Damn the lack of access to potentially amusing papers.

An interesting article perhaps?
http://www.ncbi.nlm.nih.gov/pubmed/19534179

Send in the clowns.

Duffin C </pubmed?term=%22Duffin%20C%22%5BAuthor%5D>.

Healthcare professionals are always seeking ways to improve their
relationships with patients and, to this end, some senior hospital staff
in the United States have asked a group of circus clowns to teach nurses
how to introduce a sense of levity into hospital wards. This article is
a review of the results.

And an even more interesting title to another paper by the same author
highlighted to me by a friend of mine.

http://www.ncbi.nlm.nih.gov/pubmed/18655667

Taking the risky out of frisky.

Duffin C </pubmed?term=%22Duffin%20C%22%5BAuthor%5D>.

Admittedly the lack of public access to research is perhaps more vitally
important for other papers than these two humourously entitled documents.

How mad are you?

Its an interesting question that was posed to me in a roundabout way by
a friend of mine recently. She asked the question in relation to a scale
of subjective measurement of madness. I answered her analytically and
explained that a definition would be necessary but her scale was purely
subjective.

I'd never have considered myself mad until someone else told me.
Madness, in part or perhaps wholly, is being in a delusional state
though in actual fact it is an observation or detection of the
delusional state rather than the existence of one. To self-assess as
"pretty damn mad" creates a problem because insight seems to quell
madness. Essentially a person who recognises their delusional state is
not mad. Perhaps, as has been said before, a mad person would say
they're not mad, perhaps.

So how mad are you?

Treatment for schizophrenia

Clozapine is a well established killer. Its as well evidenced as its
medically considered status as the best treatment for schizophrenia such
some, foolishly, have called for it to be used as a first line
treatment. It was originally taken off license because of its risk to
life however it returned because of its ability to 'treat' when other
medications couldn't. In epidemiological studies in Finland it has been
shown to have the most beneficial effect on total mortality which is a
product of its ability to 'treat' suicide.

The main way it kills patients is through agranulocytosis - a
drug-condition condition where granulocyte levels and other levels of
cells that make up the immune system become depleted such that there is
a risk of death (at a guess through secondary infections). This is why
patients have regular monitoring of blood levels for the first six
months and why the manufacturers recommend it is discontinued if
agranulocyctosis develops. Its noteworthy that levels can drop to danger
points within a few days and these won't be observed even with
recommended bi-weekly checks. Its also noteworthy that a high number of
the low number of people prescribed clozapine are dying much sooner than
they should (data to follow).

There are other effects on morbidity and mortality. From my experience
thses are not known in the general medical community. What is clear from
the evidence that can only come from long term use ithe drug clearly
reduces life expectancy in all users and has directly contributed to the
deaths of a few. Studies have shown that all antipsychotics contribute
to the reduced life expectancy of the individual while they treat the
suicide rate at the same time. This data along with the high rate of
death is ignored by NICE and the NHS, politicans and campaigning
organisations freom my personal experiencing attempting to highlight the
problem last year.

The ethics espoused by Hippocrates are something like "if you don't know
what you're fucking doing then don't be a prick and do harm" as a
central tenet of medical ethics. Even today the modern Hippocratic Oath
is still taken by doctors upon becoming doctors but in reality its
ignored by psychiatry in the example of clozapine. They choose a
treatment that harms because of lack of ability to understand and treat
something that may not actually be an illness. The medical model of
illness means that it makes sense to keep trying more dangerous
treatments, like cancer treatments which use therapies that drastically
reduce quality of life and cause reduced life expectancy because there
is no other way to treat the illness. However there are alternatives
that are safer but cost more and are in need of refinement. These
alternatives lack the multi-billion pound budgets for research and
certain have none of the equally large marketing budgets that
psychopharmaceuticals have. The best ones are often developed in the
fringes of the mental health system. The need is urgent though because
it is immoral to treat what is a behavioural and emotional disorder,
increasingly against their will, with medication that kills.

