Life lessons learned from Rake

I was a newcomer to the television show Rake, and have only watched it a few times. I was thinking last night during a particularly poignant episode (it's the last one for the series), that there are many life lessons that can be learned from Rake, and shows like it, which I think is a big part of their appeal.

As I am a newcomer, I'm not completely across the full plotline, characters, subtleties etc., so please forgive any errors. It's not really about the show so much anyway, as about what it can teach us. There's also one correction that 'needs' to be made (we are neuropsychologists after all), to the storyline involving the witness who had sustained a brain injury after a fight with Cleaver Greene.

1. The only certainty in life is change

When I started watching the show, Cleaver Greene was recently out of gaol, had no job, no clients, and no relationship; his apartment had been taken over by his secretary, and his ex-wife was about to remarry. By the end of the series, he had rebuilt his career, retained numerous high profile clients, his ex-wife was single again, and was building what appeared to be quite a healthy relationship with a new woman. Rake takes it to extremes of course, few people's life circumstances are that dire, or change that quickly, but no matter how bad things are, take comfort in the fact that they will change.

2. The brain is an amazing organ

The storyline about Rake's ex-wife Wendy being only able to speak Bahasa following a siege where she is held hostage by her fiancé seems a bit far-fetched, but there have been other cases of individuals losing their first language (temporarily) and only being able to speak a second language following trauma. (As far as I'm aware the other known cases have been following brain trauma rather than psychological trauma, so a bit of poetic licence has been taken by the show here. Or maybe she did sustain a brain injury, I'm not sure.). It is thought that this can happen following damage sustained in the area of the brain where language knowledge is stored. The ability to speak a first language tends to be localised to an area in the left hemisphere of the brain, whereas the ability to speak a second language predominantly comes from the right hemisphere. So when trauma results in better recall of the second language, it may be that they had an injury to the left side of the brain and are better able to access the knowledge of the second language localised to the right hemisphere.

The correction...

The other reference to the human brain in this episode warrants further discussion. Cleaver manages to discredit a witness who had recently sustained a mild traumatic brain injury (mTBI) by claiming that since he had developed amnesia, they couldn't rely on his testimony about events that had occurred (as far as I'm aware) some time prior to the injury. The type of amnesia that follows a mTBI tends to be difficulty recalling events that occurred around the time of the incident. People may experience retrograde amnesia (loss of memories formed shortly before the injury, typically minutes before for a mTBI) and/or anterograde amnesia (difficulties creating new memories after the injury, e.g., remembering new appointments, learning new tasks) following a mTBI. So while it is possible that the witness would not recall that it was Cleaver who attacked him, he is however very unlikely to have difficulties recalling details of the fraudulent deal which was the subject of the court case.

3. Being genuine is endearing

Cleaver Greene is a bit of a 'Warnie' (Shane Warne) type character. No matter how badly he behaves, he always has his fair share of loyal friends and lovers, and the appeal of his character is a big part of the show's success. This is because he is genuine. While he may tell the odd lie to get out of trouble, overall with Cleaver Greene what you see is what you get: he doesn't pretend to be anyone other than who he is. Pretending to be somewhat you're not may impress people in the short-term, but real friendships and relationships are built on a foundation of being genuine.

If you'd like to know more about traumatic brain injury, mental health issues, assessment of brain injury or illness or rehabilitation following brain injury, please contact the team at ANTS.

The Neuropsychology of Depression

In his recently released autobiography, Ian Thorpe describes how he has suffered from depression most of his life. Like many young Australians with depression, the 30-year old revealed that he kept the illness behind closed doors to the point that not even his family and close friends were aware of his battle with the mental illness, and rather than seeking professional help he would instead often turn to alcohol. He recalls in his book periods of low mood that would often last a month, during which he contemplated suicide.

Depression is not uncommon in young Australians, with approximately 160 000 individuals between the ages of 16 to 24 years of age living with the mental illness. Like Thorpe, a high percentage of sufferers experience suicide ideation and such individuals are at increased risk of completing suicide.

Depression is mainly known for its affect on mood. A lesser known fact is that sufferers also exhibit a number of neuropsychological impairments. Research has shown that individuals with depression have poorer episodic memory and slower psychomotor speed. In addition, those with depression exhibit difficulties with problem-solving, planning and mental flexibility.

