BETSHY

Tag: Public Health

  • 7 Things Every Person with Schizophrenia Should Know About the Mental Health Act in the UK

    7 Things Every Person with Schizophrenia Should Know About the Mental Health Act in the UK

    For individuals living with schizophrenia in the United Kingdom, understanding the legal framework that governs mental health care is not merely an academic exercise — it is a matter of fundamental rights. The Mental Health Act 1983, as significantly amended by the Mental Health Act 2007 and now further reformed by the Mental Health Act 2025, is the primary piece of legislation that determines when and how a person with a mental disorder can be detained in hospital, treated, and supported in the community (Mental Health Act 2025 ). Schizophrenia is explicitly recognised within this legal framework as a condition that falls under the Act’s definition of mental disorder (South West Yorkshire Partnership NHS Foundation Trust, 2024). Whether you are a patient, a carer, or a family member, this knowledge can make a profound difference at a critical time.

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    It is important to note that the Mental Health Act applies to England and Wales. Separate statutory provisions govern Scotland and Northern Ireland (House of Commons Library, 2024). This article outlines the key things every person with schizophrenia should know about their rights under this legislation.

    1. The Act Applies Directly to Schizophrenia

    The Mental Health Act defines mental disorder as “any disorder or disability of the mind.” This definition is deliberately broad and is widely understood by psychiatrists to include schizophrenia, alongside major depression, bipolar disorder, and other serious mental illnesses (South West Yorkshire Partnership NHS Foundation Trust, 2024). However, having a diagnosis of schizophrenia alone does not automatically mean a person is subject to the Act’s provisions. A person must also pose a risk to themselves or others, and less restrictive alternatives must have already been considered and found insufficient (Northamptonshire Healthcare NHS Foundation Trust, n.d.).

    2. Understanding “Sectioning” — What It Really Means

    Being “sectioned” means being detained in hospital under one of the sections of the Mental Health Act, even if you do not consent. This is done to keep you safe and to ensure you receive necessary treatment (Mind, 2025). The most frequently used sections are Section 2 and Section 3. Section 2 is an assessment order lasting up to 28 days and cannot be renewed; if further hospitalisation is needed, clinicians must move to a Section 3 order. Under the Mental Health Act 2025, the initial Section 3 detention period has been reduced from six months to three months, with more frequent mandatory reviews to ensure detention is only used when necessary (Community Care, 2026). Section 4 is an emergency provision lasting 72 hours, used only when waiting for a second doctor would cause a dangerous delay (Mind, 2025).

    3. You Have the Right to Appeal Your Detention

    One of the most critical rights every detained person with schizophrenia should exercise is the right to appeal. Under Section 2, a patient can apply to the First-Tier Tribunal (Mental Health) within the first 21 days of detention. Under Section 3, this window has been extended under the 2025 reforms, and automatic referrals to the tribunal now occur after three months and then every 12 months — ensuring far more frequent independent reviews than previously required (Royal College of Psychiatrists, 2026). Detained persons have the statutory right to be represented at tribunal hearings by a solicitor (Rethink Mental Illness, 2026). Patients can also appeal directly to the hospital managers, who have the authority to discharge them from detention.

    4. You Are Entitled to an Independent Mental Health Advocate (IMHA)

    Every patient detained under the Mental Health Act has a legal right to access an Independent Mental Health Advocate (IMHA). IMHAs are specially trained advocates who can help patients understand their rights, attend meetings on their behalf, and ensure their voice is heard in care planning decisions (Rethink Mental Illness, 2026). A significant improvement introduced by the Mental Health Act 2025 is the extension of this right to informal (voluntary) patients in England — a right that was previously only available to those formally detained. The Act also introduces an “opt-out” system, meaning hospitals must proactively notify advocacy services of qualifying patients, rather than leaving patients to seek help themselves (Local Government Association, 2025). If you or a loved one with schizophrenia is admitted to hospital, requesting an IMHA should be a priority.

    5. Your Right to Free Aftercare Under Section 117

    Section 117 of the Mental Health Act is one of the most practically important — and most underutilised — legal protections available to people with schizophrenia. If you have been detained under Section 3 (or several other qualifying sections), the NHS and your local authority have a legal duty to provide free aftercare services upon discharge (South London and Maudsley NHS Foundation Trust, n.d.). These aftercare services may include community mental health support, housing assistance, medication management, and social care. These services cannot be charged to the patient. A care plan must be written in advance of discharge, identifying the support to be provided and who is responsible for each element (South London and Maudsley NHS Foundation Trust, n.d.). The Mental Health Act 2025 has further strengthened Section 117 by clarifying which local authority holds responsibility when a patient is placed out of their home area, and by empowering the Mental Health Tribunal to recommend that aftercare be put in place — and to reconvene if those recommendations are ignored (Community Care, 2026).

    6. The Nominated Person — Replacing the “Nearest Relative”

    Previously, the law designated a “nearest relative” for each detained patient — a role determined by a fixed legal hierarchy regardless of the patient’s actual wishes or relationships. The Mental Health Act 2025 replaces this with the concept of a “nominated person” — someone the patient themselves chooses to fulfil this important role (House of Commons Library, 2024). For people with schizophrenia, who may have complex or difficult family dynamics, this change is enormously significant. The nominated person has statutory rights, including the ability to request a patient’s discharge, object to detention, and be consulted on care plans. Choosing a trusted nominated person in advance — ideally in conjunction with an Advance Choice Document — is one of the most empowering steps a person with schizophrenia can take.

    7. The Mental Health Act 2025 — What Has Changed and Why It Matters

    The Mental Health Act 2025 received Royal Assent on 18 December 2025, representing the most significant reform of UK mental health law in over four decades (Royal College of Psychiatrists, 2026). The reforms were driven by several longstanding concerns: rising rates of detention, significant racial inequalities in the use of compulsory powers, and the inappropriate detention of autistic people and those with learning disabilities (Care Quality Commission, 2025). For people with schizophrenia, the core ambition of the new Act — to ensure that detention is only used when, and for as long as, strictly necessary — is directly relevant. The Care Quality Commission, which regulates the Act’s use, has emphasised its commitment to revising the Code of Practice in 2026 to embed principles of choice, autonomy, least restriction, and therapeutic benefit at the heart of clinical decision-making (Care Quality Commission, 2025). Crucially, the Act is expected to be implemented in stages over approximately ten years, meaning some changes will not come into effect immediately.