It is exceptionally good at 'treating' the suicide rate but the
mechanism is important. It is hopefully becoming more recognised that
antipsychotics are like a straightjacket in pill form or a "chemical
cosh" which is why they are now becoming used for treatment of dementia
patients - patients who don't have a diagnosis of schizophrenia. I have
tried to use single quotes to indicate that 'treatment' isn't really
treatment in my opinion. A straight jacket is not really a treatment, in
my opinion, even if it comes in pill form and has lots of well-funded
studies to prove that it is effective. It is my estimation that were
clozapine prescribed for patients with Borderline Personality Disorder
(BPD), a diagnosis that has parasuicide as one of the cluster of
symptoms and a completed suicide rate twice that estimated for
schizophrenia (at 20%) in the upper range of estimates, the study would
show that it also has an exceptionally high ability to 'treat' the
suicide rate associated with that diagnosis. It could potentially be
used to 'treat' many things for the convenience of society, just as
dementia patients are experiencing with the presecription of
antipsychotics for challenging behaviour that have been shown in one
study to reduce life expectancy by 50% (the patients were much older and
the effect of the reduction in life expectancy has been magnified but it
is indicative of the effect on life expectancy in all people given
antipsychotics).

In mental health there are other options and I feel like its so obvious
that there must be another reason as to why an alternative to a life
threatening treatment isn't being developed or considered. BPD has been
shown to be treated by a psychological therapy called Dialectical
Behaviorual Therapy. Its an expensive therapy compared to cheap
Cognitive Behavioural Therapy that NICE have recommended above all other
psychosocial therapies and interventions in their latest schizophrenia
guidelines. Its a new development and has shown success in the treatment
of a diagnosis that's part of a class traditionally conisdered
untreatable and intractible. I would hope that there would be a similar
treatment in development for schizophrenia and psychosis, something that
was being developed with a sense of urgency given the evidence coming
out on how people are dying through 'treatment' with clozapine and other
anitpsychotics. These treatments will also offer better quality of life
and a hope for people afflicted by what is considered the severest, most
dehabilitating and disabling psychiatric diagnosis associated with high
levels of stigma and self stigma, suicides, unemployment and
disadvantage on a number of psychiatric measures.

There are other options and my knowledge in this field is limited. It is
my hope that the International Society for the Psychological Treatment
of the Schizophrenias and Other Psychoses (http://www.isps.org/
<http://www.isps.org/>) is developing the humane option to help people
with the diagnosis of schizoprenia and other psychotic disorders because
it is desperatedly need to save the lives of the thousands of people
prescrbed clozapine and the millions prescribed other antipsychotics.
The number of life years and the quantity of quality of life that would
be increased would offest any costs.

Psychiatry has a long history of gold standard treatments that were
unethical and dangerous. It was the insulin-induced coma (or seizure)
that was the gold standard treatnent for acute schizophrenia/psychosis
in the UK after the end of WWII. It was most significant triumph of the
Randomised Controlled Trial to prove that it wasn't as effective as
other options such as barbituate induced comas/seizures (the lesser of
evils). I am confident that in a decade I will be proved to be right but
in that time there will be a lot of people who would have died
needlessly. Guess no one gives a shit about another dead schizophrenic
though...

Laughter is the best medicine

I went looking for the source of the quote and Googled the text to find over 3 milllion web pages use that quote. Possibly the most extraordinary case of its health benefits is on the front page of (http://www.happinessandlaughter.com/).

"Norman Cousins (1915 to 1990), longtime editor of the Saturday Review, global peacemaker, receiver of hundreds of awards including the UN Peace Medal and nearly fifty honorary doctorate degrees, overcame a life threatening disease and a massive coronary, each time using his own nutritional and emotional support protocol.

Cousin's seminal book "Anatomy of an Illness" details his healing journey overcoming ankylosing spondylitis (a degenerative disease causing the breakdown of collagen). Given up to die within a few months in 1965, almost completely paralyzed, Cousins checked out of the hospital, moved into a hotel room and began taking extremely high doses of vitamin C while exposing himself to a continuous stream of humorous films and similar "laughing matter". His condition steadily improved and Cousins regained the use of his limbs until he was able to return to his full-time job at the Saturday Review."

The site also has a view video jokes on the left hand side bar to get started on a healthy and fun way to better physical and mental health.

As with everything there's a pathological version.
http://journals.lww.com/jonmd/Abstract/1982/02000/Pathological_Laughter__A_Review_of_the_Literature.1.aspx

For the majority of people though humour is a great tool.

I'm unable to find the author of the quote. Its such a simple bit of wisdom that perhaps it was said by lots of people isolated from each other in time and geography such that no single person could be attribute it. Or my internet searching skills are lacking this evening.

Samba

I made this image three or four years ago. Its a homage to Warhol.

Its one of those images that was a mess - poorly exposed and blurred. But it felt right for some reason. Its one I worked on in different ways to try and bring out the aesthetic. This was the result.