The range of cognitive impairments seen in individuals with depression is the consequent of several biological changes in the brain. One of the most widely researched biological dysfunction concerns a deficiency in Serotonin, an important neurotransmitter that is known to mediate memory and learning. Brain MRI studies have shown that, relative to healthy controls, individuals with depression have decreased activity in the frontal lobe, an areas of the brain important for problem-solving, planning and mental flexibility. In addition, research has shown that depressed people exhibit abnormal activity in the amygdala, an area important for processing emotional aspects of information.

Thorpe described that after years of suffering with depression he finally consulted with his doctor who prescribed medication “but little in the way of explanation”. Ironically, he noted that this consultation isolated him further as he felt he "now had a secret and no one to share it with.”

While most antidepressant medications are thought to improve symptoms of depression by correcting deficiencies in Serotonin, they are not affective in addressing the important psychological component of the mental illness, namely negative and maladaptive thinking-patterns. This is usually addressed by supplementing antidepressants with some form of cognitive therapy. Interestingly, there is some preliminary evidence to suggest that cognitive therapies may in themselves alter neural circuitry and normalise abnormal amygdala and frontal activity. Whether these changes lead to corresponding neuropsychological improvements, however, is yet to be determined.

Mental health care for Newton

Successful treatment for Matthew Newton

After a string of assaults and alleged assaults, including domestic violence incidents involving two ex- partners, punching a taxi driver in Sydney and attacking a hotel receptionist in the US, Matthew Newton has recently been released from a high care mental health facility for treatment for bipolar disorder and obsessive compulsive disorder. He previously spent time in a mental health facility in Sydney in late 2010.
His latest treatment has reportedly been a resounding success, with Newton currently free of medication and 'unrecognisable' according to his lawyer, since spending 84 days at the clinic, when he appeared in the Downing Centre Local Court to face charges over the taxi driver assault. His lawyer, Chris Murphy is making a second application to have the matter dealt with under the Mental Health Act, given his diagnoses. An application made earlier this year was rejected.

Section 32 of the Mental Health Act diverts people suffering from mental illness who have been charged with a crime from the criminal justice system and imposes a treatment plan. Charges can be dismissed with the condition that the individual undergo treatment.

Serious psychiatric conditions such as bipolar disorder are known to be associated with higher rates of violence, particularly when an individual is in a manic state.

ABC News Photo Illustration

While this is certainly no excuse for violent behaviour, having a diagnosed mental health condition can help to explain Matthew Newton's actions and can be taken into account as an extenuating circumstance in legal matters. Section 32 of the Mental Health Act exists in part, to help ensure that people who have a mental health condition and engage in criminal behaviour undergo appropriate treatment, which benefits both the individual and the wider community.

As his lawyer made the point via Twitter, you "can't cure mental illness with 'You stop that!'".

With appropriate diagnosis and treatment, most people with mental health conditions can lead happy, safe and fulfilling lives.

Mental health and the federal budget

The 2012-13 federal budget has been released, and according to some expert commentators, there is good and bad news for mental health arising from the budget.

The good news is:

• Overall funding for mental health has not been cut.
• Funding for the Mental Health Nurse Incentive Program, providing incentives for community based general practices to engage mental health nurses, has been maintained.
• The government will provide $21 million to fund additional allied mental health services for patients under the Better Access initiative, whereby treatment for those with diagnosed mental health problems is partially covered by Medicare.
• New spending of $115m over five years is directed towards better mental health care for veterans.
• From 2014-2015 $9.1m will be provided to the Australian Bureau of Statistics to conduct its Survey of Disability every three years, rather than every six years.

Teenagers, sleep and brain changes

Adolescents are renowned for their ability to sleep and for their erratic behaviour.

A recent study examining adolescent brain activity during sleep reveals what is happening in the brains of adolescents (that may help explain their behaviour!).

The study, led by Dr Ian Campbell and Prof Irwin Feinberg at the University of California, involved 67 adolescents. The researchers took electroencephalogram (EEG) recordings of their brainwaves while sleeping. They found that there was a 60% drop in the activity of delta waves in the brain as the children moved through puberty, particularly between the ages of 12 and 16 years. Delta waves occur during non-rapid eye movement sleep, the phase of sleep where the brain recuperates from its activity during the day.

