance to have fun try ‘strictly come dancing’ or karaoke in your own home  or wherever… If you used to dance the Foxtrot, then dance the Waltz. If you used to dance the Salsa then dance the Zumba…

How to find a recovery from depression

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Posted by on August 15, 2013 in Training and Advice


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What is ‘mental health’?

I am now continuing to air my views on mental health along with ideas that I have extracted from the Slovenian psychiatrist Andrej Marušič I mentioned in my last blog about depression
I have often wondered what we mean by Mental Health and was interested in his ideas but then when I read the news today proclaiming that one third of children under the age of 16yrs contemplate suicide I realised that the mental health of the nation is a serious problem and stretches deeper than one could imagine.
Mental illness accounts for 23% of the UK’s total burden of disease (compare this to cardiovascular disease or cancer which each account for 16% of the total burden of disease). Yet only 13% of current NHS health expenditure is on mental health. The World Health Organisation estimates that depressive disorders were the third biggest global health problem in 2004 and by 2030 they will be the largest.
What is important is, that when we talk about ‘mental health’ we take into account everything we see – appearance, behaviour, the way the person moves and what they say. Based on this we can assume what we think and guess which mood someone is currently in. If I was crying five minutes ago and then yelled at you in the next five minutes you would probably think my mood very unstable and would benefit from seeing  a psychiatrist.

This is mental health, as we see.  Psychiatrists frequently make assumptions – GPs do the same – and, actually, this is not a big deal. Firstly,what we see and assume about mental health, about the health of someone’s mind, is captured between two very important determinants – one is genetics and the other is environment.

Genetics may appear less important when it comes to mental health, but that’s not true because two thirds of our genes determine our brain function, whilst the remaining third determines all our other organs. Hence, genetics is very important when it comes to mental health, but clearly it is not the only thing that is important. Each and every one of us is like a book – full of genes that only express themselves if we allow them to do so. If you spent all your life in the same town and had the same job as your father who also lived and worked in the same town all his life, it is clear, that you will be more likely to suffer the same diseases as your father. But if you move from one town to another , or even another country, you would probably be experiencing something else as different genes would appear in your book.
But we must remember that we should never underestimate the role of genetics in mental health. For instance, have you ever heard of two elderly people in care homes been accidentally “swapped”? I doubt it. Babies, however, have been accidentally swapped. This implies that our unique genetic fingerprint becomes more defined each day and with every day we become more and more who we are, and those of you who would like to be as different as possible from your parents should be aware that we become more and more like our parents every day.
I have to say when I worked in a community in South Wales where extended families stayed in the same village or town and rarely moved away the genetic element of disease was very more obvious but when I came to London I have been aware of how the environment has more of an impact on health. I remember a type of woman who functioned reasonably well and then periodically took to her bed unable to open her eyes or respond to anyone and was often married to a doting, caring husband who waited on her hand and foot but was descibed as ‘just like her mother or aunt’ implying a genetic element. Everyone feared that if the husband died as to how she would cope but as often happened the husband did die first but surprisingly enough the woman thrived in more ways than one. If I speak to anyone from that community they know exactly what I mean. Is it depression? Is it unhappiness but whatever it is the person often female needs to withdraw or opt out to survive and in my experience survived to a good age. However,in London most people troubled by mental health problems associate it with stress or change of environment with perhaps some genetic factors.
The second very important thing to consider when assessing ‘mental health’ is that it is ‘captured’ between temperament and behavioural habits. What is temperament ? when a person attends surgery they adopt very similar behavioural pattern on each visit and it makes it virtually impossible for to say anything about a persons temperament when they are seen in surgery.
We all have a temperament which should be tested frequently to determine to what each of us is prone. When I was in a family practise with may be four generations of a family in a close community it was easier to establish the temperant as receptionists or other people gave you the ‘gossip’ “she is always the life and soul of the party” or “he nevers goes out, never has!”

We also have behavioural patterns, this is what we do during most of our waking hours depending on what our role or work is and different behavioural patterns are prone to different diseases.

The third most important thing is the fact that mental health falls somewhere in between mental health in a very narrow sense and mental illness. Whenever someone develops a mental disorder, or mental illness they can be restored to full health. When famous athletes injure themselves, their performances drops that season, but in the seasons to follow they can improve their results.
Or for example, when a manager gets depression, if he recovers he will manage his company better, I believe, because he starts to understand other people and empathises with them better.
I remember being in conversation with GP colleagues and telling them that there were some days I could get full score on depression assessment and some colleagues agreed but one colleague said “I never get depressed”. Not only were we surprised but wondered how she managed to empathise with most of her patients.

