Art: An unlikely form of army therapy

With the lack of military hospitals, many veterans are turning to charities for help. One is using the unlikely weapon of art to help fight the psychological wounds of war, while another organisation is actively encouraging artwork in the army.
Outside of the NHS, the charity Combat Stress is the biggest provider of support to armed forces veterans with conditions such as post-traumatic stress disorder (PTSD), depression and anxiety.
Art therapy is one of the treatments it uses. Drawing, sculpting and painting are helping patients manage their symptoms with great success.
"Traumatic memories take a different path from our normal memories and tend to be frozen in the body in the central nervous system," explains Janice Lobban, who has been a trauma therapist at Combat Stress for the past 10 years.
"When a trauma happens, the person will react to get through the experience, but it leaves the trauma unprocessed. A person might then get a sensory memory like a sound, or sight, or smell, that is reminiscent of the trauma and they re-experience it happening again."
'Blank mind'
essions begin with a quick creative session to get thoughts and images down on paper
Art therapy, therefore, aims to help people express themselves unconsciously and process the meaning afterwards.
Group sessions typically begin with the therapist giving a one or two word brief to inspire creativity before veterans are given a selection of materials for painting, modelling or writing.
After 45 minutes of quick work, the group then get together to talk about and describe what they've just created.
"I try to keep a blank mind and just let images and feelings rise out from my unconscious to my hand and things start appearing," says Richard Kidgell from Braintree, Essex, who served in the Royal Air Force from 1978 to 1985.
"What surprises me is that while I'm drawing I don't know what it is - they're just images, but by the end of the session I've made a complete story. It's quite enlightening as sometimes I'm not entirely sure what I've drawn until I speak to others about it."
After their sessions, the veterans are encouraged to develop their initial artwork into fuller, finished pieces to further interpret and explore their feelings.
Invisible wounds
Veteran Richard Kidgell with his finished artwork inspired by an art therapy session
Although many of the veterans who try the therapy may never have had any interest in art before, there are some servicemen who actively pursue the craft and use it to reflect their experiences.
The Army Arts Society, set up by war artist Linda Kitson after the Falklands War, promotes and supports arts and crafts within the British Army - working with serving military, those who have retired and even their dependants.
One of its latest initiatives is to provide operational art packs to troops - the first 20 of which went out to Afghanistan in September.
"Art is a way of keeping some people sane," says committee member Francesca Bex, herself a painter and the wife of a bomb disposal expert.
"The packs can give soldiers an alternative. A lot of them watch awful films when they have down time and art can give some a different option."
'Angry and frustrated'
Art has been invaluable for 32-year-old Norfolk serviceman, Nick Hendry. Having joined the army when he was 16, he has been posted in countries including Germany, Kosovo and Afghanistan.
Painting gave Nick Hendry something to aim for after becoming injured during his service
After qualifying as a diving supervisor for his regiment's airborne unit in Portsmouth, he was attacked while out one evening last May and left with serious head injuries.
In a coma for almost a month, he spent a lengthy time in a rehabilitation unit, where he had difficulty walking and talking, and suffered from hallucinations and memory loss.
"I was due to go on tour in September to Afghanistan but couldn't make it as I was in hospital. I felt guilty this had happened to me," he says.
"Eventually I got put back to my regiment and I tried to do my diving job but my head wasn't good enough to enable me to do it.
"I was quite angry and frustrated and, as a lot of the lads were away on tour or leave, I didn't have anyone to talk to. I thought I'd lost everything I loved."
It was while looking through regiment photos that Nick thought he would try his hand at painting - something he used to enjoy doing. A colleague's wife then suggested he join the Army Arts Society and he gained a new lease of life.
"I'd spend about 50 to 70 hours on a picture and every night, instead of sitting on the steps and questioning everything. I just worked on it and it was heaven," he says.
Even though he was not confident in his abilities, the society encouraged Nick to enter its Serving War Artist of the Year competition - which he went on to win for his watercolour, Deliberation.
Nick Hendry won the Serving War Artist of the Year award for his watercolour, Deliberation
Nick says art has been invaluable in giving him something to aim for again: "I was struggling trying to justify everything, but as soon as I get hold of a paintbrush it takes my mind off some really bad thoughts and focuses my mind on one thing."
He fully supports the operational art pack initiative. During his time in the army, he says there was no outlet for art - unlike the more traditional pastimes of rugby or football.
Richard Kidgell agrees it's a good idea to give soldiers the opportunity to process what they are experiencing on a tour of duty. Potentially, it can allow the military to spot the symptoms of PTSD early.
"My guess is a lot of the packs will be largely wasted as people will dabble for 10 minutes and think it's not for them," he says.
"But even for the minority who will grasp the idea, the benefits for catching those people at an early stage and giving them a chance to vent will be brilliant."
The Culture Show: Invisible Wounds is on BBC Two and BBC HD on Friday 11 November at 19:00GMT.

