“Leisure-Links”

This article describes research undertaken to assess the need for a community leisure service in Tower Hamlets, part of London's East End. The results replicate the findings of other researchers; that many people with mental handicaps, though “living” in the community, remain isolated from the “community” in its widest sense. People in this study spent the majority of their free time engaged in housebound, solitary, passive, and family oriented activities. Pursuits which did involve “going out” tended to be for groups, such as attending clubs or sports activities. It was found that 84 per cent of respondents, that is, potential consumers, felt they would like to take part in leisure activities that they were not pursuing at the time of the study. The development of Tower Hamlets “Leisure-Links” scheme is described, highlighting features of the scheme which distinguish it from other similar initiatives. Applications for funding are outlined.     

The functional significance of mu rhythms: Translating “seeing” and “hearing” into “doing”

Existing evidence indicates that mu and other alpha-like rhythms are independent phenomena because of differences in source generation, sensitivity to sensory events, bilateral coherence, frequency, and power. Although mu suppression and enhancement echo sensorimotor processing in frontoparietal networks, they are also sensitive to cognitive and affective influences and likely reflect more than an idling brain state. Mu rhythms are present at early stages of human development and in other mammalian species. They exhibit adaptive and dynamically changing properties, including frequency acceleration and posterior-to-anterior shifts in focus. Furthermore, individuals can learn to control mu rhythms volitionally in a very short period of time. This raises questions about the mu rhythm's open neural architecture and ability to respond to cognitive, affective, and motor imagery, implying an even greater developmental and functional role than has previously been ascribed to it. Recent studies have suggested that mu rhythms reflect downstream modulation of motor cortex by prefrontal mirror neurons, i.e., cells that may play a critical role in imitation learning and the ability to understand the actions of others. It is proposed that mu rhythms represent an important information processing function that links perception and action—specifically, the transformation of “seeing” and “hearing” into “doing.” In a broader context, this transformation function results from an entrainment/gating mechanism in which multiple alpha networks (visual-, auditory-, and somatosensory-centered domains), typically producing rhythmic oscillations in a locally independent manner, become coupled and entrained. A global or ‘diffuse and distributed alpha system’ comes into existence when these independent sources of alpha become coherently engaged in transforming perception to action.     

‘Thank-you for Saying “No”…’

This case study describes an approach to one individual's non-compliant behaviour, which focuses upon reduction of excessive refusal through change of the caregiver interactional style and acknowledgement of the inherent ‘message value’ of escape and avoidance responses. Positive outcomes include not only increased participation, but also greater personal competence, choice and access to ordinary community facilities, with these gains being maintained at three-month follow up. Implications of the approach are discussed.     

“The Elements”

On the 17th and 18th February 1982, the residents of Starcross Hospital performed a masked drama entitled “The Elements” at the Northcott Theatre, Exeter. This formed part of a larger programme aimed towards emphasising the Theatre's role as a community arts centre. The programme, under the title “A Community Tour-In”, consisted of small groups of amateur and professional performers, whose work was specifically geared towards integrating the theatre arts into the social structure of everyday life.     

“Selected truth”

Professional staff in the National Health Service tend to assume without question that the patients they meet are genuine, honest, and well-intentioned in the problems that they present. The same applies to the parents and relatives of patients, and to professional associates. The large majority are, so that any rare exceptions appear almost incredible. In this respect interviews with doctors and other health workers differ from those with lawyers and the police where the veracity and goodwill of the client is not automatically taken for granted. Downright deliberate dishonesty or premeditated manipulation of truth on the part of patients, their relatives, and people caring for them may be construed as reflecting some personality or psychiatric disorder. Milder forms and shades of “near truth”, “selected truth”, “graduated truth”, “white lies”, “exaggerated facts”, and data chosen for maximum impact, are more frequent and are probably not always suspected or detected. In all communications between people, degrees of licence and flexibility are found, and are institutionalised in different societies and cultures. For example, it has been good manners in Britain not to be too outspoken or blunt, and to use understatement. This is reminiscent of Voltaire's “Speech was given to man to conceal his thoughts.” The term “graduated truth” is used in medical work when it is thought to be in the interests of the patient to deliberately and knowingly conceal or modify the truth. This paper considers some facets of services for mentally handicapped people where “graduated truth” is used in practice. These are: selectivity of data; differential behaviour; fabrication, fantasy and make-believe; and patient management.     

