Month: November 2024

The Benefits of Makaton Signing, Engagement, and Inclusion

Makaton sign language uses the body to aid communication. It’s similar to an  extension of the natural gestural body language we use when we travel – trying to make ourselves understood. It is known in Special Educational Needs and Disabilities (SEND) as an AAC tool.

The Benefits of Makaton: Engagement, Inclusion & Communication for All

  1. Keeps Focus and Enhances Engagement
  2. Increased brain activity promoting cognitive growth
  3. Develops hand-eye coordination and fine motor skills
  4. Kinesthetic Learning beyond Key stage 2
  5. Introduces diversity into communication
  6. Supports Mental Health and Wellbeing
  7. Reduce isolation
  8. Better Outcomes
  9. Builds Empathy and Understanding
  10. Conclusion


Makaton is more than just a sign language system—it’s a powerful tool for connection.  Makaton blends signs, symbols, speech, and body language to support and enrich communication for everyone, not just those with speech challenges.

Keeps Focus and Enhances Engagement

Makaton signing helps children maintain focus by adding a visual and physical element to communication. For example, Sarah, a young girl with ADHD, found it difficult to sit still and concentrate during lessons. By incorporating Makaton signs into classroom instructions, Sarah was able to focus better. She could follow along because the signs added meaning. They acted as a physical memory anchor (muscle memory). Sarah could associate this with the verbal instructions, making them easier to remember.

Increased brain activity promoting cognitive growth

Makaton offers benefits to all children, not just those with specific communication challenges. Studies have shown that children who use sign language, including Makaton, exhibit increased brain activity. These activities occur in areas related to language development, promoting cognitive growth. Learning signs connects words with physical actions, enhancing learning through multisensory experiences and offering a deeper understanding of the world.

Develops hand-eye coordination and fine motor skills

Makaton encourages the development of motor skills, which contribute to the creation of new neural pathways in the brain. This leads to improvements in problem-solving, language comprehension, and memory, benefiting children across various developmental stages

Learning fine motor skills, which are essential for cognitive development. Fine motor activities, such as hand-eye coordination and finger movements, play a crucial role in neural development. They support children’s ability to learn. They help them solve problems and communicate effectively.

Kinesthetic Learning beyond Key stage 2

Makaton enhances kinesthetic learning by linking physical actions with words. This makes the learning process more interactive and accessible for all children. Beyond Key Stage 2, this can greatly influence children’s ability to learn new concepts. The impact is especially evident when they can connect movement and gesture with content. Kinesthetic learning, which involves physical movement, helps reinforce memory and understanding by engaging multiple senses.

For example, a child learning about “weather” could sign different types of weather (e.g., “sun,” “rain,” “cloud”) while physically mimicking actions, such as moving hands to imitate the rain or spreading arms to show the sun. This connection between action and word supports content learning. It strengthens the child’s ability to recall and understand the concept.

Introduces diversity into communication

Makaton introduces diversity into communication, making learning more accessible to all children and creating a joyful, inclusive environment. Whether it’s the joy of signing a song or the excitement of learning a new word, Makaton enriches children’s lives in meaningful ways.

Our way

When I use Makaton  in public with others, becomes an emotional bridge. It allows others to acknowledge James’ communicative capacity. It gives them a model they may use if they wish to acknowledge James’ presence. They can also use it if they wish to communicate differently.

Supports Mental Health and Wellbeing

For children like James, who struggle to express their emotions verbally, it can be beneficial. It also supports verbal children to express their feelings and needs. The pressure of producing verbal speech and expression is removed, reducing anxiety and frustration.

I began modeling and practising Makaton signs with James in a natural way, which is known as non-direct teaching. As a result, he became more comfortable trying to sign himself. As I learned more, I signed more. It doesn’t matter if his signs are not correct. It is difficult for him. The feedback is his attention, fueled by engagement, confidence, and well-being.

The emotional support of adult modelling encourages a safer environment where children can explore communication openly and without correction.

Reduce isolation

One of the most profound benefits of Makaton is its ability to break down communication barriers. Without accessible communication methods, children can easily feel isolated and disconnected from their peers. Makaton empowers children by offering a means of interaction, even at a basic level. A simple gesture, like a wave or a sign for “hello,” can reduce feelings of loneliness and exclusion.

Better Outcomes

A study by the National Institute of Health found that inclusive communication strategies in schools led to better academic outcomes. These strategies also fostered a greater sense of belonging among students with special needs.

Builds Empathy and Understanding

Makaton signing is not just for children with communication challenges. It can also benefit all children. It fosters empathy and a deeper understanding of communication differences. When children engage with different methods of communication, they become more aware of others’ needs. They also develop greater respect for diversity. This cultivates an environment where empathy and inclusion thrive, preparing children for a diverse world beyond the classroom

Conclusion

We can create environments where all children have the opportunity to engage. They will learn and thrive by incorporating Makaton into everyday routines. The benefits of Makaton extend far beyond communication, promoting a world that celebrates diversity and inclusivity.

In environments where inclusive communication methods like Makaton aren’t used, children may feel disconnected from their peers. However, teaching Makaton ensures that all children, regardless of their communication abilities, can participate in learning and social activities. This inclusive approach fosters a sense of value and support, leading to improved self-esteem and social skills.