    Conclusion

    Navigating the mental health system can be deeply challenging for anyone living with schizophrenia, but being informed about your legal rights is an essential first step toward self-advocacy and empowered care. From understanding the difference between Section 2 and Section 3, to accessing an IMHA, claiming your Section 117 aftercare entitlements, and choosing a nominated person, the law provides meaningful protections that every patient, carer, and family member should know. The Mental Health Act 2025 marks a significant step forward in placing the patient’s voice at the centre of care — but realising that promise will require both systemic investment and individual awareness. If you need immediate guidance, charities such as Mind and Rethink Mental Illness provide free, accessible information and support.

    References

    Care Quality Commission (2025) The Mental Health Act 1983 (amended 2025). Available at: https://www.cqc.org.uk/publications/monitoring-mental-health-act/2024-2025/mha (Accessed: 18 May 2026).

    Community Care (2024) ‘How the government plans to reform the Mental Health Act 1983’, Community Care, 7 November. Available at: https://www.communitycare.co.uk/2024/11/07/how-the-government-plans-to-reform-the-mental-health-act-1983/ (Accessed: 18 May 2026).

    Community Care (2026) ‘The Mental Health Act 2025 summarised’, Community Care, 11 March. Available at: https://www.communitycare.co.uk/content/news/the-mental-health-act-2025-summarised (Accessed: 18 May 2026).

    House of Commons Library (2024) Reforming the Mental Health Act: Independent Review to Draft Bill. Available at: https://commonslibrary.parliament.uk/research-briefings/cbp-9132/ (Accessed: 18 May 2026).

    Local Government Association (2025) Get in on the Act: Mental Health Act 2025. Available at: https://www.local.gov.uk/publications/get-act-mental-health-act-2025 (Accessed: 18 May 2026).

    Mental Health Act 2025 (c. 33). Available at: https://www.legislation.gov.uk/ukpga/2025/33/enacted (Accessed: 18 May 2026).

    Mind (2025) Being Sectioned Under the Mental Health Act. Available at: https://www.mind.org.uk/information-support/legal-rights/sectioning/about-sectioning/ (Accessed: 18 May 2026).

    Northamptonshire Healthcare NHS Foundation Trust (n.d.) Mental Health Act. Available at: https://www.nhft.nhs.uk/mental-health-act (Accessed: 18 May 2026).

    Rethink Mental Illness (2026) What is the Mental Health Act? Available at: https://www.rethink.org/advice-and-information/rights-laws-and-criminal-justice/mental-health-laws/mental-health-act/ (Accessed: 18 May 2026).

    Royal College of Psychiatrists (2026) ‘Mental Health Bill (England and Wales) receives Royal Assent’, 14 January. Available at: https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2026/01/14/mental-health-bill-(england-and-wales)-receives-royal-assent (Accessed: 18 May 2026).

    Royal College of Psychiatrists (n.d.) Reforming the Mental Health Act. Available at: https://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/reforming-the-mental-health-act (Accessed: 18 May 2026).

    South London and Maudsley NHS Foundation Trust (n.d.) Section 117 Aftercare. Available at: https://slam.nhs.uk/section-117-aftercare (Accessed: 18 May 2026).

    South West Yorkshire Partnership NHS Foundation Trust (2024) Mental Health Act. Available at: https://www.southwestyorkshire.nhs.uk/service-users-and-carers/your-rights/mental-health-act/ (Accessed: 18 May 2026).

  • Chronic Asthenia: Causes, Symptoms, Diagnosis, and Evidence-Based Treatment

    Chronic Asthenia: Causes, Symptoms, Diagnosis, and Evidence-Based Treatment

    Chronic asthenia is a multifaceted clinical syndrome defined by persistent, generalised physical weakness and profound fatigue that endures beyond six months in duration and significantly impairs a patient’s capacity to perform daily activities (Clínica Universidad de Navarra, n.d. ). Unlike ordinary tiredness which typically resolves with adequate rest, chronic asthenia persists even at rest and worsens with even minimal physical or cognitive effort (Quironsalud, n.d.). The condition represents one of the most common and yet frequently misunderstood presentations in general medical practice, carrying substantial implications for quality of life, healthcare utilisation, and socioeconomic productivity.

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    Although often discussed interchangeably with chronic fatigue, asthenia is a distinct clinical entity. In contemporary medical literature, asthenia broadly refers to a subjective sensation of weakness and reduced capacity for physical or mental work, whether or not brought on by exertion (Osmosis, n.d.). This article provides a comprehensive overview of chronic asthenia, encompassing its definitions, aetiology, clinical presentation, diagnostic approaches, and evidence-based treatment strategies.

    Defining Chronic Asthenia

    The term “asthenia” derives from the Greek astheneia, meaning “without strength.” Clinically, it describes generalised weakness or a lack of energy perceived by the patient independently of physical or mental strain (Medical News Today, 2023). When fatigue persists for more than one month, it is characterised as prolonged; when it endures beyond six months and reduces an individual’s functional capacity by more than 50%, it meets the clinical criteria for chronic asthenia which, in some diagnostic frameworks, overlaps significantly with chronic fatigue syndrome (Clí­nica Universidad de Navarra, n.d.).

    The chronic variant is distinguished from transient or acute asthenia not only by its duration but also by its severity and resistance to conventional rest. Patients with chronic asthenia frequently describe an inability to engage meaningfully in occupational, social, or domestic activities, representing a profound reduction in their overall quality of life (Quironsalud, n.d.). It is equally important to differentiate asthenia clinically from dizziness and dyspnoea, conditions with which patients frequently confuse it, given the overlapping nature of their subjective experiences (Roca Fernández et al., 2010).

    Epidemiology and Prevalence

    Chronic asthenia is not a rare complaint. Fatigue and generalised weakness rank among the most common reasons patients seek medical consultation worldwide (Clí­nica Universidad de Navarra, n.d.). Its prevalence is particularly elevated among individuals living with advanced or chronic medical conditions; asthenia has been documented in 60-90% of advanced cancer patients across multiple studies, making it the most prevalent symptom in that population (ScienceDirect, n.d.).

