Dr Levy-Carrick opens with some definitions of psychiatric trauma, providing categories/examples. The macro statistic (from one very large mental health study) is that 63% of people have experienced trauma of some sort. There is a discussion of affluence/resource, and the relationship between early trauma and later negative life events or conditions. Those who have experienced trauma have much higher incidence of behavioral health issues later in life – smoking, diabetes, depression etc.
Allostasis – the body’s ability to return to a neutral state (after stress). Citation: McEwen, 2017. Trauma negatively affects allostasis.
Susan opens with a description of the issues the US is currently facing with babies who are born with opioid addiction, including those born to mothers who were receiving methadone treatment during pregnancy. She describes her own experience of comforting newborns using non-pharmacological intervention therapies.
After a brief (and fascinating) biography, Woody shares a list of possible music-related therapies and treatments, and provides his macro hypothesis:
More about Right Turn, an addiction treatment center that uses arts therapies. [JB comment – note that this is an example of a non-profit organization that attracts real health insurance dollars, and designs and evaluates its treatments based on clinical evidence and data. This is a model of funded mental health/addiction therapy that we don’t see in the UK in quite the same way, and indeed may only be possible because of the way US health insurance works – there is a particular cost incentive to investing in preventative treatments of this type].
Drug Story Theater: Where the Treatment of One Becomes the Prevention of Many
Dr Shrand’s opening is about the definition of stigma – he shows us the Gary Larson Tuba player gag to illustrate!
His work in Drug Story Theater involves young people participating in theater, treating teenagers in the early stages of addiction recovery, and he describes how the first scene of one of their recent shows talks about dopamine, and its connection to addiction.
Dr Brandoff opens with two vignettes; one where he describes a time of personal social frustration where he wanted to punch a wall (but played some classical piano instead – he demos it live!). His second example is a patient case (see slide).
As a palliative care expert and pain specialist, he gives us an overview of patient needs, in the context of his profession, and in the context of US healthcare. He considers opioids an important part of pain treatment, but acknowledges the rampant public health opioid crisis. We look at some disturbing stats of overdose deaths involving opioids in the US, correlated with heroin and fentanyl takeup, and a more local analysis of the picture here in Massachusetts.
Dr Carr ones with a powerful statement: Pain itself is a disease. There are a number of causes, and types, of disease (heart disease, lung disease etc) but once they become established and manifest as pain, they have similarities. Dr Carr believes that having access to pain control is a human right. Pain is a public health issue. Pain professionals view it it as a disease, which can be understood as a combination of pathology, host and environment. Definition discussion (Williams and Craig, 2016).
Pain, Dr Carr suggests, is a public health issue (O’Brien et al, 2017) and lower back pain is argued to be a global disability.
Our first speaker, Dr David Silverstein, leads us through a fascinating overview of ‘music and the brain’, and he begins with a quotation from Hippocrates:
And men ought to know that from nothing else but thence [from the brain] come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations. And by this, in an especial manner, we acquire wisdom and knowledge, and see and hear, and know what are foul and hat are fair, what are bad and what are good, what are sweet, and what unsavory… And by the same organ we become mad and delirious, and fears and terrors assail us…
We see evolutionary comparisons of the prefrontal cortex of various mammals, from rats to humans. As Dr Silverstein puts it “[our brains] hitch a ride on blood oxygenation”. Neurology and psychology are the fields by which we learn about our subjective brain experiences.