Makaton is one example of a low technology Augmentative and Alternative Communication method (AAC).

As simple as ABC? Addressing Barriers Collectively

As simple as ABC? (addressing barriers collectively…)

P-p-pick up a penguin, phonology, philosophy, presence and policy.

Trigger Warning: This text contains references to derogatory and emotive language that may be distressing or upsetting.

As the year ends, I begin preparing for the festive season. I will use our Makaton signs for Christmas carols. This will demonstrate a different way of learning language and communication.

  1. Phonology
  2. Makaton
  3. P, p, p – Prophecy, Policy, Political Correctness, Progression, Pygmalion, Presentation, Philosophy, Pathology, Perceptions, Problems
  4. Self-Fulfilling Prophecy

Phonology

refers to the sounds we make, hear, and understand from the words we use. This is also known as pronunciation or speech sounds. It is crucial for understanding each other when communicating verbally. This applies when communicating with others in the same language or another language.

Stuttering (no longer an official diagnosis) could be described as a speech disorder or impediment. I prefer to call it a characteristic that affects pronunciation or phonology. If you belong to my generation and were raised in England, you might recall the chocolate biscuit bars called Penguins. The manufacturer, McVities executed a genius marketing campaign that caught the publics attention. In fact, it was so memorable I still buy and remember it 40 years later. It also provides a perfect example of a phonological difference. This difference is present in some populations of people: the prolongation or delay to a part or start of a word. The key points highlight that problems with phonology make communication difficult. Thankfully, it can be transient and is no longer diagnosed as a disorder! (Yet it is still classified in the DSM-V as a Childhood-onset Fluency Disorder).

Makaton

sign language uses the body to aid communication. It’s similar to an extension of the natural body language we use when we travel and try to make ourselves understood. It is known in Special Educational Needs and Disabilities (SEND) as an AAC tool. We use it to aid and augment communication. It is an alternative to speech and written communication. However, it is often used in conjunction with these more standard techniques for learning.

Makaton benefits all children by promoting focus, motor skills, and cognitive development while encouraging empathy and inclusion. By incorporating Makaton into daily life, we create an environment where learning is accessible, diverse, and enriched, benefiting everyone through different ways of connecting and expressing themselves.

Click here to read Benefits of Makaton Signing, Engagement, and Inclusion.

Another key aspect of the “P-p-p Pick up a Penguin” song is its memorability! Perhaps it was the catchiness of the tune or because it was so amusing and different, it became so popular.

In terms of inclusion, promoting learning through song and sign is not a new concept. Yet it is has not yet become mainstream, memorable or universal enough that more people know it well. I spend quite a lot of time learning it, forgetting it and trying again. Like I do with most of my learning, especially Thai language… My understanding improved when I started making my own learning resources, specifically short videos that cater to my attention span, learning style and time constraints, and then use in songs. I share these on my social media, as I learn.They are a little rough and ready but they do the job and I don’t have the time.

Numerous benefits for institution-led Makaton learning are highlighted in the podcasts below. I will summarise them in a link below.

P, p, p – Prophecy, Policy, Political Correctness, Progression, Pygmalion, Presentation, Philosophy, Pathology, Perceptions, Problems

A quick discussion and play on the p, p, p theme – more “P” words.

In my opinion, when we label children as disordered and deficient, we create a ‘Pygmalion’ effect. This refers to an imposed identity, potentially through negative medical labelling. It is sometimes used in the context of a self-fulfilling prophecy. In this context, a belief or expectation about a person or situation leads to behaviours. As I like to break down words and phrases to understand them a quick Google search explains prophecies ‘as any statements or beliefs about the future, past, or present’. These statements ‘may or may not involve supernatural elements’. In social contexts, “self-fulfilling” describes something that becomes true because of the actions and beliefs built around it. For example, if a teacher believes a student is talented, they may give that student more attention. This extra attention leads the student to perform better, which then confirms the teacher’s belief.

A person’s potential can therefore be predicated upon the perception of themselves imposed by others. It is so powerful that sometimes policies are built around such perceptions.

‘Political Correctness’ is a term supported by radical policies that refers to the use of inclusive language and the avoidance of language or behaviour that can be seen as marginalising or insulting. This is crucial for groups that are disadvantaged or discriminated against, especially those defined by ethnicity, sex, gender, sexual orientation, or disability. This term has been around since the 1980s, and why I advocate for the use of neurodiversity-affirming language instead of derogatory and debilitating labels. It is more politically correct.

Considering the impending neurodiversity acceptance revolution, it is useful to understand historical labels for neurodiverse and disabled people. Some were called “feeble-minded,” “retarded,” “spastic,” and were thought of as useless at the extreme end of the scale. In addition, people used words like “chink,” “paki,” “nigger,” and “faggot.” in the contexts of bullying, shielded racism or cruelty.