The bleeding obvious

But its worth hearing said from a clever geezer. Someone called Alfred
Kinney quoted in a recent study about Facebook gaydar from MIT I'm
reading through.
(http://firstmonday.org/htbin/cgiwrap/bin/ojs/index.php/fm/article/view/2611/2302)

Its about men and sexuality but it speaks of so many other things. I'm
sure every reader will take their own meaning from this short paragraph.

""Males do not represent two discrete populations, heterosexual and
homosexual. The world is not to be divided into sheep and goats. Not all
things are black nor all things white. It is a fundamental of taxonomy
that nature rarely deals with discrete categories. Only the human mind
invents categories and tries to force facts into separated pigeon–holes.
The living world is a continuum in each and every one of its aspects.
The sooner we learn this concerning human sexual behavior the sooner we
shall reach a sound understanding of the realities of sex.""

More information on CBT, IAPT and research into psychological therapies

I think I've hit a gold mine this evening but there's so much
information to go through.

A slew of evidence that I wish I had the time to go through.

Cognitive Behavioural Therapy and Increasing Access to the
Psychological therapies

http://www.iapt-cbt.info/
The papers look really interesting. I would guess this is the research
war chest against IAPT's CBT focus.

The editorial highlights the issues in a deeply complex debate that is
over my head at the moment.
http://ipnosis.postle.net/pages/IAPTCBTIpnosisEditorial.htm

Here's where the debate gets fun. Its like hearing a very intelligent
religious debate. There's a lot of information on this page as well. Its
a series of intellectual correspondance by the heads of two of the major
psychological therapy agencies.
http://ipnosis.postle.net/pages/IAPTCBTdebate.htm

two signficant papers on CBT

I might have posted this already....

The massive review that shows CBT to work
The empirical status of cognitive-behavioral therapy: A review of
meta-analyses
http://dunx1.irt.drexel.edu/~emf27/Lab%20Group/Publications%20and%20Presentations_files/Bulter,%20Chapman,%20Forman%20&%20Beck%20(2006).pdf

And the single, higher quality one that shows it doesn't.

Cognitive behavioural therapy for major psychiatric disorder: does
it really work? A meta-analytical review of well-controlled trial

http://journals.cambridge.org/action/displayFulltext?type=6&fid=6778268&jid=&volumeId=&issueId=01&aid=6778264&bodyId=&membershipNumber=&societyETOCSession=&fulltextType=RV&fileId=S003329170900590X#
<http://journals.cambridge.org/action/displayFulltext?type=6&fid=6778268&jid=&volumeId=&issueId=01&aid=6778264&bodyId=&membershipNumber=&societyETOCSession=&fulltextType=RV&fileId=S003329170900590X#>

An important result for therapy research and perhbaps a solution

This is an interesting chapter of a book.
http://books.google.co.uk/books?hl=en&lr=&id=jEtD2YFC5XoC&oi=fnd&pg=PA17&ots=E1z24-vgVV&sig=X_azXuEw_mIjcxF4N3gANJNbOS0#v=onepage&q=&f=false
<http://books.google.co.uk/books?hl=en&lr=&id=jEtD2YFC5XoC&oi=fnd&pg=PA17&ots=E1z24-vgVV&sig=X_azXuEw_mIjcxF4N3gANJNbOS0#v=onepage&q=&f=false>

Here's a summary from some information a friend of mine sent me that led
me to this paper.
"The reality is that the material is a small part of the equation - the
teacher is nearly everything - as is the willingness of the pupil to
learn, and how supportive his or her parents are. And it's a similar
picture in therapy. The attached diagram was created by Lambert,
Norcross and others, on the basis of a meta-analyses of therapy
research, to show the factors that have the biggest impact on therapy
outcomes. It shows that:

40% of improvement in therapy is attributable to factors that are PART
OF THE CLIENT (e.g. personality, circumstances, social support,
fortuitous events)
30% is attributable to 'common factors' - i.e. things that ALL therapies
have in common such as talking, empathy, regularly meeting with another
person etc
15% is attributable to the placebo effect - i.e. the expectancy that it
will work
15% is attributable to the specific techniques used "

The last line is the most interesting. For all the research and clever
thinking that goes into measuring the effectiveness of psychological
therapies the small amount of potential for variance is measured and the
more important aspects, such as a good therapeutic alliance, seem to be
ignored in commissioning.

Psychological therapies should look to match client with therapist first
and apply whatever technique is considered best as the next treatment
decision. I question the latter because I personally feel that the
majority of research in psychological therapies is flawed and has small
effect sizes so its better to offer a spectrum of options and trials of
different therapy and therapists.