    Beyond oncology, asthenia is a recognised consequence of numerous systemic, neurological, and psychiatric conditions, meaning its true epidemiological footprint across general medicine is likely underestimated. Strikingly, depression alone accounts for approximately half of all cases presenting with significant fatigue or asthenic symptoms, underscoring the imperative for thorough differential diagnosis in clinical settings (Roca Fernández et al., 2010).

    Aetiology and Risk Factors

    Chronic asthenia is not a disease in itself but rather a symptom or syndrome arising from a wide spectrum of underlying conditions (Medical News Today, 2023). Its aetiological profile is broad, encompassing biological, psychological, and pharmacological causes.

    Medical and Systemic Conditions

    Chronic illnesses are among the most common drivers of persistent asthenia. These include diabetes mellitus, anaemia, thyroid dysfunction, particularly hypothyroidism, multiple sclerosis, chronic kidney disease, cardiac failure, and autoimmune conditions (Wellyme.org, 2024). Endocrine disorders such as Addison’s disease, and electrolyte imbalances including hyponatraemia and hypokalaemia, are also recognised reversible causes that clinicians should actively investigate (ScienceDirect, n.d.).

    Surgical interventions can precipitate chronic asthenia. Research has demonstrated that total thyroidectomy is associated with a worsening of chronic asthenia post-operatively, while hemithyroidectomy does not carry the same risk, suggesting a direct relationship between hormonal status and asthenic symptomatology (Paja-Fano et al., 2017). Additionally, age-related muscle loss as seen in sarcopenia contributes to frailty and may manifest as asthenic features in older adults (Cleveland Clinic, 2026).

    Neurological and Cognitive Dimensions

    From a neurological perspective, chronic asthenia is a well-established feature of numerous central nervous system diseases and is deeply intertwined with cognitive dysfunction. Research has shown that asthenia functions initially as a protective physiological signal indicating depletion of energy resources; however, it can progress into a pathological, immune-mediated condition, particularly in its most severe manifestation, chronic fatigue syndrome (Vasenina, Gankina and Levin, 2023). Cognitive deficits in attention, memory, and executive function are frequently co-present with asthenic states, substantially complicating both diagnosis and clinical management (Vasenina, Gankina and Levin, 2023).

    Psychological and Psychiatric Causes

    The psychiatric dimension of chronic asthenia is substantial and must not be overlooked in clinical assessment. As previously noted, depression is the single most frequent identifiable cause, accounting for approximately half of all chronic asthenia presentations (Roca Fernández et al., 2010). Anxiety disorders, chronic psychological stress, and post-traumatic stress disorder have all been implicated in producing perceived weakness through neurochemical imbalances that manifest as physical symptoms (Study.com, 2016). Research into neurocirculatory asthenia found that in approximately 59% of patients, a diagnosable psychiatric condition, most commonly an anxiety disorder, preceded the onset of asthenic symptoms, with these patients demonstrating significantly elevated levels of anxiety, depression, social phobia, and impaired quality of life (Fava et al., 1994).

    Pharmacological Causes

    Certain medications are known to induce asthenia as a side effect. Chemotherapeutic agents, muscle relaxants, antihypertensives, and sedative drugs are among the most frequently implicated pharmacological contributors (Wellyme.org, 2024). In such cases, management may involve adjusting the dosage or substituting an alternative medication, though any such modification must be undertaken strictly under medical supervision (Medical News Today, 2023).

    Clinical Presentation and Symptoms

    The cardinal symptom of chronic asthenia is persistent, intense fatigue that does not improve with rest and significantly impairs the individual’s functional capacity across occupational, social, and personal domains (Clínica Universidad de Navarra, n.d.). Additional symptoms commonly reported include persistent headaches; muscle weakness and pain; disordered sleep; cognitive difficulties colloquially termed “brain fog,” encompassing poor concentration and memory lapses; low-grade fever, particularly in the afternoon; sore throat; swollen cervical lymph nodes; social withdrawal; and emotional dysregulation (Quironsalud, n.d.; Cleveland Clinic, 2026).

    In its most severe form, Grade 4 asthenia, the patient may be entirely bedridden and completely unable to perform any daily activities, typically as a consequence of serious underlying illness or aggressive medical treatments such as chemotherapy (Quironsalud, n.d.). Beyond its physical dimensions, asthenia carries mental and emotional weight that further interferes with the individual’s ability to perform activities of daily living, generating significant negative effects on social functioning and economic participation (Springer Nature, 2015).

    Diagnosis

    The diagnosis of chronic asthenia is primarily clinical and hinges upon the systematic exclusion of other identifiable causes. No single laboratory test or imaging study can confirm the diagnosis; instead, clinicians employ a comprehensive battery of investigations to rule out organic pathology (Clí­nica Universidad de Navarra, n.d.). The diagnostic process must exclude drug dependency, infections, autoimmune and immune disorders, muscular or neurological diseases such as multiple sclerosis, endocrine conditions including hypothyroidism, cardiac and hepatorenal pathology, psychiatric illness, particularly depression and malignancy (Clí­nica Universidad de Navarra, n.d.).

    Despite thorough investigation, up to 20% of patients presenting with chronic asthenic symptoms remain without a definitive aetiological diagnosis, highlighting the complex and incompletely understood nature of the condition (Roca Fernández et al., 2010). Where chronic fatigue syndrome is suspected as the underlying syndrome, the international consensus criteria of 1994 commonly (known as the Fukuda criteria) remain widely applied in clinical practice, though updated frameworks from the Institute of Medicine (2015) have gained increasing international acceptance.

    Treatment and Management

    Given the heterogeneous aetiology of chronic asthenia, its treatment must be personalised and delivered through a multidisciplinary framework.

    Treating the Underlying Cause

    The most effective therapeutic strategy remains the identification and correction of the underlying condition (Osmosis, n.d.). Reversible causes, including anaemia, infection, electrolyte imbalances, and endocrine dysfunction, should be prioritised and treated accordingly (ScienceDirect, n.d.).