I use them here to express the emotive quality of words, how they depict different eras and mentalities, and their subsequent disuse. I witnessed this progression and evolution of language and social conscience firsthand. I am thankful for the cultural revolution and appreciate the prevailing predominance of positive promotion of all people in the population. There is an increasing understanding and respect for difference. Yet, I was shocked to hear the word “retard” spoken from a young man’s mouth just a few weeks ago. This seems specifically relevant, as Joanna raises this controversially in her podcast ‘R is for Rosie’ (linked below). She notes that it is still used as a basis for humour. Consequently, it is prolonged and propagated by some people in some homes.

The final “P” word for this piece will be philosophy. The nature of our current reality (metaphysics) shapes our experience. The scope and limits of human knowledge (epistemology) are defined at a particular point in time. The principles of right and wrong (ethics), taught to us by our parents and public policy, guide us. The structure of reasoning (logic) and our appreciation of the beauty of our environment (culture) define who we are. These aspects define the meaning of life and affect how we exist and coexist.

In the context of disability, there appears to be a misbalance between values and pathology, perceptions and problems. This leads to discussions on the next play on the “P” word: the Pavlov’s Dog experiment and learned helplessness. To be continued 🙂

Self-Fulfilling Prophecy

The self-fulfilling prophecy can be observed in various contexts, including education, relationships, and organisational settings. It demonstrates how our beliefs and expectations can shape reality through our actions and interactions.

Self-Fulfilling Prophecy In Psychology: Definition & Examples

Merton’s work highlighted the power of social expectations in shaping individual and group behaviour, making the concept crucial for understanding social dynamics and interpersonal relationships.

Pygmalion – My Fair Lady, George Bernard Shaw, another phonological, musical story, and Christmas classic 🙂

Sustainability, salt and the single most important source of brain damage

Did you know that iodine deficiency is the single most preventable cause of brain damage worldwide?

  1. The Connection Between Iodine and Brain Health
  2. The Role of Soil, Water, and Climate in Iodine Deficiency
  3. Climate Change and Mental Health
  4. A Simple Solution: Iodized Salt
  5. The Interconnection Between Iodine, Water, and Health Equity
  6. The Path Forward: What Can We Do?
  7. Conclusion
  8. Links

Recently, I had the privilege of meeting Dr Rani, a public health expert working with at-risk populations here in Thailand. She shared some of her inspiring work in delivering iodine to communities, helping combat the effects of iodine deficiency as part of the International Support Foundation.

I met Dr Rani through the We-Woman Network, a knowledge-sharing group that promotes kindness, connection, learning, sharing, and empowerment. It was through this network and meeting its founder Dr Manisha Bose I was inspired to write this blog today. Her vision to connect people through meaningful exchange is inspiring. We are joined to celebrate and enrich each other.

The Connection Between Iodine and Brain Health

Iodine is essential for the thyroid gland to produce hormones that regulate vital processes in the body, including brain development. Hyperthyroidism and other thyroid-related issues are directly linked to iodine deficiency.

The result? Brain damage that is often irreversible and entirely preventable.

But why does iodine deficiency persist, even with knowledge and solutions available? The answer lies in sustainability and accessibility.

The Role of Soil, Water, and Climate in Iodine Deficiency

In many parts of the world, especially in riverine and agricultural areas, iodine levels in the soil have been depleted due to practices like overgrazing, deforestation, and unsustainable farming. The loss of iodine in the soil means that local food sources—especially those grown in these regions—are severely lacking in iodine. This deficiency affects anyone in the food chain who consumes these products.

As global demand for cheaper and faster food production increases, the cycle continues—leading to malnutrition, impaired cognitive function, and socioeconomic disparities. People in impoverished regions are the hardest hit. This is particularly true in rural areas with limited access to iodized salt or iodine-rich foods such as milk, yogurt, and cheese. Other iodine-rich foods include seaweed, certain fish and seafood, such as cod, tuna, and shrimp, as well as beans and fruit.

Climate Change and Mental Health

The links between climate change, resource depletion, and brain health cannot be ignored. As the environmental crisis worsens, it’s crucial to understand its long-term implications on human cognitive function, particularly in the next generation. This issue raises some very important points about protecting our children’s mental health. Eco-anxiety—the difficult emotions caused by direct or indirect exposure to climate change—has a significant impact on our sense of agency, or our ability to individually and collectively navigate the challenges we face in an increasingly uncertain world.

A Simple Solution: Iodized Salt

The solution is simple and cost-effective: iodized salt. By adding just a small amount of iodine to the salt we consume, it’s possible to eliminate iodine deficiency globally. Salt is a common part of our daily diet, and widespread iodine fortification can have an immediate and lasting impact.

The World Health Assembly made a recommendation back in 1991 to target this global health crisis. This initiative has led to significant improvements over the last few decades. However, many pockets of the world still suffer from iodine deficiency. Statistics from Southeast Asia between 1994 and 2006 showed that 30% of the population was affected. This remains a concern for Southeast Asia today. To put it into perspective, this represents 503.6 million people at risk of preventable brain damage.

The Interconnection Between Iodine, Water, and Health Equity

Ensuring access to adequate iodine intake is as important as access to safe drinking water (which is crucial to maintaining normal brain function). Yet, disparities persist, and it is shocking to discover that safe drinking water and sanitation are still out of reach for billions.