Its expensive but another friend of mine suggested a way that it could
be done. Tele-therapy, specifically using VoIP and video calls, could
create new PT call centres to manage the mental health of the nation
empowered by digital information. Frankly I consider ths not a great
solution because it still lacks the importance of physical presence,
full body language communication between client and therapist and the
opportunity for physical contact. "*hugs*" aren't enough when a person
needs a hug.

It would make sense because these therapy farms would be cheaper to run
and "battery farmed" (mass produced) therapists could be trained for low
severity interventions. I think the cost benefits would outweigh the
need for high quality therapists and the understanding that battery
farmed therapists are more likely to be the bad ones that produce poor
outcomes than "organic" therapists. The more skilled therapists could be
reserved for face to face, high severity conditions or complex
conditions. They can also provide "second line support" to escalate
difficult problems or to help if a therapeutic intervention by a
battery-farmed therapist goes awry.

Telemedicine is a prospect for the future and its just a matter of time
before going to see the doctor is as convenient as making a phone call.
This solution does have the benefit of offering more opportunity to chop
and change therapists and avoid being put to the end of the waiting list
and a number of other benefits, e.g. access to notes from other therapists.

Its not such a crazy idea. Employee assistance programs have already
being providing therapy over the phone and recent developments in NHS
mental healthcare have seen some experiments with telephone-based
services. The addition of video is an important one because, in my
opinion, correct communication is essential and body language is a large
part of that. Call centres are already moving towards providing video
call services and there will be contact logging software that integrates
with the VoIP systems so there's no need to create bespoke software to
handle the data. Middleware applications could provide the interface
with patient medical records however as far as I am aware these are
rarely used by therapists but I'm not sure about that. Of course the UK
is in the dark ages when it comes to electronic medicine and electronic
patient records are a long way off so the element of integration with
current record systems is moot.

1 in 6

This was shot in a shoe shop window a couple of nights ago in Central
London.

Its the number of people in the UK that think about killing themselves
at some point in their lifetime and comes from the Adult Psychiatric
Morbidity Survey.

5/6 would probably say thats a terrible thing. Of the 1 in 6 there would
be many who are surprised its not higher.

There could be two things taken from this information:
1) lots of people consider suicide and its normal
2) there's a real problem with the mental health of the nation because
so many people think of killing themselves.

Its worth noting that most of those wishes never turned to attempts. In
fact the number of attempts in the UK is a tiny fraction of that number.

As always there's this question of what is normal and what is illness.
It could be possible to make up a disorder called Suicide Risk Syndrome
where a person who is having suicidal thoughts is immediately treated.
The expectation is that it would decrease the suicide rate and that's a
healthcare objective.

The suicide rate is a terrible thing and its worse when its noted that
its 6 times the murder rate in the UK. I'm not so sure suicidal thoughts
should be immediately considered as disorder. As a person who has lived
with suicidal thoughts for a long time and for different reasons I
understand that a person can become resilient and often its limited what
a society can do, or perhaps should do. There are rational suicides.
Suicidal thoughts can also be a coping mechanism and for some
parasuicdial behaviour a form of help- or attention-seeking. The
important thing is action and its clear that most of the 1 in 6 never
attempt suicide so it makes no sense to medicalise vast tracts of the
population.

I'd be interested to know what that figure means to you?

Foucault's nightmare

Foucault was a French thinker. You can read more about him here.
http://en.wikipedia.org/wiki/Michel_Foucault

His relevant work is Madness and Civilisation. A simplified version of
the impenetrable text is available on Sparknotes.
http://www.sparknotes.com/philosophy/madnessandciv/section1.html

Sadly I expect that much of the sense of what he was trying to say is
lost in that translation. I've attempted to read the original which is a
translation in itself and found it to be impenetrable in the detail.

The idea itself is simple: madness is an ever evolving construct of
society and a modern product of a number of changes in society.

My own take on it is that the idea of mental illness is a way to
understand madness and the lesser forms of unreason but it is not a real
thing. It is only what society chooses to call it. Its just as easy to
call them societal illness that developed along with the industrial
revolution and the age of reason. Society promoted the value of
robot-like individuals, those best designed to work as automatons in
factories. Those that worked like computer programs and machines were
considered superior and those not considered worthless. The mad
themselves were spurned by society (and replaced the previously excluded
lepers in fulfilling society's need to exile a group).