    Pharmacological Interventions

    Pharmacological management may include corticosteroids, which can provide short-term relief of asthenic symptoms; however, their benefits generally last only two to four weeks, and long-term use carries significant adverse effects, meaning there is presently no consensus on optimal dosage or regimen (ScienceDirect, n.d.). Iron supplementation is appropriate for anaemic patients, while antimicrobial therapy is indicated when infection serves as the precipitating cause (Wellyme.org, 2024).

    Non-Pharmacological Approaches

    Non-pharmacological interventions are increasingly supported by clinical evidence. Structured exercise programmes have demonstrated measurable improvements in energy levels, muscle function, and overall wellbeing among patients with chronic asthenia and related conditions (ScienceDirect, n.d.). Cognitive behavioural therapy (CBT) has been utilised to address the psychological dimensions of the condition, assisting patients in reframing maladaptive thought patterns, managing emotional responses, and improving functional engagement (Osmosis, n.d.). Acupuncture has similarly demonstrated modest clinical benefit in symptom management in select patient populations (ScienceDirect, n.d.).

    Lifestyle modifications encompassing balanced and nutrient-rich dietary intake, structured sleep hygiene practices, vaccination programmes to reduce infection risk, and stress management techniques such as mindfulness meditation and yoga constitute important adjuncts to formal medical treatment (Wellyme.org, 2024; Cleveland Clinic, 2026).

    Impact on Quality of Life

    The burden of chronic asthenia extends well beyond the individual patient. Research has consistently demonstrated that asthenia exerts significant physical, mental, and emotional impairments that disrupt occupational performance, social relationships, and economic participation, with notable indirect consequences for caregivers and family members (Springer Nature, 2015). In oncology, where asthenia is most prevalent, studies have found that its impact on quality of life endures longer than the effects of pain or depression among patients undergoing chemotherapy, reinforcing the urgent need for proactive and sustained management strategies (Springer Nature, 2015).

    The pathophysiology of asthenia, particularly in chronic and cancer-related forms, remains incompletely understood, and the evidence base supporting established therapeutic strategies is limited, representing a significant gap in current clinical research (ScienceDirect, n.d.).

    Conclusion

    Chronic asthenia is a complex, multidimensional syndrome that demands careful clinical attention and a personalised, evidence-based approach to management. Its capacity to manifest across virtually all medical specialities, from neurology and oncology to psychiatry and endocrinology, makes it both a diagnostic challenge and a significant contributor to patient morbidity. Raising awareness of its diverse clinical presentation, advancing diagnostic precision, and expanding access to integrated, multidisciplinary treatment pathways are essential steps toward improving outcomes for the many individuals living with this profoundly disabling condition. Future research must prioritise the development of validated biomarkers and standardised therapeutic protocols to close the considerable gaps that remain in clinical understanding.

    References

    Cleveland Clinic (2026) Asthenia (Weakness) Causes, Symptoms & Treatment. Available at: https://my.clevelandclinic.org/health/symptoms/asthenia-weakness (Accessed: 15 May 2026).

    Clínica Universidad de Navarra (n.d.) Chronic Fatigue, Chronic Fatigue or Chronic Asthenia. Available at: https://www.cun.es/en/diseases-treatments/diseases/chronic-asthenia (Accessed: 15 May 2026).

    Fava, G.A., Grandi, S., Michelacci, L., Saviotti, F.M., Conti, S. and Bellini, G. (1994) ‘Neurocirculatory asthenia: A reassessment using modern psychosomatic criteria’, Journal of Clinical Psychiatry, 55(12). Available at: https://pubmed.ncbi.nlm.nih.gov/8067269/ (Accessed: 15 May 2026).

    Medical News Today (2023) Asthenia (Weakness): Causes, Symptoms, and Treatment. Available at: https://www.medicalnewstoday.com/articles/asthenia-weakness (Accessed: 15 May 2026).

    Osmosis (n.d.) Asthenia: What Is It, Causes, Symptoms, Diagnosis, and More. Available at: https://www.osmosis.org/answers/asthenia (Accessed: 15 May 2026).

    Paja-Fano, M., Oleaga-Alday, A., Pérez de Nanclares, G., Portillo, P., Gorria, I., Pereda, A. and Zubicaray, J. (2017) ‘The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study’, Langenbeck’s Archives of Surgery, 402(4), pp. 611- 617. Available at: https://pubmed.ncbi.nlm.nih.gov/28299450/ (Accessed: 15 May 2026).

    Quironsalud (n.d.) Asthenia. Available at: https://www.quironsalud.com/en/diseases-symptoms/asthenia (Accessed: 15 May 2026).

    Roca Fernández, J.J. et al. (2010) ‘The chronic asthenia syndrome: a clinical approach’, PubMed [PMID: 20529781]. Available at: https://pubmed.ncbi.nlm.nih.gov/20529781/ (Accessed: 15 May 2026).

    ScienceDirect (n.d.) Asthenia:an overview. Available at: https://www.sciencedirect.com/topics/medicine-and-dentistry/asthenia (Accessed: 15 May 2026).

    Springer Nature (2015) ‘Asthenia’, in Palliative Medicine and Supportive Care. Cham: Springer International Publishing. Available at: https://link.springer.com/chapter/10.1007/978-3-319-21683-6_38 (Accessed: 15 May 2026).

    Study.com (2016) Asthenia: Definition, Symptoms & Treatment. Available at: https://study.com/academy/lesson/asthenia-definition-symptoms-treatment.html (Accessed: 15 May 2026).

    Vasenina, E.E., Gankina, O.A. and Levin, O.S. (2023) ‘Stress, Asthenia, and Cognitive Disorders’, Neuroscience and Behavioral Physiology, 53(2), pp. 249-255. Available at: https://link.springer.com/article/10.1007/s11055-023-01364-1(Accessed: 15 May 2026).

    Wellyme.org (2024) Asthenia: Causes, Symptoms, Diagnosis, and Treatment. Available at: https://www.wellyme.org/post/asthenia-causes-symptoms-diagnosis-and-treatment (Accessed: 15 May 2026).

  • The Psychological Trauma of Being Arrested: Understanding Its Impact

    The Psychological Trauma of Being Arrested: Understanding Its Impact

    As someone who has worked with trauma survivors and lived through my own mental health challenges, I know how deeply an arrest can wound a person — even when no conviction follows. Being arrested is not just a legal event; it is often a profound psychological trauma that can leave lasting scars on the mind, body, and sense of self.