Changes in brainwaves indicate that pruning of brain cells occurs at this time. As discussed in our earlier blog, Neuroplasticity in Children, pruning involves brain cells and the connections between them being removed, leading to changes in brain efficiency.

Another researcher, Prof Mick Hunter of the University of Newcastle, stated that "People don't realise what massive changes occur in adolescence in a very short period of time. There are so many changes - physiologically, mentally and socially". These changes appear to be interdependent.

These findings may have implications for the study of mental illness such as schizophrenia. It may be that errors that occur during the rapid process of brain reorganisation at the end of adolescence give rise to mental illness.

Mental illness can be associated with cognitive difficulties. To learn more about the relationship between mental illness and cognition, contact us.

New evidence regarding ECT

Mention ECT (Electroconvulsive therapy) to most people and they are likely to imagine a scene out of One Flew Over the Cuckoo's Nest with a patient being involuntarily strapped to a table and given a painful electric shock.

However, ECT is actually a humane and effective treatment for patients with mood disorders like severe depression, particularly in cases when alternative treatments have been ineffective.

Current techniques involve first anaesthestising the patient and then electrically inducing a seizure.

Whilst it has been used successfully in clinical practice for 70 years, until now it has not been well understood how or why it works. Prof Ian Reid and his team from the University of Aberdeen in Scotland found that ECT changes the way different parts of the brain communicate. By comparing the brains of people before and after the treatment using brain imaging they showed that ECT reduces the strength of overactive connections between parts of the brain that control mood and those that control thinking/concentrating.

This finding could help improve diagnosis and treatment of mental illness and other disorders including schizophrenia, autism and dementia.

One of the possible side effects of ECT is memory loss. A neuropsychological assessment can be used in conjunction with ECT to monitor any changes in cognition. To find out more about our neuropsychological assessment services contact us.

Mental health and the community

ABC TV's Australian Story program on Monday 5 March reported the heart-breaking story of Adam Salter, a man with a history of psychosis, who was shot and killed by police in November 2009 following a call made by his father that he was trying to stab himself.

Full details of the story can be found here.

The police involved on the day and in follow-up investigations of the matter were criticsed by the deputy state coroner of NSW at an inquest into Mr Salter's death in 2011.

Mental health advocates have described Mr Salter's medical and psychological treatment as a "failure of care".

While this is an extreme example of how mental health issues are not always dealt with well within the community, it is not an isolated incident. It has been well documented that mental health continues to carry a stigma within the community and does not always receive the same level of care and attention as physical illnesses. In Mr Salter's case, he was admitted to a mental health facility during a psychotic episode in 2008 as an involuntary patient and discharged without follow-up by the community mental health team and without his family being advised of his high risk of relapse. He is not alone. A Mental Health Council of Australia report, Consumer and Carer Experiences of Stigma from Mental Health and Other Professionals, which reports the results of a study of 400 mental health patients and 200 carers, found that 29% of patients reported feeling shunned or avoided by health professionals. Fourty-four percent of the carers believed that doctors behave differently towards patients when they find out that they have a history of mental health issues. Close to three quarters (73%) of the respondents said they had experienced stigma or discrimination in the last 12 months because of their mental illness.

Mental illness is not uncommon. One in five Australians suffer from a mental illness. The impact of mental illness is felt by the sufferer, their family, friends, workplaces and the broader community. It is important that mental health is treated seriously and that appropriate care is provided, including follow-up, appropriate referrals, case management and consultation with the family. An important component is community education.

We here at ANTS certainly recognise the importance of mental health and of educating the community. We run Mental Health First Aid Training programs to help increase knowledge about common mental health problems and to teach people and organisations to deal with mental health crises.

To learn more about our programs and our services more generally, contact us. We look forward to hearing from you.