Cigarette safety rules tightened

  All cigarettes sold in the European Union must now burn themselves out if left unattended New cigarette safety standards have come into force in an attempt to cut the number of people killed in house fires.

They mean that every cigarette sold in the EU must meet a reduced ignition propensity (RIP) requirement.

Cigarette paper must have special bands at intervals down its length so that, once lit, a cigarette will go out if it is not actively smoked.

The change has been welcomed by safety campaigners and anti-smoking groups.

According to latest figures from the Department for Communities and Local Government, around 2,800 fires in the UK were caused by smoking materials in 2008 -101 people died and 932 were injured.

Continue reading the main story One in three of all fire fatalities are caused by cigarettesThey are the single biggest killer in accidental house fires Of the 212 people killed in accidental house fires in 2010/11 - 81 died as a result of smoking materials

Source: Department for Communities and Local Government

It is estimated the new cigarettes could prevent 1,800 fires, 67 fire deaths and 600 casualties a year in the UK.

The anti-smoking charity Action on Smoking and Health (Ash) believes the new cigarettes could dramatically reduce the number of house fires.

Its director of policy and research, Martin Dockrell, said "Cigarettes are without doubt the most dangerous consumer product on earth - they kill 50% of people who use them.

"Finland has already introduced RIP cigarettes - last year the number of smoking-related fire deaths there fell 40%.

"You have to ask yourself why the tobacco companies resisted this change for so long. This simple change will dramatically reduce the number of household fires," he said.

The London Fire Brigade has lobbied for the new safety standards to be adopted since 2005.

The chairman of London Fire and Emergency Planning Authority's Community Safety Committee, Councillor Susan Hall, said the introduction of the law is a "watershed moment" for UK fire safety.

"Cigarette fires are a killer, destroying lives and properties across the country every day".

"These new safety standards amount to an all-out attack on the single biggest cause of fire deaths in the country. But people still need to take care. Never smoke in bed and always dispose of cigarettes carefully," she said .

Code of conduct for care workers

 Secret filming by one family revealed a poor standard of care for a relative

A code of conduct and minimum standards of training is to be drawn up for health care assistants and care workers who look after the elderly in England.

The government said the new standards are likely to focus on communication, confidentiality, nutrition and hydration amongst other things.

The announcement follows growing concerns about the training and quality of care provided by some care workers.

They are often poorly paid whilst doing a difficult and demanding job.

It is cases like that of Carol-Anne Norman that have caused concern.

She and her sister set up a camera to monitor the care their 85-year-old father was being given. He has dementia.

They say the closed-circuit television pictures showed a number of care workers who didn't appear to know what they were doing.

One worker was filmed wetting his flannel and toothbrush, wiping the basin with a towel to wet it then sprinkling talcum powder on the floor.

In the notes it said their father had had a full wash, but their father was nowhere in sight. That worker has been suspended.

Mrs Norman was shocked.

She said: "It was just not care and, at times, I would call it abuse and they've done it because my father can't protect himself or speak for himself."

'More safeguards'

The local government ombudsman for England, Dr Jane Martin, is seeing a steady stream of cases that underline why a code of conduct is needed.

Dr Martin can investigate what local authorities do, but believes there's a gap in the system when it comes to care workers.

"It seems to me, if there were more safeguards around the qualification or perhaps the registration of care assistants, that would give me greater assurance that they were being properly vetted and employed to do a job that we had more confidence in."

It is likely to be next September before details of the code and the training are published and a voluntary register of care workers is likely to be set up in 2013.

Many will see it as a step in the right direction, but some will feel it doesn't go far enough.

Nurses in particular have been pressing for a compulsory register for health care assistants. It is seen as a way to raise standards.

In February, Health Secretary Andrew Lansley ruled out compulsory registration for care workers and scrapped the last government's plans for a register.

Mr Lansley reportedly said that a compulsory system couldn't be justified in the current economic climate.

He maintained voluntary registration could improve standards and quality of care without imposing the costs of mandatory regulation.

Codes of practice have already been developed for health support workers in Scotland and Wales.

Computer gamers' brains 'differ'

Do our brains make us play more often or does play change our brains? The brains of people who regularly play computer games differ from those of infrequent gamers, research suggests.

A study in teenagers showed the "reward hub", which is involved in addiction, was larger in regular players.

A report in Translational Psychiatry said it was unknown if games changed the brain or if brain differences made people more likely to play.