Neurophysiological “markers”— EEG sleep measures

Although a number of neurophysiological “markers” have been suggested as potential correlates of depression, the most promising set has been based on the electroencephalographic (EEG) measurement of sleep in affective disorders. Our knowledge, based on episodic biological correlates of depression, has attained considerable consensus in demonstrating specific findings for EEG sleep and depression. While there are some controversial issues remaining, the available evidence suggests that EEG sleep correlates can certainly be used as a state measure in affective disorders. A second phase of inquiry is now concerned with two issues—whether there are any specific markers during remitted phases of depression, and how the data base can help us understand some of the key theoretical biological issues in affective states.     

Perceived social support and dysfunctioning in “clinical” and “normal” adolescents

The purpose of this study was to examine the extent to which inpatient and non-patient samples of youngsters differ from each other with regard to prevalence and co-occurrence of emotional and behavioural problems and negative perceptions of family, school and peers. The sample comprised 202 12–21-year-old adolescents: 101 psychiatric inpatients and 101 matched “community-based” youngsters. Possible differences between the subgroups were tested by means of multi-variate analysis of variance and relative risk ratios.All specific problems and combination patterns were reported significantly more often by the “inpatient” than by the “non-patient” youngsters. However, after correcting for differences in base rates, only the combination of emotional and/or behavioural problems and family problems remained significant. The combination of emotional and family problems was reported about 12 times more often and the combination of behavioural and family problems even about 21 times more often by adolescents in the “clinical” sample than by those in the “normal” sample.Two important conclusions were drawn: (1) co-occurrence in itself did not appear to be the distinguishing factor between the “clinical” and the “normal” sample; and (2) a dominant role of negatively perceived family support in adolescent functioning was suggested. The implications of these findings are discussed.     

Perils of “pseudo-normalisation”

This article draws attention to a number of factors that threaten the quality of life for children, young people, and adults with mental handicaps. First, there is a risk that ideologists will assume too great an influence in shaping policy, provision, and practice. Second, without the introduction of better conceived and more extensive professional training for front-line staff and administrators, current deficiencies in the delivery of mental handicap services are unlikely to be remedied. Third, the rush towards community care is likely to set back the very considerable advances that have been made in the field of rehabilitation over the last twenty years.     

“SKILLS TO SHARE”

This paper looks at the preparation of direct care staff who, after an initial three-week orientation period, went on to work in the community with young people who are severely mentally handicapped, all of whom had previously been residents of Northgate Hospital. In order to move children and young people who are severely mentally handicapped back into the community, it is essential to devise a staff training programme which recognises the need for them to be seen in a positive way. This paper briefly describes the underlying values of the training period, its planning and content, and the project itself.     

“FOREWARNED IS FOREARMED”

— Nursing staff take much of the blame for the inadequate level of care given to the mentally handicapped — but is this reasonable when they are thrown into the job with no proper notion of what they should be doing? —     

“Special” puppet shows

SUMMARY: Much has been written about the motivational value of using puppets as an effective teaching aid with the mentally handicapped, whether it be for story-telling, language work, social skills or music. This, however, is an account of puppetry used as a performing art by a group of long-stay children attending Courtenay School at Stoke Lyne Hospital, Exmouth.     

“Recumbent” gait: Relationship to the phenotype of “astasia‐abasia”?

Psychogenic gait disorders can present in many different ways. Among patients with a pure psychogenic gait disorder, buckling of the knee is the most common feature, followed by astasia-abasia. Here, we describe one such patient with a very unusual gait disturbance that might be regarded as a variant of astasia-abasia. The patient characteristics are described and discussed in a historical context.