In her talk, ‘Water is Life’, Marisha Wojciechowska discussed how the climate story is, in fact, a water story. She highlighted that in 2021, 80% of natural disasters in Southeast Asia were storm and flood-related, affecting 43 million people and causing economic damages in excess of 35 billion USD.

The Path Forward: What Can We Do?

  • Improve Salt Iodization: Ensuring that iodized salt is used in food manufacturing and animal consumption (since we are what we eat) can drastically reduce IDD.
  • Support Local Solutions: Identify areas where iodized salt is not available and work with communities to provide affordable access.
  • Raise Awareness: Promote the understanding that iodine deficiency is preventable, and advocate for its inclusion in public health policies.

Marisha recommends implementing grey and green solutions to address the direct impacts of flooding on humanity. Examples of green solutions include planting more mangroves, while grey solutions involve building storage systems to capture excess rainfall. One example of a grey solution is the manmade lake at Benjakitti Park in Bangkok.

On a smaller scale, individuals can choose to reduce, reuse, and recycle where possible. Another piece of advice that I picked up was simple and will help me save my water bill too. This simple action allows us to do our part in conserving water right from our homes.

Sustainable water solution tip. Placing a 2-liter bottle of water in the flush tank prevents the entire 5-6 liters of water from being wasted.

Conclusion

Iodine deficiency and sustainability are interlinked global challenges. Iodine deficiency is entirely preventable, yet millions continue to suffer from its effects. Addressing sustainability is not only about health. It also involves breaking the cycle of poverty. It ensures that future generations have the mental capacity to thrive. Ultimately, it’s about creating a more sustainable and fair society

Supporting Neurodiverse Learners: Building Self-Esteem

Commonalities in Dyslexia, Language Processing, Developmental Delays: Building Self-Esteem

As a parent and advocate, I’ve spent a lot of time reflecting on how we can better support neurodiverse learners—children who face challenges with language processing, reading, comprehension, and communication. Through my journey with James, combined with the expert insights I’ve encountered, I’ve realised that many learning differences, such as dyslexia, developmental language disorder (DLD), ADHD, and autism spectrum disorder (ASD), have more in common than we might think. Instead of focusing on their differences, I believe we should bridge the gaps in understanding these conditions and take a more inclusive approach to learning, one that helps improve self-esteem and empowers neurodiverse learners.

Common Threads in Learning Differences

Reflecting on SENDCAST episodes featuring Louise Selby and Dr. Helen Ross, alongside research from Jill Boucher and Maggie Snowling, I’ve noticed a common thread in how learning, communication, and attention difficulties manifest in children with different diagnoses. A helpful approach is to understand that many of these conditions stem from shared challenges in processing language, not deficits in intelligence.

For example, dyslexia is often misunderstood as simply a reading disorder, but it’s more about how a person processes and decodes language. Dyslexic learners often struggle with phonics and word recognition, but this difficulty is not a reflection of intelligence. Likewise, developmental language disorder (DLD) isn’t a cognitive issue but involves challenges with syntax, semantics, word retrieval, and pragmatics (as highlighted in Maggie Snowling’s paper on Developmental Dyslexia and Specific Language Impairment: Same or Different?).

Interestingly, ASD is often treated as separate from language disorders, but Jill Boucher points out that this division can blur the lines between appropriate interventions. For example, in my studies of Intensive Interaction, I’ve observed that teaching non-verbal or minimally verbal children with autism using rigid, speech-focused methods can suppress their communicative intent. Nurturing their communication and language skills in a more holistic way—such as using Intensive Interaction techniques—could yield better results.

Additionally, Rita Jordan, in her work on autism with severe learning disabilities, highlights how children with autism may have fewer opportunities for language exposure and interaction, especially when learning disabilities are misunderstood or not specifically addressed. She suggests these children may experience limited exposure to natural language and meaningful communication, often due to inappropriate interventions. As a result, these children miss crucial opportunities for language development. Without this foundation, they may fall further behind their peers, even in basic social communication skills. This underscores the importance of creating learning environments that promote language development through natural interactions and respectful communication.

It’s essential to recognise that ADHD, ASD, and DLD share overlapping challenges in language comprehension, working memory, and social communication. Professor David Daley reminds us that children with ADHD or ASD may exhibit developmental delays, meaning their brain maturity often lags behind their chronological age. Their defiance, indifference, or struggles to learn are not personal choices but responses to cognitive and language processing differences.

The Power of Morphology in Supporting Learners

As Louise Selby explains in her discussions about dyslexia, traditional phonics approaches don’t always work for all learners, especially those with DLD, ADHD, and ASD, who may struggle with phonemic decoding. Morphological instruction, on the other hand, provides children with a meaning-based strategy for word comprehension. This approach is effective for all learners, not just those with language difficulties, as it helps children build a deeper understanding of language and the structure behind it.

Moreover, morphology can be particularly useful for learners who struggle with reading comprehension. For instance, a child who understands that “un-“ means “not” or “happy” means a positive emotional state can more easily figure out the meaning of unfamiliar words. Given that around 80% of English words are made up of morphemes, this strategy works for a wide range of learners, including those who may not typically be diagnosed with learning disabilities but still struggle with word meaning.