The history of mental illness of the history of exclusion and rejection.
The creation of the idea of illness is sensical in that people were
presented in medical settings but much of the illness lay with a society
that was discompassionate and unaccepting of square pegs when it wanted
things that fitted through round holes. The psychiatric system developed
to bash the square pegs into suitable round ones, all in the name of
healthcare. It is compassionate to house the poor, mad and exiled in the
asylums but it created the Great Confinement (the period after the Poor
Law, Pauper's Law or Lunatics Act created the asylum system in the UK)
where the mad were removed from public view (Hanlon's razor yet again -
http://en.wikipedia.org/wiki/Hanlon's_razor) and redoubled the stigma.
The idea of illness may have been a way to side step the stigma using
the protective shield of disability and the privelidge of the invalid
applied based upon a truth that the mad were disabled and somewhat
moreso than some physical disabilities. People seemed readier to change
society to adapt it to the full spectrum of physical impairment so lifts
are installed and wheelchair ramps are available but the rectification
of the mistakes of society's development that created the disability and
illness of madness as well as the perjorative meaning of madness itself
will take more than my lifetime to see through.

a brief history of the hell in my life Part1

Don't read this if stuff about suicide and self harm is a trigger. Its
actually pretty dull stuff anyway.

This I had to write for a very good friend of mine. He's someone I open
up to because I trust him and cherish him dearly. For reasons I can not
explain I haven't explained the dark stuff that I sometimes chat to
random strangers about. This and the next post will correct that error.
Sorry buddy.

My first interaction with a psychiatrist was at the tender age of 15. It
was before my GCSEs. I'd been kicked out of home by my parents who
couldn't handle my detrioration. A war had ensued between us and I'd
stopped speaking to them. I rebelled against them by leaving my room a
total mess and playing Rage Against The Machine at full volume. It was
around that time I first started self-harming. I can't recollect why I
started. It just seemed an appropriate thing to do to carve "Fuck you"
into my arm with a compass.

Eventually after a fight with a family friend I was taken to hospital to
have my wounds dressed and told my parents didn't want me back. My
memory is hazy but I remember being okay with that. I was moved to a
children's home in Harlesden. It was lucky in a way. I didn't have
anything else to do but revise for my exams. I still kept turning up to
school. I told my friends but they didn't believe me. It was only when I
showed them I was travelling from a different stop to my usual one that
they realised. Even back in those days no one could tell what I was
going through. I remember seeing a psychiatrist at some point and they
declared me sane: a child reacting to an unusual set of circumstances,
reacting against the oppressive regime of strict professional Asian
parents with no ability to have a dialogue.

The children's home was an interesting experience and one to elaborate
on in another post. There is one memory I had of one of the workers
coming to have a chat with me. That was so important because I was very
isolated - imagine the alienation a public school boy would find in a
place where people had lived their lives in abject poverty. It was a
black man and he was very kind. He spoke to me about god but I explained
I was a hardened atheist. He explained that I could speak to god. God
was the voice in my head. I didn't believe him but I tried it and heard
nothing back. Its only in the last few years that I've come to
understand what he meant.

I was moved to a foster home and soon returned to living with my parents
within six months. I got surprisingly good GCSEs and my parents packed
me off to a local boarding school so I continued my education without a
break. I managed to get into a top 5 university to study a degree in
Electronic Engineering. I fitted in well there and quickly became well
known and even popular through being the friendly, recognisable drunk
with his name in the paper every week as one of the student newspaper
photographers.

My second year was somewhat different. My friends had noticed a pattern
of deterioation from the start to the end of term. It was worse that
year. I took on a lot, slept little and ate less. I never turned up to
lectures but I kept busy being involved in lots of clubs and societies
in the Students' Union. I was probably going to fail my degree. I had a
torrid relationship and my first experience of requited love. Eventually
we split up a week around the time my grandmother died (someone I had
grown up with and had looked after me when I was a baby while my parents
were in the UK during my early childhood). That triggered my first
thought of a suicide attempt though it was a very poor one, not thought
through and done in public. After a break up I downed a handful of
paracetemol and downed some vodka. On the advice of my friends I went to
see a university counsellor who told me to pull myself together and had
I not been reading about mental health before then and known that was
the worst thing to say I would have been broken. Instead I told my
friends and laughed about it.

I dropped out of university shortly afterwards and isolated myself from
my family. The self harm started again and I carved my ex-girlfriends
name into my arm. Its always the same arm and at the time it served as a
lifelong reminder to me but in retrospect I don't see the sense in it. I
also self harmed to feel again. I'd never had much value for my life
anyway and I contemplated suicide but got through that bleak patch. I
eventually started seeing the same counsellor who'd told me to get over
it, managed to get back to university and get my degree. The last year
was a lot of fun and I did copious amounts of drugs but managed to get
my work done. I even managed to get a well-paid graduate job with a blue
chip company which I deferred for a year so I could do a bit of travelling.