When you go to the gym you learn to lift increasingly heavier weights for longer periods of time without developing aches in your muscles. You can use the same principle to practise psycho-fitness.
In the same way that someone who regularly goes to the gym can say “I have been practising this for six months now. I can run for quite some time, I don’t feel at all tired and I am in very good shape”, someone who practices psycho-fitness can develop their abilities to put up with 8Mb of stress instead of 4Mb, or even 12Mb and still go to bed without any worries on their mind.

This makes sense as I am aware when you have a stressful job alongside personal stresses I is imperative that you practise psycho-fitness.

The best thing our mothers and teachers can give us while we are growing up is self-confidence. Self-confidence strengthens our psycho-skeleton which can then put up with more, which means that we can live more easily and are less likely to develop different mental disorders. Italian and Jewish mothers constantly build up their children’s self-confidence by telling them that they are the best looking, the smartest and so on. Whilst it can be difficult to work with such people, who are so full of themselves, you must admit they never suffer mental health problems.
You may be familiar with the phrase ‘nervous breakdown’ for depression. The best way to describe what really happens: the psycho-skeleton breaks, the psycho-muscularity breaks, and this expresses itself on the monoamine level.
Our ability to deal with problems diminishes, our hardware becomes soft. The bottom line is something breaks under the burdens we carry in our backpack, for example physical disability, diabetes or cancer. Sometimes the trigger can be a physical or mental illness which one of our parents may be suffering from.

Imagine,a newly retired lady who resolves to go to her holiday home, everyweek-end, with her husband. But then her mother develops dementia and, she has to become her mother’s carer and something she has looked forward to doing is thwarted. In short, burdens like this can break us, and when we get hit; from the left or from the right – it doesn’t matter from which direction – this hit is like a loss and when we lose something the chance of developing depression increases.
If we are afraid of something the chances of us getting anxious are greater. This is scientifically proven and this breaks us, and when it breaks us we develop depression, which usually manifests itself via biological symptoms, so even though this is a psychiatric disorder it manifests with typical biological symptoms, i.e.a person wakes up every two hours and cannot sleep and if he sleeps for six or eight hours he is just as tired because he lacks the REM (rapid eye movement) dream phase, which helps him reorganise his thoughts. Then he develops psychological symptoms, such as guilt feelings or other distressing feelings. Or the other way around: there are people whose psychological structure is so inclined to depression that they push themselves into depression. The explanation is that they have loads of negative thoughts; that they are inclined to think negatively.
In 1952 Norman Vincent Peale wrote a book ‘Power of Positive Thinking’ which was created a significant following for many years. He quoted
“The way to happiness: Keep your heart free from hate, your mind from worry. Live simply, expect little, give much. Scatter sunshine, forget self, think of others. Try this for a week and you will be surprised.”
However, as Andrej Marušič suggested it could be argued whether there are such things as negative or positive thoughts. “If I tell my children they are not going out until they have finished their homework, this is a positive thought for me, because I am raising them up to be good citizens, although it is a negative thought for them as they are not allowed to go out.
So who will be the judge of what’s positive and what’s negative? The Prime Minister? I don’t consider anybody able to judge what is negative and what is positive.”
Let me illustrate how people think. Basically, we think all the time and our thoughts usually follow the same pattern. Every initial thought is followed by a second thought, usually associated with the first, and so on – moving around universe of thoughts, quite healthily thinking both positively and negatively. This is completely normal, but what happens if a “short circuit” occurs? A short circuit can even occur with completely positive thoughts. Let’s imagine the thought “If I stop going to work, I’ll be fired”. This is a positive thought, in general, since someone who thinks like this is smart and can anticipate consequences. But if this thought is so disturbing and causes so many worries that this person actually stops going to work then this thought – due to its monotony – bears potential for depression.