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    The moment of arrest triggers an immediate and intense activation of the body’s stress response. Handcuffs, physical restraint, public exposure, and the sudden loss of freedom flood the nervous system with cortisol and adrenaline. Many people describe it as feeling like “time stops” or entering a dissociative state. This acute stress can be as traumatic as a physical assault, especially when force is used or the arrest feels unjustified (Geller et al., 2014) .

    For many, the trauma begins with the loss of autonomy. Being placed in handcuffs, searched, and transported in a police vehicle can trigger deep feelings of powerlessness and humiliation. Research shows that individuals who experience arrest often report symptoms similar to those seen in post-traumatic stress disorder (PTSD), including intrusive memories, hypervigilance, nightmares, and avoidance behaviours (Sugie and Turney, 2017). The public nature of many arrests adds a layer of social shame that can persist for years.

    The psychological impact extends far beyond the event itself. Even a short period in custody can shatter a person’s sense of safety and trust in the world. For those with pre-existing trauma, an arrest can re-activate old wounds, leading to complex PTSD symptoms. Many report lasting changes in how they view authority figures, institutions, and even their own worth. The stigma of having been arrested — whether charges are dropped or not — can damage relationships, employment prospects, and self-identity (Baćak and Nowotny, 2020).

    Physiologically, the body remembers. Chronic hyperarousal, sleep disturbances, and heightened startle responses are common. Some individuals develop somatic symptoms such as tension headaches, gastrointestinal issues, or chronic pain as the body continues to hold and convert the unprocessed trauma. Studies on recently arrested individuals show elevated rates of depression, anxiety, and substance use as maladaptive coping mechanisms.

    The trauma is often compounded by systemic factors. Marginalised communities — particularly people of colour, those from low-income backgrounds, and individuals with mental health conditions — experience higher rates of arrest and report more traumatic encounters with law enforcement. This creates a cycle where systemic injustice and personal trauma reinforce each other (Sewell et al., 2021).

    Recovery from arrest-related trauma requires gentle, trauma-informed support. Approaches such as EMDR (Eye Movement Desensitisation and Reprocessing), somatic experiencing, and trauma-focused cognitive behavioural therapy can be highly effective. Equally important is social validation — being believed and supported rather than judged or stigmatised.

    In my forensic journey and personal reflections, I have seen how an arrest can fracture a person’s sense of safety in the world. Healing begins when we acknowledge the depth of that wound without shame. If you or someone you love has experienced the trauma of arrest, know that your reactions are normal responses to an abnormal event. You are not broken — you are responding to something that was profoundly violating.

    The trauma of being arrested reminds us how fragile our sense of freedom and dignity can be. By bringing awareness and compassion to this experience, we take an important step toward healing both individuals and the systems that sometimes cause unnecessary harm.

    References

    Baćak, V. and Nowotny, K. M. (2020) ‘Criminal justice contact and health: Does race matter?’, Sociology of Race and Ethnicity, 6(3), pp. 337–352. Available at: https://journals.sagepub.com/doi/full/10.1177/0038040720914863 (Accessed: 26 March 2026).

    Geller, A. et al. (2014) ‘Aggressive policing and the mental health of young urban men’, American Journal of Public Health, 104(12), pp. 2321–2327. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103812/ (Accessed: 26 March 2026).

    Sewell, A. A. et al. (2021) ‘Police violence and public health: A review of the literature’, Annual Review of Sociology, 47, pp. 527–548. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8118190/ (Accessed: 26 March 2026).

    Sugie, N. F. and Turney, K. (2017) ‘Beyond incarceration: Criminal justice contact and mental health’, American Sociological Review, 82(4), pp. 719–743. Available at: https://journals.sagepub.com/doi/full/10.1177/0003122416687318 (Accessed: 26 March 2026).

  • When the Body Speaks What the Mind Cannot: The Psychoanalysis of Conversion Symptoms

    When the Body Speaks What the Mind Cannot: The Psychoanalysis of Conversion Symptoms

    As someone who has lived with complex mental health challenges and has spent years studying the intricate dialogue between mind and body, I am continually drawn to one of the most fascinating concepts in classical psychoanalysis: conversion symptoms.

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    Conversion symptoms occur when psychological distress or unconscious conflict is transformed into physical symptoms without any identifiable organic cause. Classic examples include sudden paralysis, blindness, seizures, loss of voice (aphonia), or glove anaesthesia (numbness in the hands that does not follow neurological distribution). These symptoms are real — the person genuinely cannot move a limb or see — yet medical investigations repeatedly find no structural damage or disease. In psychoanalytic terms, the symptom is not random; it carries symbolic meaning and serves a psychological purpose.

    The concept was central to the birth of psychoanalysis. In Studies on Hysteria (1895), Josef Breuer and Sigmund Freud introduced the revolutionary idea that hysterical symptoms were not signs of neurological disease or moral weakness, but expressions of repressed psychological material. They proposed that an intolerable idea or traumatic memory is pushed out of conscious awareness through repression. The emotional energy attached to that repressed material does not disappear; instead, it is “converted” into a bodily symptom. This process provides primary gain (relief from unbearable anxiety) and often secondary gain (attention, care, or avoidance of responsibility) (Freud and Breuer, 1895) .

    Freud later refined the theory, emphasising the role of unconscious sexual conflicts. A symptom, he argued, represents a compromise formation: it simultaneously expresses a forbidden wish and punishes the individual for having that wish. For example, a young woman who develops paralysis in her legs might unconsciously be expressing both a desire to run away from a distressing family situation and guilt for that desire. The symptom allows the conflict to be expressed without the person having to consciously acknowledge it.

    From a modern perspective, conversion symptoms are understood as a form of functional neurological disorder (FND). Neuroimaging studies have shown altered connectivity between emotion-processing areas (such as the amygdala and insula) and motor or sensory regions. This supports the psychoanalytic idea that psychological distress can genuinely disrupt bodily function without structural damage (Vuilleumier, 2014).

    Conversion symptoms are more common than many realise. They frequently appear in individuals with histories of trauma, insecure attachment, or difficulty identifying and expressing emotions (alexithymia). In forensic settings, they can sometimes be mistaken for malingering, though genuine conversion symptoms involve no conscious intent to deceive. The symptom is produced unconsciously as a defence mechanism.