Bridging the Gaps and Improving Self-Esteem

One of the most concerning issues for children with learning differences is the impact on their self-esteem. Labels like dyslexia, ADHD, and autism can make children feel “less than” their peers, and over time, they may internalise these negative labels. In her SENDCAST talk, Dr. Helen Ross discusses the profound mental health effects of a dyslexia diagnosis, where children may begin to see themselves as “lazy” or “dumb” simply because they process language differently.

As a parent, it is heartbreaking to see any child begin to doubt their worth. Understanding the brain’s differences in processing language is key. We need to shift the conversation away from deficits and focus on a child’s unique strengths.

That’s why I created IAMJamesMum.org—to share our story and advocate for neurodiversity. By celebrating the idea that being different is not a deficit, we can help children build their self-worth and embrace their strengths, not just in language, but in all areas of life.

A Holistic Approach: Inclusive Practices that Celebrate Neurodiversity

In my view, the best way to support neurodiverse learners is through a holistic, inclusive approach that recognises the shared experiences of children with different neurological profiles. Instead of treating each condition in isolation, we need to adopt universal strategies that support all learners. This might include explicit teaching methods, a focus on morphology for language learning, and meaningful, context-rich environments where all learners can thrive.

I’m also passionate about the work of Hope Haven, which is working to build a model for welcoming and inclusive spaces for the SEND community. By creating environments where neurodiverse children feel valued and accepted, we help them not only build academic skills but also foster emotional resilience and improve self-esteem.

Moving Forward Together

The neurodiversity movement, championed by Advocates Apparel, Hope Haven, and this blog, is about creating a world where differences are celebrated and neurodiversity is recognised as a strength. Let’s continue to work together to bridge the gaps in understanding and build a more inclusive and supportive world for all neurodiverse learners.

Resources to Explore:

  • Advocates Apparel: Supporting the neurodiversity movement with pride.
  • Hope Haven: Celebrating neurodiversity through inclusive environments.
  • SENDCAST Podcast: Insightful discussions on SEND, dyslexia, ADHD, and inclusion with experts like Louise Selby and Dr. Helen Ross.
  • ACAMHS Learn: Free CPD sessions on ADHD, autism, and more, providing professional development in neurodiversity.

Additional References:

  • Dr. Helen Ross, Trustee of the British Dyslexia Association www.helensplace.co.uk
  • Louise Selby, author and dyslexia specialist www.louiseselbydyslexia.com
  • Maggie Snowling, Professor at the University of Oxford, world-leading expert in language disabilities, including dyslexia
  • Jill Boucher, Professor of Developmental Psychology, City University London
  • Rita Jordan, Professor of Autism Studies, University of Birmingham

The Mental Health Crisis: Is It Really an Epidemic?

The growing number of diagnoses, particularly in Western societies, has coincided with a global rise in mental health problems. According to the World Health Organisation, mental health disorders are now the leading cause of disability worldwide, with conditions like depression, anxiety, and psychosis becoming more prevalent. This increasing trend has been described as a “mental health epidemic,” but is it truly an epidemic of mental illness, or is it more about the way we have come to understand and categorise mental distress?

The sharp rise in diagnoses cannot solely be attributed to an actual increase in mental health problems. The growth of the mental health industry, has created a system in which many individuals are identified as having disorders, even when their experiences may not be pathological in the strictest sense. It’s possible that these tools have created a self-fulfilling prophecy, where people who might have otherwise adapted to challenges in their lives are now labelled as “sick” and in need of treatment.

In many cases, the over-categorisation of human emotion and behaviour risks turning normal human experiences—such as grief, stress, or anxiety—into clinical conditions. This can make people feel as though they are constantly battling mental illness, even when their symptoms may be part of the natural human condition.

Over-Categorisation and the Medicalisation of Human Nature

As psychiatric diagnostic tools have become more refined, the scope of what is considered a mental health disorder has expanded. Normal human experiences such as anxiety, sadness, or stress—common reactions to life events like a job loss or the death of a loved one—are increasingly being labelled as clinical conditions. The fine lines between what constitutes normal psychological distress and what qualifies as a diagnosable disorder are often blurred.

In fact, the DSM-5 has faced criticism for contributing to the over-diagnosis of relatively minor or transient conditions. For instance, what was once considered a natural response to grief, such as sadness after the loss of a loved one, can now be diagnosed as major depressive disorder if it persists for a certain length of time. Similarly, the increasing number of disorders in the DSM-5 has led to concerns about pathologising normal human behaviour. Conditions like generalised anxiety disorder or attention-deficit hyperactivity disorder (ADHD) may be diagnosed even when symptoms do not meet the clinical threshold, leading some to question whether psychiatry is over-complicating what are essentially variations of human experience.

This trend towards over-diagnosis is not just an issue for the individual, but has wider societal implications. When everyday experiences are medicalised, individuals may begin to see themselves as inherently “broken” or diseased, rather than recognising that their struggles are part of the complex fabric of being human. This pathologisation can also lead to unnecessary treatment, with people turning to medication or therapy for what might simply be a temporary emotional response.

