BJPsych Kaleidoscope September 2019

magazine-coverTrigger warning: the following contains disturbing content that might be harmful for some.

This is psychiatry’s version of “the following contains flashing images”, but what’s the science behind it? At face value it seems reasonable for those who have suffered trauma: we are aware how PTSD can manifest with avoidance of trauma resembling or reminiscent scenes, and distress at their occurrence. There are also sociological debates about creating inclusive environments and allowing victims of trauma to make more informed decisions about potentially challenging situations. Except that research has never really shown the warnings to be helpful. September’s Kaleidoscope reports on a paper that tested this, exposing almost 500 participants, all of whom had trauma histories, to literature rated as having varying degrees of distressing material. Some carried warnings, some did not. The warnings made no difference, even when the described scene resembled the trauma an individual had suffered. Indeed, there was some evidence that the warnings were counter-therapeutic as they reinforced a disabling model of trauma being a core part of the person’s identity. So, useless at best, harmful at worst: that’s the end of that debate? I doubt it – and anticipate push-back – but the work puts out the challenge of how best to support those who have suffered such enormous difficulties, and tests our presumption that ‘just’ putting down ‘trigger warning’ is adequate.

The UK’s estimated seven million informal carers provide immeasurable love and support, and save the UK economy billions each year; what is the emotional burden placed upon them?

There have been few long-term trials following this up, but we report such analysis from the large and nationally representative UK Household Longitudinal Study. Fascinatingly, informal caregiving was associated with increased psychological distress in women, but not men. Now I’m anticipating that, like me, at this point you’re wondering what is wrong with women, and why they don’t seem as robust as men, but let’s look at the data in a bit more detail. Firstly, it turns out that women provide far, far more caregiving than men: so Finding Number One is that men are lazier. But, I hear you say, maybe men are lazier yet still stronger? Certainly, if we forget about the total numbers and match genders for duration and frequency of caring episodes, the findings *still* hold that caring does not seem to impact men as much as it does women. Once again, such seemingly sensible analysis turns out to be superficial. The data show that duration and number do not take into account the more meaningful measure of how onerous such work is, and Finding Number Two is that women typically take on greater responsibilities and look after those with the greatest need. I appreciate that this will shock the men amongst you, and for women, those of you who have met men before*. Stopping my facetious introduction and giving this the seriousness it deserves, the toll on the carers in the UK is enormous, and many of you will not need this study to appreciate that. But the work highlights just how much of a stress it is, and how, in particular, long-term caring takes such a toll on so many who give their time, their compassion, their love, and their energy, and sacrifice so very much to do so. Our healthcare systems are traditionally less well primed to support them; I think that needs to improve, whatever anyone’s gender.

*However, notably, Tracy’s Law of Domestic Chores states that – like a tree falling in a forest when no one is there – to men, if it cannot be seen, dirt does not exist. I mean, seriously, who cares about dirt *under* a sofa? Boys, you know what I’m saying, right?

Get in contact to receive further information regarding a career in psychiatry