Now, let’s see how I – and a few others – distinguish between the different types of depression by dividing them into three groups: Blue depression, Red depression, Yellow depression.
Blue depression is the most prevalent and this is why the circle is the biggest and that is the so-called serotonin depression, which is characterised by sleeping disorders, people wake up two hours earlier, they are tired, their appetite is weak and their libido low. A weak appetite doesn’t mean less food intake and a low libido doesn’t mean less sex.
But to me sexuality is not just lying back and thinking of England, it should be joyous.
In short, lack of serotonin reduces libido. In this picture dreams are coloured blue. Dreams are very important but not because you are explaining what you were dreaming while lying on the couch. Dreams are nothing other than recollections of what you experienced through the day put into perspective against your past experiences. This enables us to store only relevant data, as if cleaning up our computer desktop and we place these files into different directories and, according to how much we save, our day may appear long or short.

For example, if you go to Taiwan for a week, this week will appear much longer to you because you will store more data during your dreams than you would during a week at work where you’ve been employed for the last 10 years. We accumulate our memories from our dreams. As we age we experience things we have already experienced before, so time appears shorter. There is a big difference between four years at school and four years at work, when we are 40 years old. We think time passes quicker as we age, because we don’t store memories we have already laid down – we are not travelling to Taiwan.


Red depression is a lack of will, a lack of motivation and a lack of energy. This is a very important depression, so-called noradrenergic depression, and doctors know, that when they give a patient noradrenalin in intensive care, the patient suddenly wakes up, gets up and this is what a noradrenergic depression patients is lacking.

Patients with yellow depression related to levels of dopamine lack enthusiasm and “joie de vivre” or motivated behaviour- “get up and go”. This type of depression is more complex and there are still no specific antidepressants for this type of depression although those on the market do help in some situations. It can be drug induced or in diseases such as Parkinson’s disease which is classically due to severe lack of Dopamine.

With all three types of depression people develop specific psychological symptoms
People with blue depression feel emotionally empty, people with red depression become sad, I know that about I wanted you to see; and people with yellow depression feel extreme hopelessness.

All these people can develop feelings of guilt, low self-esteem and so on. A good psychiatrist, or GP, will listen to you to understand when and how your depression started. If he/she puts you on an antidepressant before you stop talking, turn around and walk out. What’s the target? Every good psycho-pharmacologist must know what he is treating. However. sometimes it is more obvious and the target is reached immediately but in more complex depression which may involve a mixture of more than one types it may changing medication until the appropriate target is met.When the correct medication is found biological depression disappears automatically within four weeks, while psychological symptoms remain. Feelings of guilt are usually the last to disappear.
In summary mental health falls somewhere in between mental health in a very narrow sense and mental illness. It must take into account – appearance, behaviour, the way the person moves and what they say. It is determined partly by genetics and partly by environment depending on where a person spends their life , either remaining in the family circle or moving away. It is also captured between temperament and behavioural patterns.
The type of depression if diagnosed properly medication can treat it effectively. Healthy mental health can be maintained by psycho-fitness which will be my next blog!


The Samaritans is available for anyone struggling to cope, round the clock, every single day of the year. Call 08457 90 90 90, email or find local branch details at


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Is mental illness still a stigma?

When I blogged  a couple of weeks ago I implied that I wanted to revisit this subject.
At that time I seemed to be overwhelmed in the media and in the surgery with patients that felt hopeless and were finding it very difficult to go on. One busy surgery on aTuesday morning I could feel the atmosphere of tension and anxiety that sometimes pervades the surgery and indeed during that morning 4 people got up and stormed out. On this occasion because of the way I perceived the vibes I decided to phone each one to see if I could give a telephone consultation or arrange to see them later. What shocked me was the fact that all 4 said they had been feeling desperate and that life was not worth living and waiting was the final straw. Interestingly each person was pleased I had phoned and in 2 cases the act of waiting then storming out angrily had made them feel much better and in effect had  ‘snapped’ them out that of deep feeling. The other 2 wanted to talk and happy to reschedule an appointment at a quieter surgery time but felt better for the phone call.
That night I re-read a paper I had recently read on depression and decided to blog some of the ideas I thought would be good to share.

Following my stumbling across his secretary and family whilst at a gathering in France I was given the privilege of reading some papers written before 2008 by a Slovenian psychiatrist,Professor Andej Marušič  who also worked at Kings College London before he  died tragically from bowel cancer aged 43yrs.
He was brought up in the downtown area of the city Port of Koper,Slovenia  and had been aware from an early age that the incidence of suicide in Slovenia was one of the highest in the World and most of his childhood friends from that time had become either dependent on alcohol or illegal substances, or had already died a violent death. He was the only one who somehow made it through. He made the point that if it wasn’t for his upbringing he had had, he probably would have been a good drug dealer. He made it his life’s work to research ways to prevent this tragic end of life.