The Need for a New Paradigm in Psychiatric Research and Practice

Given these concerns, it is clear that the field of psychiatry is at a crossroads. The historical foundations laid by Kraepelin were vital in moving psychiatry toward a more structured, scientific understanding of mental illness. But as diagnostic tools have become more detailed and comprehensive, we must ask whether we’ve reached a point where standardisation has gone too far, leading to an over-medicalisation of everyday human struggles.

The current mental health crisis calls for a shift in perspective. Instead of focusing solely on labels and diagnostic criteria, we need to look more holistically at the causes of mental distress. Environmental factors, social isolation, economic instability, and the impact of climate change are critical components that cannot be ignored. Mental health must be understood not just as a set of symptoms to be categorised and treated, but as a complex interplay of biological, psychological, and social factors.

Kraepelin’s Legacy: The Birth of Psychiatric Classification

Emil Kraepelin is widely regarded as the father of modern psychiatric classification. His work in the late 19th and early 20th centuries marked the beginning of a systematic approach to understanding and categorising mental disorders. Kraepelin introduced the concept of longitudinal observation, classifying mental illnesses not just by their symptoms, but by their course over time. His descriptions of conditions like schizophrenia and bipolar disorder are still influential today.

However, Kraepelin’s methods were based on clinical observation and lacked the statistical tools and diagnostic criteria that we now use. His classification system was relatively broad. It relied on subjective assessment and description. Consequently, it was more prone to variation. It was also less reproducible than modern systems. Moreover, Kraepelin’s view of mental illness as a form of biological degeneration has been largely debunked. Advances in neurobiology and genetics prompted this change. Contemporary research, such as that led by Professor Robin Murray, has shifted the understanding of psychosis and other disorders from a purely biological model to one that considers genetic predisposition, environmental stressors, and socio-cultural factors.

Despite its limitations, Kraepelin’s pioneering work laid the foundation for the DSM (Diagnostic and Statistical Manual of Mental Disorders). It also laid the groundwork for the ICD (International Classification of Disease). Psychiatric diagnostic tools have evolved over the years. The classification of mental disorders has become increasingly standardised. It has also become increasingly complex. These developments have allowed for clearer communication. They have also improved treatment protocols. However, they may have led to the overcomplication of human nature. This has fueled a mental health crisis. Many are questioning whether we have over-medicalised the human experience.

These standardised systems have undoubtedly improved diagnostic accuracy. They have also improved communication among healthcare providers. However, they bring their own set of challenges, particularly in the context of the mental health crisis we face today.

Conclusion: From Kraepelin to Today – Rethinking Mental Health Diagnosis

By over-categorising human experience and medicalising normal emotional responses, we risk turning ordinary human struggles into clinical conditions, exacerbating the very mental health crisis these tools were designed to address.

As we move forward, we propose a more balanced approach. This approach respects the complexities of human experience. It also ensures that serious mental health conditions are properly diagnosed and treated. The challenge is to develop a mental health framework that promotes well-being. It should reduce the stigma of seeking help. Additionally, it must foster a deeper understanding of the socio-environmental factors that contribute to mental distress. Ultimately, we need a new paradigm for understanding psychiatric challenges. This new paradigm should value neurodiversity and human complexity. It must support holistic treatment and provide a more compassionate, less pathologised view of mental health.

Rethinking Spectrum ‘Disorders’

When Labels Become a Societal and Personal Identity: The Impact of Psychosis and the Schizophrenia Spectrum

Severe psychosis is a complex and multifaceted condition that has long been misunderstood. This post collates expert opinions from Professor Robin Murray, Dr Soumattra Datta, and Associate Professor Keri Ka Ye-Yee Wong, to offer a deeper understanding of the schizophrenia spectrum and neurodiversity.

In his podcast for The Mental Elf, ahead of his keynote talk, Professor Sir Robin Murray reflects on his 50 years of experience as a psychiatrist and researcher. A key takeaway from his reflections is his challenge to the validity and existence of schizophrenia as a diagnostic label.

For decades, the diagnosis of schizophrenia has carried a heavy stigma, akin to other such deficient, permanent, and debilitating labels—both in society and within the medical community. A diagnosis of schizophrenia often meant a lifetime of institutionalisation or heavy reliance on medication, with little hope for recovery.

Given my current knowledge, I was alarmed by the idea of youth diagnosis. In a 12-minute video, Dr Soumattra Datta discusses the misdiagnosis of psychosis in adolescents. He explains the transient and differential understanding of managing psychosis in this population. Dr Datta refers to this as ARMS (At Risk Mental State) and suggests preventative and follow-up measures, along with the dangers of misdiagnosing. In fact, the prevalence rate of schizophrenia in children is only 1 in 10,000, so care must be taken when applying such labels. Additionally, he mentions that neurotypical children can have hallucinations too, often as part of an overactive imagination or transient experiences.

The Spectrum Concept

The concept of “spectrum” in mental health disorders, such as schizophrenia spectrum disorders, refers to a range of conditions that share common symptoms or characteristics but can vary in severity, presentation, and impact on daily functioning.

Keri Ka Ye-Yee Wong discusses the core symptoms of schizophrenia spectrum, how they can present, and how these symptoms will vary across individuals. The key takeaway is for families to explore symptoms and ask: Are the delusional beliefs held with conviction? When provided with an alternative explanation, does the child change their mind? Are the hallucinations intense, frequent, or impairing the child’s daily functioning? Have the symptoms persisted for more than 6 months?