I'll skip forward to the period where I started my graduate job. It was
a time of great hope and fun for me, and it was the start of my proper
fall into the hands of the psychiatric system. I was smoking an insane
amount of high quality gear - almost £160 a week - doing a high pressure
job with my own high pressure attitude, living in a new place and
drinking myself silly. I'd probably been hypomanic before but I hit a
hypermanic stage. It was psychotic too and I experienced high levels of
paranoia as well as some unusual, transcendental experiences. My state
of consciousness and experience of reality would change on a daily basis
and with a high degree of variability. One day I might hear the voice of
god speaking directly to me through the MCs voice in a drum and bass
tune, the other I'd be thinking that the Illuminati were trying to get
me and paying cab drivers not to tell them where I'd been. There were
lots of good and interesting parts to this experience but I'll skip on.

Eventually a threat of suicide (not an intent) to one of my housemates
(who I thought was part of the evil conspiracy) during a very paranoid
evening got the assertive outreach team over and they dragged me into a
psychiatric ward. I was told I had to stay otherwise they'd section me
and I wanted to leave so they did. I didn't wanted to be treated, I
didn't want to be detained and I didn't want to take medication.
Eventually after I was acute tranquilised (forced down, a large needle
shoved in my arse and a high dose of antipsychotics injected to cause
unconsciousness) my will was broken.

I was given a diagnosis of bipolar. Eventually I got out of hospital and
carried on being a bit mental but had calmed down a lot. I can't
remember if I was taking medication at this time. Eventuallly I returned
home and was seen by a top private psychiatrist. He medicated me with
antidepressants, mood stabilisers and antipsychotics at very high
levels. The reason he gave was my blood levels showed that they were
necessary at those levels. I think the high dose of antipsychotics may
be because I continued to smoke skunk and drink but also because the
medication didn't seem to work on me. Brown people can also be slow
metabolisers.

I wanted to die during that time for a number of reasons, not least the
loss of my potential life of success. It was worse. I was mad. I was a
loony. I was a bipolar. I experienced a lot of the self-stigma. My life
was cursed to be shit by abnormality and illness. If I didn't take the
medication, medication that ruined my life, I would be ill with this and
I would end up becoming hypermanic again and destroying my life anyway.
A Hobson's choice. I didn't do anything about it because I couldn't get
the energy together but there were days all I wanted was to die. I
struggled through a live less lived and experienced, so much colder and
darker from the colourful pre-psychiatric life.

I got a job as a temp delivering post at a local council then helping
out sort out some data for another department. There I quickly showed
that I was capable and they exploited my misery and avolition to get
high standard work for little pay. To them it didn't matter that I was
doing the work my boss should have been doing with her salary several
times mine but I'd been so crushed that I worked for less than an 18
year old temp doing a basic administration job while I sorted out
complex, statutory data returns. I they ignored the quality of my work,
my dedication and silent sacrifices and preferred to focus on the
negative aspects of me, my lifestyle and my work.

Eventually I ended up in a pointless disciplinary proceeding but it
affected my mental health very badly and I was quickly signed off sick
for several months. I could have been signed off for longer but I worked
for children's services so I quit. That began a bad journey. I wanted to
kill myself after that. I was still taking medication and still smoking
my medication but I no longer had that purpose or that reason to live.
As always serendipity gave an opportunity through a friend of a friend
who wanted to start a magazine. I got involved to give them advice but
ended up running the startup. I was suicidal throughout and that changes
how a person makes decisions. For example loans were the easiest thing
to get without thinking about it because there were no consequences. I
took big personal loans to live my life and run the business whenever I
needed them because if the business wasn't a success and the money ran
out I could simply kill myself. In fact even if the business did work
out and I wasn't happy I could still kill myself.

I ran the business with that deep underlying depression and had a good
time even though the stress was high. It probably could have been a
success as well if I had a thought for the future. In the end it failed
and the loans needed to be paid back. I took an overdose of
antipyschotics - half the dose that could potentially kill someone from
the information I'd gleaned from the internet. It didn't work so I tried
again the next week but I did it while I was drunk. I'd had a massive
episode of whatever that evening and ended up self harming infront of a
family member and taking the pills in front of her. I don't know why I
did that. An unconcious cry for help or an attention seeking outburst? I
also burnt my medication and swore off them.

