Amy’s story
Amy* was thirteen when her parents brought her for a consultation. There was a dramatic and ongoing deterioration in Amy’s behaviour. Several months earlier she had started acting aggressively and at times violently towards various friends, out of character and for absolutely no reason – and the problem was escalating. Amy’s parents were at the point of taking the psychiatrist’s advice to medicate her.
In thirty years of practice I have examined and treated thousands of patients, many with mental health problems. I examined Amy by holding and sensing the different parts of her skull. There was a specific area just inside her right eyebrow that did not feel normal. Closer examination revealed the faint impression of a scar, prompting her mother to recall that at the age of two Amy had fallen against a radiator. There had been lots of blood, a hospital visit and then the incident was forgotten.
Through the bones of the skull, what caught my attention at this particular point was a ‘pull’ or tension in the dura, the tough membrane which lines the skull and encloses the brain. This area forms the housing of a region of the brain that manages some very primitive emotions, including violent urges. By ‘cradling’ the skull and exerting a very light pressure in a specific direction, using techniques practised over many years, I was able to release the pull of the dura and normalise the housing of this part of the brain. Amy’s behaviour greatly improved following the treatment.
HISTORICAL HEAD TRAUMAS AND LONG-TERM MENTAL HEALTH PROBLEMS
News headlines these days tell the stories of many well-known football and rugby players developing early onset Alzheimer’s following multiple head impacts during their sporting years. This is just one of the distressing long-term outcomes now being recognised as a consequence of repetitive head trauma. Mood disorders and other brain degenerative conditions are also involved.
There are more than 5 million rugby players worldwide, 1.6 million ice hockey players, 3 million field hockey players, 250 million football players, plus all the boxers, cricket players, winter sportsmen and women and others involved in impact sports. A proportion of this hugely significant number of sportsmen and women – and children – may be suffering needlessly with mood disorders at present or will suffer in the future as a consequence of head trauma. That head trauma may be a single strong blow or a low-grade repetitive trauma as in heading a football or being repeatedly punched.
As well as sportspeople there are estimated to be in America alone some 4.5 million people (adults and children) wearing teeth braces. This represents a low-grade insidious trauma on the skull and can create a similar scenario. Then there are those who have suffered blows to the head through car accidents, falls, attacks or just simply walking into a cupboard door!
MEMBRAIN DISORDER
‘Membrain’ is the term used in this book to describe the intimate relationship between the dural membrane and the brain itself. ‘Membrain disorder’, the topic of the first part of this book, means a physical condition which, once recognised, allows for a successful therapeutic approach to mental health problems arising from physical head trauma(s). The traumas to the head may be recent or historical. Membrain disorder can be caused by a head injury which, left untreated as in Amy’s case, may in the shorter term cause mood disorders such as depression or anxiety and in the longer term lead to brain diseases such as dementia. Such a link has been established statistically in the case of rugby and football players and others who have suffered sport-related head traumas, but the nature of the link remains obscure to medical scientists. ‘Membrain disorder’ offers an explanation of that ‘missing link’ and a possible solution to the problem, which involves treating the environment of the brain.
Imagine an office block that has seen better days. The windows are small and not designed to open, so no fresh air and very little natural light comes into the office. The ventilation system controls the temperature poorly; it is either too cold or too hot and the same air is recirculated. The sewage system gets blocked periodically leading to unwanted smells. The occupants of that building, the work force, will not thrive over time. Some members of the work force may become physically sick or mentally unwell. The work force becomes depleted. This is what is known as ‘Sick Building Syndrome’.14,15 “Over time” is very relevant here
Sick building syndrome can be described as an ‘outside-inside’ phenomenon. The health or behaviour of any system, wherever one looks, at whatever level one looks, is dependent to a very large extent on its environment. The system is the ‘inside’ and sits within its environment – the ‘outside’ – but in fact the two are intricately linked. A system will always respond to its environment and that response can be described as a behaviour.
For example, a group of water molecules will behave as ice, water, or steam, dependent entirely on the temperature and pressure of their environment. A body of water will behave as a tidal stream in response to gravitational pulls from the moon and the sun. The behaviour of a sunflower is to turn its head to follow the light and warmth of the sun as it moves from East to West through the day.
Sick Building Syndrome facilitates an understanding of how the behaviour of the brain can be adversely influenced by its environment. The brain is like the office staff, who need to be fit and alert to coordinate and perform all sorts of complicated activities properly (their normal behaviour). The protective housing of the brain is the building. The irrigation of the brain – the provision of nutrients and oxygen via the blood supply and the removal of used products to and from the brain – is equivalent to the lighting, ventilation and plumbing system of the building. When the environment is poor, the workers’ behaviour is adversely affected. The behaviour of the brain, just like the behaviour of the office staff, changes according to its environmental conditions over time – as does any system. Eventually the brain will not just change its behaviour but become depleted.
THE ENVIRONMENT OF THE BRAIN
The dura, the bony parts of the skull, and fluids flowing into, through and back out of the cranium constitute the physical environment of the brain. The brain effectively sits in a bag and the bag sits in a box (figure 7).
If any of this environment is disturbed, the brain will, sooner or later, be disturbed too.
W. G. Sutherland, the founding father of osteopathy in the cranial field, discovered over a century ago through self- experimentation – applying constant pressure to different parts of his own skull – that if the mechanics of the skull are subject to a physical strain then psychological distress can be an outcome.
What WGS clearly understood is that the condition of the skull can have a huge influence on the behaviour of the brain and this affects the psychological health of an individual. This knowledge is shared by all those who have subsequently trained and worked in the cranial field but so far the phenomenon hasn’t been given a name. The new term ‘membrain disorder’ used in this book describes a malfunctioning of the brain due to disruption of its environment. A malfunctioning of the brain can directly affect actions, thoughts and feelings.