Core Symptoms:

  • Delusions: Fixed, false beliefs, such as persecutory (feeling others are out to get them), referential (believing ordinary events hold special meaning), somatic (believing something is wrong with their body), or grandiose (having beliefs in special powers or missions).
  • Hallucinations: Perceptions of things that aren’t present, such as hearing voices, seeing things (e.g., ants crawling on the skin), or smelling non-existent odors. Heightened sensory perception can sometimes blur the line between real experiences and hallucinations.
  • Disorganized Thinking: This may manifest as jumping to conclusions or incoherent speech, making it difficult to follow a conversation or thought process.
  • Abnormal Motor Behaviors: This can range from hyperactivity to being mute, showing a lack of movement or response.
  • Negative Symptoms: These include a reduced range of emotions (blunted affect), poor eye contact, and social withdrawal.

The Impact of Diagnosis: The Dangers of Labelling and the Evolution of Psychiatric Understanding

Sir Murray advocates for a more nuanced understanding of severe psychosis. He encourages clinicians and the public to recognise that psychosis exists on a continuum, with varying degrees of severity and a range of potential causes. He emphasises that psychosis is not a static condition; it can change over time, influenced by treatment, environment, and individual factors.

He discusses the damage of prematurely diagnosing a permanent, degenerative condition. This can lead to hopelessness for those affected and their families. Professor Murray’s work over the past 50 years demonstrates the evolution of psychiatric thinking.

The Role of Neurobiology in Psychosis: Brain Changes and the Impact of Medication

A central aspect of Professor Murray’s work is his exploration of the neurobiological underpinnings of psychosis. Regarding the evidence of brain changes in people diagnosed with schizophrenia, he suggests that these changes are not necessarily indicative of a progressive, degenerative disorder. Traditionally, the brain changes seen in schizophrenia include a reduction in cortical volume and an increase in fluid-filled spaces, known as ventricular enlargement. These changes have been interpreted as evidence of a deteriorating condition. However, Professor Murray challenges this interpretation. He suggests that these brain changes may not be caused solely by the illness itself. Other factors, such as the effects of long-term medication, could contribute. Antipsychotic drugs, commonly prescribed to manage symptoms of psychosis, are known to have neurological side effects. Some studies have shown that antipsychotics can cause structural changes in the brain, which may be misinterpreted as signs of the condition itself rather than a side effect of treatment.

In addition to medication, lifestyle factors such as smoking, poor diet, obesity, lack of exercise, and high blood pressure all contribute to brain changes that can exacerbate the symptoms of psychosis. Professor Murray’s work highlights the importance of taking a holistic approach to managing psychosis—one that addresses not only the biological aspects of the condition but also the social, environmental, and lifestyle factors that play a role in its onset and progression.

Can Severe Psychosis Be Managed Without Medication?

While recognising that medication can be useful for some individuals, I strongly believe that it should not be the first or only line of treatment for any type of psychosis. As someone who currently relies on antidepressant and ADHD medication, I also know the dangers of over-reliance or the use of something not targeted to the problem.

When medication is prescribed without any other holistic intervention, there is a danger of an over-reliance on medication to address mental health, often overlooking the potential for recovery through non-pharmacological treatments.

Early intervention, psychosocial support, and therapies such as Cognitive Behavioural Therapy (CBT), Cognitive Remediation Therapy (CRT), and family therapy have been shown to be effective in reducing the severity of psychosis and helping individuals manage their symptoms.

Professor Murray advocates for a shift in focus from simply managing symptoms to addressing the root causes of psychosis. For example, he highlights the role of social isolation, drug abuse (particularly cannabis and cocaine), and childhood trauma as key contributors to the onset of psychotic episodes. By addressing these underlying factors, rather than just medicating the symptoms, individuals can experience a more meaningful recovery.

Reducing the Impact of Psychosis: Neurological Acceptance and Holistic Care

Accepting that neurological differences, such as those seen in psychotic disorders, should not be viewed solely through a pathologising lens and understanding that brain changes may be part of a person’s neurodevelopmental makeup, rather than a sign of irreversible disease, can lead to a more compassionate and less fear-driven approach to care.

In addition to medication, Professor Murray advocates for a range of interventions, including psychoeducation, lifestyle modifications, social support, and psychotherapy. By offering a broader spectrum of treatments, we can better support individuals experiencing severe psychosis, while also reducing the stigma and fear associated with psychological challenges.

Conclusion: The Importance of Rethinking Labels

The work of Professor Sir Robin Murray represents a pivotal shift in our understanding of severe psychosis. His research highlights the complexity of psychotic experiences, urging us to move beyond simplistic labels like schizophrenia and recognise psychosis as part of a spectrum of mental health conditions that can be managed with a variety of treatments.

Professor Murray does not focus solely on medication or accept a grim prognosis. Instead, he advocates for a more compassionate, holistic approach to care. This approach addresses not only the biological factors but also the psychological, social, and environmental influences that shape mental health.