A trip to A and E was next like a repeat of my childhood and the message
that my parents didn't want me back. This time I ended up in a
psychiatric ward but it was for accomodation rather than mental ill
health per se. I was a voluntary patient then. From that point I refused
to take medication and ended up in temporary accomodation. For three
months I went mad and suffered a hell I would wish on no one. I came off
all my meds including alcohol and skunk. My life was in tatters as well
as my self-esteem. I had nothing to do during this time and few
possessions so I played Sudoku all day. Pretty soon I got back to my old
self-medication though at much lower levels and felt much better.

Things were getting better slowly but I started to come out of
depression too quickly. I wasn't manic but was told I was. I was
starting to experience psychosis again. On Christmas eve I went out to
the pub, got drunk and tried to score some weed. I couldn't and I blamed
the force or entity that was controlling things. I decided I'd had
enough so I decided to kill myself rather than live with this
controlling force messing with everything and controlling everything. I
lay down on the road on my local high street and waited for a car to run
me over. I came very close to dying and to this day I wish that I'd
succeeded. It marked the start of a new chapter in my shit life. One for
another post.

Useful link for explaining terminology in evidence based medicine

http://www.whatisseries.co.uk/whatis/
The *What is …?* series is intended to demystify some of the
terminology, techniques and practices used to assess clinical and
economic evidence within healthcare. It contains a range of titles covering:

Ain't nothing but the blues

This was shot at a blues bar in central London last week.

The blues is a beautiful music form. The expression of sadness through
song, melody and rhythm. The blues is synonymous with depression and
sadness and the music may have been a way to salve the pain. For
listeners it was a way to relate to the pain or to get away from it.
Music is a wonderful way to complement or escape depression.

The roadmap of research

Reading mental health research is hard work because there are few
truths. The trials using the highest standard of evidence are biased.
Even the meta-analytic technqiues high on the hierachy of evidece reveal
failures in bias. Few good truths seem to come out and much of the
research is still about averages, i.e. what will happen in general when
applying a treatment to a sample that represents the whole populations,
rather than how to predict what works for an individual.

What I feel is needed that doesn't exist as far as I am aware is a
roadmap of necessary research such that all treatments and techniques
are explored. At the moment there are very large numbers of studies on
pharmacotherapy and they're well funded so high quality. Psychological
therapies research has a long history but there's a dearth of high
quality studies that are required for commission and there are problems
with the outcome measures used when applied to more complex, less
directive treatments. Not only is there a need for high quality research
in all psychological therapies but in all forms of therapy, including
alternative and holisitic therapies. This broad range of therapies will
mean a long list of research required but it is necessary to truly show
that one treatment is of benefit.

All that still isn't enough because the research is about averages. Its
like knowing that if you toss a coin a hundred times it'll most likely
land heads up 50% of the time. That's useless for telling what'll happen
the next time however a much more advanced science like physics can
predict that. Based a few variables its possible to predict which way a
coin will land or a pancake will flip or to understand that toast really
does fall butter side down given standard sized pieces of toast falling
off standard tables. That's what's essential for providing effective
mental health treatments but is a way off in the future.

There's a lot of what seem like pointless studies while there's high
quality studies that desperately need doing. A roadmap, which is a term
from computer development, can organise the path of activity required
for progress and increase the focus of the general research movement
looking for truths in mental health and healthcare.

Its not that easy though. I've been reading a little on the Ig Noble
Awards for dumb science.
From http://en.wikipedia.org/wiki/Ig_Nobel_Prize
For instance, in 2006 a study showing that the malaria mosquito
</wiki/Mosquito> (/Anopheles gambiae/) is attracted equally to the smell
of Limburger cheese </wiki/Limburger_cheese> as it is to the smell of
human feet^[3] <#cite_note-2> earned the*Ig Nobel Prize* in the area of
biology. As a direct result of these findings this cheese has now been
placed in strategic locations in the nations of Africa to combat the
epidemic of malaria. The significant contribution this study
inadvertently made toward preserving human life arguably highlights the
importance of sharing sound experimental findings, irrespective of
intended uses of said findings.

So its possible for pointless research to do some good. No roadmap
should be so controlling that it doesn't allow for some experimental and
seemingly pointless research to be carried out. What's needed is some
modicum of direction more than currently exists and based on a better
understanding of epistomology than the current NICE dogma.

Cats tails

Photography can be simple.