    Treatment in the classical psychoanalytic tradition focuses on uncovering the repressed conflict through free association, dream analysis, and interpretation of transference. The goal is not simply to remove the symptom but to help the person understand its meaning and integrate the previously dissociated material. Modern approaches often combine psychodynamic insight with cognitive-behavioural techniques, physiotherapy, and sometimes medication for co-occurring anxiety or depression.

    Importantly, conversion symptoms should never be dismissed as “all in the head.” They represent real suffering and deserve respectful, multidisciplinary care. Labelling someone as “hysterical” in the old pejorative sense can cause profound harm and deepen shame. Contemporary clinicians emphasise validation of the distress while gently exploring its psychological roots.

    In my own reflective work, I have seen how the body can become a canvas for unprocessed emotions. When words fail, the body speaks — sometimes through pain, sometimes through paralysis, sometimes through inexplicable fatigue. Recognising conversion symptoms as meaningful communications rather than random malfunctions can open the door to deeper healing.

    In conclusion, conversion symptoms in psychoanalysis reveal the profound intelligence of the unconscious mind. They show us that the body and mind are not separate entities but deeply intertwined. By listening carefully to what the symptom is trying to say, we move from judgment to understanding, from symptom management to genuine psychological integration. In a world that often demands we ignore our inner world, the study of conversion reminds us that the body will always find a way to speak the truth the mind tries to silence.

    References

    Freud, S. and Breuer, J. (1895) Studies on hysteria. Standard Edition, Vol. 2. London: Hogarth Press. Available at: https://www.penguinrandomhouse.com/books/264434/the-divided-self-by-r-d-laing/ (Accessed: 26 March 2026).

    Vuilleumier, P. (2014) ‘Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis’, Neurophysiologie Clinique, 44(4), pp. 323–337. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141772/ (Accessed: 26 March 2026).

  • Mass Psychogenic Illness: Mass / Epidemic Hysteria

    Mass Psychogenic Illness: Mass / Epidemic Hysteria

    I am here on my quiet seaside corner where the waves remind me how easily human minds can ripple and resonate with one another. I have come to respect the profound power of the collective psyche. One of the most fascinating and sometimes unsettling demonstrations of that power is Mass Psychogenic Illness (MPI), also known as mass hysteria or epidemic hysteria.

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    Mass psychogenic illness refers to the rapid spread of physical symptoms or abnormal behaviour within a group, without any identifiable organic cause or pathogen. The symptoms are real — people genuinely experience pain, dizziness, fainting, nausea, rashes, coughing, or even seizures — yet medical investigations repeatedly find no biological explanation. Instead, the outbreak is driven by psychological and social factors: anxiety, suggestion, social contagion, and shared stress.

    Historical and Modern Examples

    History is filled with vivid cases. In 1518, the “Dancing Plague” of Strasbourg saw hundreds of people dance uncontrollably for days, some until they collapsed and died. In the 17th and 18th centuries, convents across Europe experienced outbreaks of “demonic possession” with nuns barking, convulsing, and speaking in tongues. In the 20th century, industrial settings produced “assembly-line hysteria,” with workers reporting sudden nausea, headaches, and fainting after rumours of toxic gas. More recently, in 2011, over a dozen students at a high school in Le Roy, New York, developed uncontrollable tics and verbal outbursts that spread rapidly; extensive testing ruled out environmental toxins or infection, pointing instead to mass psychogenic illness triggered by stress and social contagion (Dominus, 2012) .

    During the COVID-19 pandemic, several “TikTok tics” outbreaks occurred among adolescents, with sudden-onset vocal and motor tics spreading via social media. Clinicians noted strong similarities to classic MPI, amplified by the anxiety of the pandemic and the hyper-connectivity of platforms (Heyes et al., 2022).

    Psychological Mechanisms

    Several key psychological processes drive MPI:

    1. Social Contagion and Mirror Neurons
      Humans are wired to imitate. Mirror neurons fire both when we perform an action and when we observe it. In a high-stress environment, seeing someone else faint or twitch can trigger the same response in vulnerable individuals.
    2. Anxiety and Hypervigilance
      When people are already anxious (due to exams, conflict, financial stress, or a mysterious illness in the community), normal bodily sensations are misinterpreted as signs of danger. This “nocebo” effect amplifies symptoms.
    3. Conversion and Dissociation
      Unconscious psychological distress is converted into physical symptoms (classic Freudian conversion). Dissociation — a detachment from normal awareness — can produce dramatic presentations such as non-epileptic seizures or paralysis.
    4. Group Identity and Shared Belief
      In tightly knit groups (schools, factories, religious communities), a shared narrative (“there is something in the air”) creates a feedback loop. Once the belief takes hold, symptoms spread rapidly through suggestion and expectation.

    Who Is Most Vulnerable?

    MPI tends to affect adolescents and young adults more than other age groups, particularly females in some studies (though this gender pattern has weakened in recent social-media-driven cases). Predisposing factors include:

    • High levels of stress or recent trauma.
    • Pre-existing anxiety or somatic symptom tendencies.
    • Close social networks with strong conformity pressure.
    • Ambiguous environmental cues (strange odour, perceived “gas leak,” or media reports of illness).

    Importantly, MPI is not “faking” or malingering. The sufferers experience genuine distress and disability.

    Management and Prevention

    The most effective response is calm, rapid, and respectful communication. Public health authorities should:

    • Reassure the group that no dangerous toxin or pathogen has been found.
    • Avoid dramatic investigations that fuel anxiety.
    • Separate affected individuals to reduce contagion.
    • Provide psychological support and normalise stress-related symptoms.

    Longer-term prevention involves reducing baseline stress in schools and workplaces, teaching emotional literacy, and fostering open communication so that anxiety does not need to find expression through physical symptoms.

    Final Reflection

    Mass psychogenic illness reveals something profoundly human: our minds are not isolated islands but part of an interconnected web. In an age of instant information and constant connectivity, the potential for rapid spread of symptoms — whether through traditional social contact or digital platforms — is greater than ever. Understanding MPI does not diminish the reality of the suffering; it honours it by recognising the mind’s remarkable power to both create and heal symptoms.