Membrain disorder is then the ‘missing’ physical link behind the statistics which show that those prone to repeated low-grade injuries or single heavy impacts to the skull have an increased likelihood of developing behavioural problems, mood disorders and early onset of degenerative brain disease.
George’s story
“I am sorry,” I said, “I don’t treat patients with psychosis.” George’s mother was persistent. She had heard of my success in treating patients with mental health conditions and she was determined to get to the bottom of what had happened to her son. He was not responding to the prescribed medication and she had an instinctive feeling that the psychotic episode he was currently experiencing was somehow linked to earlier head trauma.
I explained again that I couldn’t treat her son, but she insisted that as medical professionals themselves, she and her husband could provide the support network needed while George went through any treatment with me. “Please, please see him.”
George came for an initial consultation a week later. He was in his early twenties, a young man who appeared physically well and fit but who was alarmingly absent. His body was right there in front of me, but whoever was inside that body had been removed entirely.
His mother described his symptoms: forgetful, distant, confused, depressed, a poor sleeper, no energy, no goals, smoking, anger and disgust displayed towards women. “Tell me about the head trauma?”
When he was six years old, George had been hanging upside down on the monkey bars in his local park. His hands slipped and he plunged down, his head taking the full impact of the fall. He had fractured his skull. Two years later George was involved in another accident when he was kicked in the forehead during a collision in a game of football. He appeared to recover well after both accidents. The year before coming for this consultation, George had endured yet another blow to his head, falling backwards onto concrete, striking the back of his head this time.
There was no history of mental health disorders in the family and George himself had been a cheerful, engaged, active child. He had never suffered with a psychological illness growing up but during the last year he had changed.
On visual examination all looked normal. There were no signs of the plagiocephaly I had seen in Freddie (chapter 3). However, on palpating George’s head, all was not normal.
The dura had a story to tell.
I was at the Hay Literary Festival in 2019 and mental health nurse and author Nathan Filer, a winner of the Costa prize, was being interviewed about his excellent book The Heartland: Finding and Losing Schizophrenia.92 The message threaded throughout Nathan’s book was that the labels, for example ‘so-called schizophrenia’, attached to mental health patients are inappropriate and unhelpful and – most relevantly for our purposes – do not assist the patient in securing an appropriate treatment. In the time allowed for questions after the interview it was the same recurring question from a very receptive audience – what could be done about the poor way in which people with mental health problems are diagnosed? What needed to change? For this, the author had no answer and freely but disappointedly admitted to the fact.
The decision to write this book, and in this way, was made whilst I sat in that audience.
Here is a proposal for what needs to change; what is to be done about the poor way that patients with mental health problems are diagnosed. It has been a conscious thought in my mind for nearly three decades, an idea that has become clearer over time, and the need to air it gets more and more imperative as the crisis in mental health problems escalates in the 21st century.
I am not a research scientist, a medical doctor nor a person who sits in authority. However I am a clinician who has examined and treated heads for 30 years. This is something that very few people do, nor even contemplate why they might want to do it. It is a case of ‘knowledge’ versus ‘information’ based on a long career as a manual practitioner working with a huge variety of patients and on my own further studies involving not just books and articles but also many intensive discussions with often inspirational fellow practitioners from different countries.
There are many effective and valid treatment approaches to mental health conditions and many different types of practitioners who help in different ways – a tsunami of self-help advice coming out of every media outlet. The big problem is how to direct each patient towards a therapeutic approach which is appropriate for that individual: one which will help the patient to get well.
By understanding and considering complexity and using it to identify the causative factor(s) and the biological dimension(s) of origin of a mood disorder or other mental health issue, a metaphorical ‘road map’ emerges. This road map can then be used to direct each individual patient presenting with mental health problems towards practitioners with the knowledge and skill set appropriate to that patient. Manual therapists trained in the cranial field and those with knowledge of membrain disorder and the skills to address it should be included in that list of practitioners.
In this book, the simple image of the Russian doll has been used to represent the six dimensions at which mental health issues may originate. For purposes of identifying the pathway to the most effective treatment, this road map needs to show not only the dimensional origin of a mental health problem but also the diagnostic methods to be employed and the range of suitable and effective treatments available (as well as a note of unsuitable approaches). It is important to embrace the idea that a singular labelled condition and its collection of symptoms as described in DSM-5, such as depression, psychosis, anxiety, OCD, and attention deficit, can originate from any one or any number of those dimensions. Symptoms are not the guide to the origin of a problem. Listening, case history, observation and palpation are the guides.
An example of a road map is offered in the Appendix.
Understanding complexity in relation to mental health diagnosis, and acknowledging the link between membrain disorder and mental health, both require mind-set changes among talking therapists and manual practitioners, patients, the medical and dental professions and the insurance and drug industries. This is not an easy thing to make happen but the first step has been writing this book and the next step is for a wide range of people to read it and express an interest in membrain health and how it sits within a new model of diagnosis designed around complexity. This wide range of people includes practitioners, patients, sports coaches, contact sports players, parents who have children with teeth braces – the list goes on.
Who knows what the next steps will be? Emergent behaviour – the inbuilt unpredictability of events – is a factor here! Diagnosing the dimension(s) of origin of a mental health problem, particularly the biological dimensions, is a new idea which this book adds to the already-established system of diagnosing psychological illness. The idea may be ‘spat out’ and the original system may maintain its original form. Alternatively, the idea may be integrated and a new system emerge.
This could have far-reaching consequences well beyond the influence of this author.