Experts said more studies were needed for parents and teenagers to make sense of the findings.

Playing computer games has been linked to a range of effects from addiction to improved reasoning.

An international group of researchers investigated whether playing changed the structure of the brain.

They ranked 154 14-year-olds by the number of hours played in a week, with the middle teenagers playing about nine hours a week.

Those playing more than nine hours were classed as frequent players. None were classed as addicted.

Enlarged

Brain scans showed a larger ventral striatum, which is the hub of the brain's reward system, in regular gamers.

Continue reading the main story

For teenagers, parents, and clinicians to make sense of this finding, we need research monitoring brain structure over time”

End Quote Dr Luke Clark University of Cambridge Dr Simone Kuhn, one of the researchers from Ghent University in Belgium, said the region is "usually activated when people anticipate positive environmental effects or experience pleasure such as winning money, good food, sex".

The region has been implicated in drug addiction.

The authors said it "cannot be determined" whether this was a "consequence" of gaming or if naturally larger regions led to a "vulnerability for preoccupation with gaming".

Dr Luke Clark, from the department of experimental psychology at the University of Cambridge, said the findings were "really provocative because this is a central hub in the brain's motivational system".

"But the burning question that this study does not resolve is whether the structural difference is a change caused by the frequent game play, or whether individual differences in this system naturally dispose some people to more excessive play," he added.

In drug users, Dr Clark said it was probably a combination of the two process - long-term drug use affecting the brain as well as some people being more susceptible.

He told the BBC that: "It certainly seems very plausible that playing video games for half a day a week may well actually structurally change the brain."

But said there was no evidence for this and that: "For teenagers, parents, and clinicians to make sense of this finding, we need research monitoring brain structure over time."

Dr Henrietta Bowden-Jones, of the division of neurosciences at Imperial College London, said: "These findings, linking ventral striatum abnormalities to compulsive computer gaming in young people, are highly relevant to clinical practice as they further close the gap between this activity and other addictions, giving us a better understanding of possible long-term treatment interventions."

The researchers are now asking adults, who have never used computer games, to start gaming. They are going to see if this has any effect on the brain.

Dr Kuhn said: "This will hopefully inform us whether the bigger ventral striatum in gamers is a phenomenon that makes them like computer games better or whether this structure did grow due to computer gaming."

'Delay cord clamping' baby advice

 Some had feared delayed clamping might lead to more cases of jaundice Waiting a few minutes after delivery to cut the umbilical cord is best for a newborn's health, research suggests.

Delaying cord clamping reduces the risk that the baby will have iron deficiency anaemia without substantial side effects, the authors told the BMJ.

The World Health Organization dropped early clamping from its guidelines some years ago.

But there are no formal guidelines for NHS staff about when the cord should be cut.

An audit a few years ago found many UK hospitals advocate early clamping, as soon as the baby is delivered.

Blood boost

Mounting evidence suggests this may not be best practice and could be causing health problems.

Globally, about a quarter of preschool children have iron deficiency anaemia, the most severe form of iron deficiency. In Europe, the prevalence is 3-7%.

This is a significant health problem because it can harm a child's brain development.

A simple solution, say researchers, is to ensure babies get the best start in life by maximising the blood and iron stores they get from the placenta.

Waiting three minutes before clamping the umbilical cord at birth can boost a newborn's blood volume by a third.

In the latest study, experts in Sweden looked at the outcomes of 400 babies born after a low-risk pregnancy.

Some had their umbilical cords clamped after at least three minutes and others had them clamped in less than 10 seconds after delivery.

Routine practice

Babies with delayed clamping had better iron levels at four months of age and were far less likely to suffer newborn anaemia.

And there were no obvious adverse health effects, despite previous concerns raised by researchers about the possibility that delayed clamping could make the baby jaundiced.

The researchers estimate that, for every 20 babies having delayed clamping, one case of iron deficiency would be prevented.

They say that delayed cord clamping "should be considered as standard care for full term deliveries after uncomplicated pregnancies".

The Royal College of Obstetricians and Gynaecologists (RCOG) has no specific recommendation on when the umbilical cord should be clamped, but its scientific opinion paper admits: "Immediate cord clamping became routine practice without rigorous evaluation."

It calls for more research into the area: "Iron deficiency in the first few months of life is associated with neurodevelopmental delay, which may be irreversible. Whether increasing placental transfusion by deferring cord clamping will improve neurodevelopment in early childhood is not known but this hypothesis should be tested in large randomised trials."

Patrick O'Brien, of the RCOG, said the weight of evidence to support delayed clamping was growing and that many more hospitals in the UK were adopting the practice.

"The college will look at this and other evidence and consider if it is enough to change policy."