Garry McDonald

Best known for his screen character Norman Gunston and show bearing the same name and endeared by the Australian community for his portrayal of Arthur Beare in ‘Mother and Son’ with Ruth Cracknell. Spoke candidly of his struggle with major depression and anxiety during an interview with Andrew Denton in an episode of ‘Enough Rope’. Speaking of depression and the symptoms, he said:

I couldn't get out of bed, I couldn't concentrate, I'd go to work and I'd just, was like a fog.

He went on to describe an extraordinary event, while waiting thirty minutes to see his doctor; he ended up sitting on the kerb at the edge of the road, almost in a foetal position.

And I went off to the doctors to see the GP and I remember they said, 'oh you can see him in half an hour'. And I went outside and sat in the gutter, well on the, on the sort of edge you know. And it was like you had this sort of extraordinary hangover. And you know eventually I mean you do, you end up being in the foetal position, it was extraordinary.

We all need a break sometimes, take some timeout, get away from it all, the pressures of work, the commitments, the dead-lines and work related stress factors. Usually we only need a couple of days at the shack, a weekend fishing up in the mountains or down the coast, a short getaway; but sometimes it’s more serious than that. We ignore the signs, press on regardless, keep up appearances, maintain the pace, but in the end the human brain will protect itself, it will shun the overload, it will take a break regardless.

Gary now an advocate for mental health awareness, a board member of Beyondblue, an Australian national depression initiative, for which he was recently awarded by becoming an Officer of the Order of Australia. He recommends walking on a daily basis, saying this is the best advice he received from any psychologist and the best advice he could offer to anyone struggling with severe depression.

Take a twenty minute brisk walk each morning; it’s very, very good.

It’s good advice, though exercise would possibly be the last thing you want to do when suffering from depression or anxiety, it doesn’t need to be intense exercise like one of Forrest Gumps marathons, try a little gardening, take a stroll in the park, walk the dog to the store to buy it a treat each morning, something for yourself too. The main thing is to get up, get going, anything to get you off the sofa. Exercise will help release good brain chemicals (endorphins) that will help counter depression; exercise is also a good detox, reducing bad chemicals in the immune system; exercise also raises the body temperature which can produce a calming effect, compensating feelings of anxiety.

Exercise has some positive psychological effects too, you will increase confidence levels and emotional feelings of self worth, by maintain goals and nurturing a sense of achievement on a daily basis. It’s also a great distraction, takes your mind off all the worries and junk thoughts that are holding you down. You may even meet people, a little social interaction along the way, a smile or a good morning greeting from other people in the neighborhood can have a positive effect on your mood. The journey through depression is a one step at a time process, but it starts with a single step and culminates in a new lifestyle, a new you, with your life back on track, maybe better than ever before.

Geoff Bullock

Geoff Bullock christian singer, song writer, the author of Power of your love, former worship pastor at the Hills Christian Centre (Hillsong Church) in Sydney. In an interview with Terry Allen, says he wrote many of his songs as a result of an undiagnosed mental illness. Geoff described his symptoms as feelings of rejection and a lack of affirmation and a feeling of isolation, and that most of his works are about brokenness being repaired in the most extraordinary way.

One of the most influential Christian singer-songwriters of this generation; in 2003 Geoff was diagnosed with bipolar disorder type 2. It's been a long road, but Geoff still continues to write songs and books.

It's a fine line

We have all heard the saying "there's a fine line between genius and insanity". There have been many great and inspired people through the ages, who have achieved fame and accolades, the same have also been mentally ill or psychologically impaired. Many who suffered the constant change of depression, battling mood swings from the lowest of lows to the highest of highs. In the high times they created masterpieces of literature inspired art or music, the same ones when enduring the low times, destroyed their own works, burned their literature, trashed their inventions or inflicted themselves with horrendous self-harm and in some cases, ultimately; chose death.

"On a clear day, you can see forever", who said that? Whoever it was, was no stranger to depression, because that's what it's like. When you are up, anything is possible, the thoughts flow freely, nothing can stop the creative process, a torrent of energy that knows no bounds. You make plans, big plans, long-term goals and visions, you can see it all so clearly, you set things in motion, make commitments, appointments and agendas. The problem is, when time comes to meet the commitments, attend the appointments, it's not a clear day anymore, cognitive functioning is diminished, you can't see it how you did the week before, a dull grey memory clouds the brilliance of yesterday.