The work of professionals like Professor Murray serves as a reminder that severe psychosis is not an inevitable degenerative disorder. It can be understood, managed, and even mitigated through a more nuanced understanding of the condition. A more personalised approach to treatment is essential for meaningful recovery and improved outcomes.

For further insights on managing schizophrenia spectrum disorders in children and adolescents, please visit Schizophrenia Spectrum Disorders in Early Childhood, Management of Psychosis in children and Adolescents and The Mental Elf Podcast.

Local links

Psychotherapist Mamta Bajaj is a psychotherapist, clinical trauma counsellor, and CBT therapist based in Bangkok. She runs a non-profit organisation in Thailand that facilitates discussions on gender-based and sexual violence trauma.

Access her Anxiety Mantras and techniques for managing intrusive thoughts at Three Point Counselling.

Additionally, she offers a free 20-minute counselling session for well-being, alongside CBT, ERP, Humanistic, Somatic, and Mindfulness therapies that align with the messages in this post, based on my own experience and thoughts on how best to support families facing crisis.

Exploring identity, being and belonging

This blog features the work of Dr. Joanna Grace from the Sensory Projects

  1. Embracing identity with James
  2. The Neurodiversity Movement
  3. The Layers of Identity
  4. Embodied Identity: Recognising True Value
  5. Phenomenalism: The Embodied Self
  6. Cartesian Dualism: Mind and Body as Separate
  7. Moving Toward a More Inclusive Future

Embracing identity with James

Through my disability inclusion studies, I learn more about people like us in the world around us. I find that a new approach to longstanding beliefs is necessary. As such, I advocate for celebrating neurodiversity and exploring fresh ideas to share experiences and find support.

Our identity is shaped by our thoughts and how we experience the world through our senses. Sensory substitution explains James’s heightened senses. His reactions—whether calming or overwhelming—are his way of communicating. Sensory substitution occurs when one sense compensates for another when overloaded, allowing information to be processed differently. Co-regulation is another key concept, where we support each other in managing emotions. Understanding and responding to James’s cues, I can help him feel more settled. I’ve noticed how my responses can help us stay calm and connected.

The Neurodiversity Movement

The neurodiversity movement is a paradigm shift and an essential movement happening now. It’s a global movement to reduce the stigma around neurodivergent brains.

Neurodiversity embraces the idea that neurological differences are simply variations of the human brain. This shift is crucial for people to be valued for their unique ways of thinking and being.

The Layers of Identity

I recently watched Joanna Grace’s discussion on identity, which sparked reflections on my experiences with James.

Joanna Grace offers a powerful framework for understanding identity through five key paradigms:

  • Essentialist Identity: Our inner, unchanging core.
  • Structured Identity: How our environment shapes us.
  • Performative Identity: Adapting to social expectations.
  • Discursive Identity: The power of language.
  • Beyond Identity: The evolving nature of self.

Joanna’s work has deepened my understanding of the identity that James and I embody as mother and son. Her frameworks show that the idea of identity is multi-faceted. Understanding of disability and neurodiversity is evolving. It is shaped by new knowledge and perspectives.

Embodied Identity: Recognising True Value

Joanna’s concept of embodied identity encourages us to look beyond physical limitations and recognise the true essence of each individual. This is especially important for those with profound and multiple learning disabilities (PMLD) and individuals with complex learning and developmental needs (CLDD), like James. In essence, I am James’s voice to the world, and our identities are intertwined—we cannot exist without each other. To help us better understand this, Joanna introduces two contrasting philosophical lenses: phenomenalism and Cartesian dualism.

We must look beyond surface assumptions. Just because a body behaves differently, we cannot assume that the mind within is absent or lacking. Each person has an inner life, a sense of being, a light that deserves to be seen.

Phenomenalism: The Embodied Self

Phenomenalism proposes that mind and body are not separate but deeply interconnected. It is rooted in phenomenology, a philosophy that centres on lived experience. In this view, consciousness is always embodied—we experience the world through our bodies.

For individuals who are non-verbal or express themselves differently, this view affirms that their inner world is real and present. Their movements, expressions, rhythms, and reactions are meaningful. These should not be dismissed as mere behaviour, but recognised as communication.

Joanna encourages us to engage with others in ways by learning to listen more deeply to alternative ways of being.

Cartesian Dualism: Mind and Body as Separate

In contrast, Cartesian dualism, developed by René Descartes, separates mind and body into distinct parts. Descartes famously wrote, “I think, therefore I am”, suggesting that thinking and reason are the core of identity.

This idea has had a lasting influence. It has often led society to value people based on their ability to think and communicate in conventional ways. For someone like James, this can be limiting.

Joanna’s work helps us go further. She teaches us not to judge a person’s worth by their physical or verbal capabilities alone. She urges us to understand that identity is a synergy of mind and body.

Moving Toward a More Inclusive Future

Our responsibility is to create environments where everyone’s light can shine. Identity is shaped by experience, environment, language, and interpretation.

All individuals deserve the same rights to love, care, and fulfillment. Disability should never diminish their humanity. Ultimately, it’s about observing and understanding who we are and how we behave—creating a space where we feel understood and connected. In an inclusive future, every person is recognised, understood, and supported for who they are.

How James and I experience the layers of identity