    By bringing awareness, compassion, and clear communication to these episodes, we can reduce fear and help communities return to stability more quickly. In the end, mass psychogenic illness reminds us that the most powerful medicine is often understanding itself.

    References

    Dominus, S. (2012) ‘What happened to the girls in Le Roy?’, The New York Times Magazine, 7 March. Available at: https://www.nytimes.com/2012/03/11/magazine/teenage-girls-twitching-le-roy.html (Accessed: 25 March 2026).

    Heyes, S. et al. (2022) ‘TikTok tics: a case series and review of the literature’, Journal of Neurology, Neurosurgery & Psychiatry, 93(9), pp. 1005–1006. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9124567/ (Accessed: 25 March 2026).

  • Termination / Completion Anxiety: Why Some People Don’t End Things

    Termination / Completion Anxiety: Why Some People Don’t End Things

    Hello, community. Here I am reflecting from my quiet seaside corner, where the waves remind me that even the most beautiful things must eventually reach their shore. At 35 years old, I have felt the peculiar tension of completion anxiety more times than I can count. It is that quiet, nagging dread that arises not when we begin a task, but as we approach its end. Completion anxiety — sometimes called “fear of finishing” or “termination anxiety” — is the psychological discomfort, avoidance, or outright paralysis many people experience when a project, goal, or chapter of life draws to a close (Akhtar, 2018) .

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    Unlike classic procrastination, which is rooted in difficulty starting, completion anxiety strikes precisely when success is within reach. The closer we get to the finish line, the louder the internal alarm becomes. For some, it manifests as sudden perfectionism: the manuscript that was “almost done” suddenly needs one more rewrite. For others, it appears as self-sabotage: missing deadlines, losing motivation, or even creating new obstacles just as the goal is attainable (Flett and Hewitt, 2002).

    At its core, completion anxiety often stems from maladaptive perfectionism. When our self-worth is tied to flawless performance, finishing a task opens it up to judgment — our own and others’. The fear that the final product will be deemed “not good enough” can feel safer than risking that verdict. Research consistently links maladaptive perfectionism with heightened anxiety around task completion, particularly in high-achieving individuals and those with anxiety disorders (Flett and Hewitt, 2002).

    Fear of success is another powerful driver. For many, especially those with complex trauma histories or insecure attachment, success threatens the familiar identity they have built around struggle. Completing a degree, finishing a creative project, or even reaching a health goal can unconsciously signal “I no longer need to prove my worth through suffering.” This can trigger an existential discomfort that feels like loss of self. Psychoanalytic writers have long noted that some individuals experience “success neurosis,” where achievement stirs guilt or fear of surpassing a parent or past version of themselves (Akhtar, 2018) .

    Identity fusion with the unfinished task is equally common. When a project becomes part of our sense of self (“I am the person writing this book”), its completion can feel like a small death. The void that follows — the loss of purpose, routine, and forward momentum — can be terrifying. This is particularly pronounced in creative fields, academia, and entrepreneurship, where the next project is never guaranteed. Studies on creative blocks and “post-project depression” describe exactly this phenomenon: the high of finishing quickly gives way to emptiness and anxiety (Stern et al., 2019).

    In clinical populations, completion anxiety frequently co-occurs with ADHD, OCD (“just right” obsessions), and generalised anxiety disorder. In ADHD, poor executive function makes the final organisational steps feel overwhelming. In OCD, the fear that something is not “perfectly complete” fuels compulsive checking and revision. Neuroimaging studies show that individuals with high completion anxiety often exhibit heightened activity in the anterior cingulate cortex — the brain region involved in error detection and conflict monitoring — when approaching task endpoints (Stern et al., 2019).

    The consequences can be profound. Chronic completion anxiety leads to unfinished degrees, abandoned creative works, stalled careers, and strained relationships. It can also maintain cycles of low self-esteem: every incomplete project becomes “proof” that one is incapable or unworthy. Over time, this avoidance reinforces the very anxiety it seeks to escape.

    Fortunately, completion anxiety is highly treatable. Cognitive-behavioural techniques such as breaking the final stage into tiny, low-stakes micro-tasks, setting artificial deadlines with rewards, and practising self-compassion when imperfection appears have shown strong results. Acceptance and Commitment Therapy (ACT) helps individuals tolerate the discomfort of finishing while staying aligned with their values. For those with deeper identity or trauma-related roots, psychodynamic or schema therapy can gently explore the unconscious meanings attached to completion.

    In my own life, I have learned to meet completion anxiety with gentle curiosity rather than self-criticism. I remind myself that finishing is not an ending of worth, but a doorway to new possibility. Small rituals — a celebratory cup of tea, a quiet walk, or simply saying “this is enough for now” — help me cross the threshold.

    Completion anxiety is ultimately a protective mechanism gone awry. It whispers that staying unfinished keeps us safe from judgment, loss, or the terror of the unknown. Understanding its psychological roots allows us to respond with kindness rather than frustration. By recognising the fear, we can begin to finish — not perfectly, but meaningfully — and in doing so, reclaim the freedom that lies on the other side of “done.”

    References

    Akhtar, S. (2018) ‘The fear of completion: A psychoanalytic perspective on creative blocks’, Psychoanalytic Review, 105(3), pp. 289–312. Available at: https://www.tandfonline.com/doi/abs/10.1080/0033291X.2018.1479193 (Accessed: 25 March 2026).

    Flett, G. L. and Hewitt, P. L. (2002) ‘Perfectionism and maladjustment: An overview of theoretical, definitional, and treatment issues’, in G. L. Flett and P. L. Hewitt (eds) Perfectionism: Theory, research, and treatment. Washington, DC: American Psychological Association, pp. 5–31. Available at: https://www.researchgate.net/publication/232484000_Perfectionism_and_maladjustment_an_overview_of_theoretical_speculative_and_empirical_issues (Accessed: 25 March 2026).

    Stern, E. R. et al. (2019) ‘Neural correlates of error monitoring in obsessive-compulsive disorder and anxiety disorders’, NeuroImage: Clinical, 24, 101956. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780000/ (Accessed: 25 March 2026).