He presented this paper to at least 2000 health professionals in a very humble, unassuming manner. He was passionate about de stigmatising mental health, making the point that if someone had been in hospital with pneumonia or a heart attack friends and family would be keen to visit enquire about jprogress but if someone had been in John Connelly wing, St Bernard’s there would not be so much interest and people would keep away and not get involved.

This rung a bell as from an early age I had a fascination for medicine and the workings of the body aswell discovering books about the ancient Egyptians and medicine. I also found myself listening in to conversations about ill members of the family or friends. Moreover, I always wondered what was the matter with those people who always came out of hospital with wooden trays displaying a chocolate box picture (a hunting scene or thatched cottage) and woven around the perimeter (the image of one below was found on eBay and being sold as a retro vintage tray!). image
Years after this I then realised making the trays was occupational therapy following a nervous breakdown – and my observation was a display of the stigma of mental illness to cover up what the problem was which as a child seemed strange and somehow not right. It would be good to think that attitude like the tray has become retro and a vintage idea.

Professor Andej Marušič then gave the following example:-
A man; 47 years old; married, with problems, or married to problems; a father with worries –  employed or waiting to be employed; low back pain; irregular heart beat; feeling low; no appetite but not losing any weight; a warning for those who want to loose weight with depression; no libido; using sleeping tablets; no hobbies; drinking too much, and sports – our Slovenians are losing!  We will now try to diagnose the profile of our patient.  What do you think his doctors will diagnose? Burnout? The cardiologist will say “arrhythmia”, as the patient is experiencing irregular heart beats; the orthopod will say “lumbago”; the psychiatrist “depression”; the psychologist “neurotic structure with interpersonal relationship problems”; the sociologist “weak social network”; the employer “if it wasn’t for Employment Tribunal law you’d have been fired a long time ago”: his wife “I can’t reach him” because he has lost his libido and his children will say “the old man is bothering us again”. That’s probably more or less the way his therapy would also go, although sometimes the therapies overlap, for example the general practitioner and the cardiologist would both prescribe sedatives.   One would prescribe a benzodiazepine, the other a tranquiliser, while I must stress that these two are as similar as whisky and cognac – sedatives don’t cure. The orthopod would prescribe analgesics and give him back strengthening exercises, to which he would respond “I don’t have the time to do these”; the psychiatrist would prescribe antidepressants, as this is almost the only thing we know how to do; the psychologist would say “Be positive” – I am allowed to make jokes about psychologists, because I am one – The sociologists would say “If we had a left wing government you would probably feel better”; the employer would say “Place him somewhere I don’t have to deal with him”’; his wife will say nothing, until she starts talking about the divorce, while his son and daughter are too young to have acquired a treatment licence.

What is the main problem here?

The main problem we are witnessing here is that different people see health from different perspectives. One is looking at just the ground plan, another at just the elevation, while a third just sees the cross section. Nobody sees the whole picture – the overall health of one entire body. Have you heard the saying “When you are healthy, you have a thousand wishes, when you are ill you have just one wish” This unfortunate 47 year old, who is supposed to “Be positive”’ couldn’t care less who treats him, as long as he gets his health back.


Most of my medical career we have always assumed that patients are suffering from physical illnesses even contemplating it is ‘in the mind’ and patients want it to be physical and would be offended if it was implied that it was’ in the mind’ but now for some time as doctors we are following a biopsychosocial model and when we are assessing a patient we are taking into account all three aspects of a patients health and welfare.When I visited the nursing home a week or so ago I was asked to see 2 or the residents both unable to express themselves due to dementia. One Dorothy was quiet, not eating , withdrawn and it was thought that perhaps she had an infection or was going into a decline might have even had a small stroke. Had she had a stroke, or an infection or another physical problem she would she have to leave the home to be looked after elsewhere. Inevitably, the nurse in charge and myself pondered over physical reasons. Lets check their blood, start them on antibiotics ,get an ECG, call in the Palliative care nurses etc. Then  we both said together could they be depressed and looking at it logically it was reasonable to consider that along with everything else. Indeed they were both started on antidepressant medication accordingly having examined possible physical and other mental problems and alerting staff to be attentive to their social needs within a few days they were both in the lounge chatting calmly sipping tea and enjoying a piece of cake!  The nurse manager and myself just sat and watched them with sheer delight and the ambiance  was now peaceful and calm. This wavs a demonstration of holistic care and it works!!

I feel we are making progress and I would love to have been able to tell Professor Andrej Marušič that progress is being made. I have seen a real difference in the way employers treat patients that are depressed and I hahve no difficulty in writing ‘anxiety and depression’ or ‘stress related illness’  as a cause of sickness absence. Also, most employers work actively with their employees to address issues that may be contributing or causing the problem and create good back to work plans. I now see patients who have had time off with mental illness and see them return to work and blossom handling their lives in a much healthier fashion.
In these cases we made the decision for the patient as they were lacking mental capacity:it is different when both the doctor and patient with insight and capacity are trying to make that diagnosis. It’s also a bit more than  medication, cups of tea and cake but we have made some progress from secret hideaways and woven trays!

Yesterday, I read in the News the following proposed pilot scheme :-

Nurses are to go on patrol with four police forces across England to improve responses to mental health emergencies.
The pilot scheme aims to ensure fewer people with mental health problems are detained in the wrong environment, the government says.
Street triage teams are to be tested in the Derbyshire, Devon & Cornwall, North Yorkshire and Sussex force areas.
The patrols are part of an initiative funded by the Department of Health and backed by the Home Office.

Have you heard Ruby Wax’s take on this- yes another TED talk Stop the stigma of mental illness
I would like to be optimistic and feel that progress is being made in pdestigmatising Mental Health but I am sure there are cynics who are very guarded about that impression – lets watch this space!

image I will continue a further blog on his ideas of managing depression.


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Is Life worth Living?

image“Every man has his secret sorrows which the world knows not; and often times we call a man cold when he is only sad.”
― Henry Wadsworth Longfellow

When I was first in general practise the one sort of patient I dreaded coming through the door was someone saying. ” I feel fed up, I’m depressed, life’s not worth living, I wish I was out of it, life’s hell, I’m down, I’m b……” How could I understand, I was the happiest woman in the world:I had a lovely little cottage,a wonderful job with great staff and easygoing patients who never complained , more than enough money to live on, lots of lovely friends, a man to go out with but no commitments,no children(only borrowed) fit and healthy parents and family – life was rosy
Memories of working in the psychiatric hospital and looking after patients on intensive care having overdosed on the old fashioned drugs with horrendous complications came flooding back. But I was now in a position where I had to try to prevent these people going down that route….
Years have passed and my personal life has had many challenges and my understanding of depression has changed beyond measure- I now understand what it is like to feel in despair, hopeless and is life worth living? Fortunately I have been blessed with good friends, understanding people nearby, a strong faith and plenty of things I have been able to turn to to give me hope and worth and purpose to continue living.
When I was away someone emailed me and said “why don’t you do a blog on depression as there is lots in the news at the moment regarding bi polar (in view of Stephen fry’s recent admissions of suicide attempt) and depression / suicide (Paris jackson attempt suicide yesterday and famous Bollywood movie start Jiah Khan committed suicide this week too due to depression)

I felt that heart sink feeling again but a need to let people who are despairing that there is somewhere there for you and you have a right to be in this world and part of this world as much as anyone else. But somehow I couldn’t get around to writing anything about this subject.
However, the day before market day I had met Ann for the first time.She had recently retired and had been a PA to a Slovenian professor of Psychiatry who sadly had died at the age of 43yrs from Bowel Cancer. What’s more he had been one of the world’s experts in suicide prevention. She then proceeded to show me some of his lecture notes that she had been translating from Slovenian for future publication.

Next day we went to market ( to buy the apricots) and the local cathedral was cordoned off and we were later to hear that a 50 yr old advocat(barrister) ruuner up for mayor in 2012 had committed suicide and many hundreds of people were gathered for the funeral service.

I now feel very motivated to write on this vast subject of depression and will be continuing to review these Slovenian papers which have some very interesting thoughts ……..
***look out for further blogs

Meanwhile, if you are depressed and need someone to talk with the surgery will always accommodate you with a longer appointment -please ask at reception or by by phone- you need not disclose why you want a long appointment.
If you need to know more about depression
image in Ealing

Do thou need someone to talk to anytime,any day,anyplace, anywhere?
Tel number 24 hrs365 days/yr to call with absolutely any worries
Would you like to volunteer to be a Samaritan?



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