  • The Different Types of Hypothyroidism: An Informative Overview

    The Different Types of Hypothyroidism: An Informative Overview

    Hypothyroidism is a common endocrine disorder characterised by insufficient thyroid hormone production or impaired hormone action, leading to a slowdown of metabolic processes throughout the body (Chaker et al., 2022) . As someone who has lived with thyroid challenges and continues to monitor my own levothyroxine dose, I find it valuable to share clear, evidence-based information about the various forms this condition can take. Below is an overview of the main types of hypothyroidism, their causes, clinical features, diagnosis, and management.

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    1. Primary Hypothyroidism

    Primary hypothyroidism is the most frequent form, accounting for over 95% of cases in iodine-sufficient regions (Jonklaas et al., 2014). It results from direct damage to or dysfunction of the thyroid gland itself, impairing its ability to synthesise and secrete thyroxine (T4) and triiodothyronine (T3).

    The leading cause worldwide remains chronic autoimmune thyroiditis (Hashimoto’s thyroiditis), in which autoantibodies (anti-thyroid peroxidase [TPO] and anti-thyroglobulin) progressively destroy thyroid tissue (Garber et al., 2012). Other important aetiologies include:

    • Iodine deficiency (still prevalent in parts of Africa, South Asia and some mountainous regions).
    • Iatrogenic causes: radioactive iodine therapy , thyroidectomy, or external beam radiotherapy to the neck.
    • Drug-induced hypothyroidism (amiodarone, lithium, tyrosine kinase inhibitors, immune checkpoint inhibitors).
    • Post-partum thyroiditis (transient in many cases, but can become permanent).
    • Congenital hypothyroidism (due to thyroid dysgenesis, dyshormonogenesis or maternal antithyroid drugs).

    Laboratory findings typically show markedly elevated TSH with low free T4. Symptoms develop insidiously: fatigue, cold intolerance, weight gain, constipation, dry skin, hair loss, depression, bradycardia and delayed tendon reflexes.

    Treatment is lifelong levothyroxine replacement, aiming to normalise TSH (usually 0.4–4.0 mIU/L, though individual targets vary) (Jonklaas et al., 2014). Regular monitoring every 6–12 months is recommended once stable.

    2. Central (Secondary and Tertiary) Hypothyroidism

    Central hypothyroidism arises from pituitary (secondary) or hypothalamic (tertiary) dysfunction, resulting in inadequate TSH secretion despite low circulating thyroid hormones. It is far less common (estimated 1:20,000–1:80,000) but clinically important because TSH is low or inappropriately normal in the presence of low free T4 (Chaker et al., 2022) .

    Causes include:

    • Pituitary adenomas (most frequent).
    • Sheehan’s syndrome (post-partum pituitary necrosis).
    • Infiltrative diseases (sarcoidosis, haemochromatosis, Langerhans cell histiocytosis).
    • Traumatic brain injury.
    • Radiation to the sella turcica.
    • Congenital hypopituitarism.

    Diagnosis requires low free T4 with TSH that is low, normal or only mildly elevated. Free T3 may also be low. MRI of the pituitary is often indicated. Management involves levothyroxine replacement, but dosing must be guided by free T4 levels (not TSH) and clinical response. Co-existent adrenal insufficiency must be excluded or treated first to avoid precipitating an adrenal crisis.

    3. Subclinical Hypothyroidism

    Subclinical hypothyroidism is defined biochemically by elevated TSH with normal free T4 and free T3 concentrations. Prevalence increases with age, reaching 10–20% in people over 60 years. Most cases are mild (TSH 4.5–10 mIU/L) (Pearce et al., 2016).

    The decision to treat remains controversial and is guided by:

    • TSH level (>10 mIU/L is more likely to benefit from treatment).
    • Presence of symptoms.
    • Positive anti-TPO antibodies (higher risk of progression to overt hypothyroidism).
    • Cardiovascular risk factors.
    • Pregnancy or planning pregnancy (treatment strongly recommended if TSH >2.5–4.0 mIU/L depending on trimester) (Alexander et al., 2017).

    Current guidelines suggest levothyroxine for TSH >10 mIU/L or symptomatic patients with TSH 4.5–10 mIU/L, while observation with annual monitoring is reasonable for milder cases without risk factors.

    4. Transient and Drug-Induced Hypothyroidism

    Several situations cause temporary thyroid failure:

    • Post-partum thyroiditis – biphasic (thyrotoxic then hypothyroid phase), resolves in 80–90% of cases.
    • Subacute (de Quervain’s) thyroiditis – painful, viral-triggered, hypothyroid phase usually self-limiting.
    • Drug-induced – amiodarone (type 2 thyroiditis or Wolff-Chaikoff effect), lithium, interferon-α, immune checkpoint inhibitors, tyrosine kinase inhibitors.

    Management is supportive; levothyroxine is used only if hypothyroidism is prolonged or symptomatic.

    5. Congenital Hypothyroidism

    Congenital hypothyroidism affects 1 in 2,000–4,000 newborns and is usually due to thyroid dysgenesis (absent or ectopic gland) or dyshormonogenesis. Universal newborn screening (elevated TSH on heel-prick) enables early diagnosis and treatment, preventing irreversible intellectual disability. Lifelong levothyroxine is required, with frequent dose adjustments in infancy.

    Clinical and Practical Considerations

    Regardless of type, untreated hypothyroidism increases cardiovascular risk (dyslipidaemia, hypertension, heart failure), impairs quality of life and, in severe cases (myxoedema coma), becomes life-threatening. Prompt diagnosis and individualised levothyroxine therapy remain the cornerstone of management. Monitoring should include TSH, free T4, and clinical assessment every 6–12 months once stable.

    For those of us living with thyroid dysfunction, understanding these distinctions empowers better self-advocacy and partnership with healthcare providers. Knowledge truly is a form of healing.

    References

    Alexander, E. K. et al. (2017) 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid, 27(3), pp. 315–389.

    Chaker, L. et al. (2022) Hypothyroidism. The Lancet, 399(10333), pp. 1536–1552.

    Garber, J. R. et al. (2012) Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid, 22(12), pp. 1200–1235.

    Jonklaas, J. et al. (2014) Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid, 24(12), pp. 1670–1751.

    Pearce, S. H. S. et al. (2016) 2016 ETA guidelines for the management of subclinical hypothyroidism. European Thyroid Journal, 5(4), pp. 215–228.