This is an image I shot hungover one morning round a friend's flat. Her two cats were sitting to eat togther from the same bowl and I was trying to teach her that anyone can take an interesting photograph. It just takes seeing the moment and having the camera ready.

The shot's been edited to bring out the colour of the wood and the lines of the planks contrast nicely with the curves created by the cats' bodies and tails. Everything about this shot is simple. I've added a black border to show that it was shot full frame (without cropping) which is
something that's done out of photographic pride. The black border would be how it would have looked if it was printed full frame in the dark room though with a film there would be the detail of the film used imprinted into the celluloid.

I think it's ok that photos are cropped however there's still a part of me that wants to shoot full frame. It's something that gives a lot of credibility especially with people who are more interested in the ...cool of photography than the final image itself.

It can be something that can be an obsession that gets in the way of good photography though. The desire to stay true to film processes is an ethos skilled photographers can apply well with digital work however leaving a shot unedited because "that's proper photography" doesn't do justice to the shot. Professional photographers used a range of darkroom techniques to enhance and, in a sense, make a shot more real or as they saw it rather than how the camera processes it to be.

Mental ill health and relationships

Recent experiences in my personal life have brought a lot of stuff to
the fore. I'm sure that there are other people who go through what I go
through and that's gotten me on a line of thought.

Love is a beautiful feeling and its life-affirming and misery-making. If
there was more of it we'd all be happier. If there was a lot more of
unconditional love and compassion a mental healthcare system need not exist.

In the present though love and relationships and dating are a mindfield
for mental health and those who suffer mental illness.

For self harmers first sex is probably harder than for people with HIV.
The scars are freakish at the best of times. They're a death knell to
spontaneous passion and intimacy. It means I never sleep with people who
don't know me. It means that everyone I do sleep with has to be an
accepting person. Its a sort of positive in a horrible negative. I've
been self harming on and off since the age of 15 and the scars have
always inhibited my sexual relationships. Its gotten worse in the last
few years because during the acute epsiode of psychosis I was going
through a few years ago I was self harming prolifically. The scars fade
but there are a couple of gashes and cigar burns (yes, cigar burns from
my student days at a time when I was so dead inside that I barely felt
it) that will be there forever. Every sexual encounter, every hope of
future amour is always dogged by them. What could be done to help self
harmers through this I don't know. I'm sure many have found there own
ways to deal with it through honesty with their partner or resilience to
being thrown out by a person frightened by the freakishness.

Psychosis and paranoia make relationships a tough thing to handle. A
friend of mine who's recently been upgraded to a bipolar diagnosis from
schizophrenia (and schizoaffective before that) started dating someone
who was under section and had a diagnosis of paranoid schizophrenia. His
possessiveness and (perhaps) paranoid delusions made a relationship with
him difficult early on but she's used to being with people who are going
through unusual experiences of consciousness and has had them herself.
Her unstigmatising, accepting attitude is a quality I rarely see. Its
what comes from personal experience. More of it is needed if people who
have suffered from mental ill health are to become less disadvantaged in
this area of life.

People with anxiety and social phobias can also be disadvantaged in
relationships. Depression can be the scourge of a happy relationship and
can end relationships because of the impact of the externalisations of
misery or the apathy and reduction in libido commonly associated with
depression (but not always lost, hence the cluster of symptoms
approach). I wonder how many people are secretly self-loathing on the
inside? Or they focus on one small flaw, for example size in women or
penis size in men. If it wasn't for alcohol many people would be
severely disadvantaged but the social lubricant of choice is a potent
uninhibitor and that's so necessary for many people trapped behind their
masks and psychological shells.

Previous relationship traumas can colour future relationships and
expectations in some people. Its an understanding (from the Bayesian
model of the theory of the mind if I remember right) that previous
experiences inform interpretation of future experiences (this is the
Bayesian theory explained badly I think). People naturally expect things
to go the way they did before and can mistakenly intepret events to fit
their previous experience though some people may stay resilient to the
individuality of every experience and every person. In fact that's
probably a mentality that therapists promote. Some people's previous
experiences of relationships may cause them to construct conscious or
unconscious ways to get out of getting into a relationship through
damaging the relationship before it starts.

It must be awful for people with dissociative and personality disorders.
I could imagine that Antisocial Personality Disorder (analogous but not
the same as pscyhopathy) would be a curse of solitude and this may be
often seen assoicated with people with this diagnosis. Dissociative
Identity Disorder (or multiple personality disorder by its old name)
must come with many problems and relationships would probably be
impossible, but perhaps people have learned to cope. I'm a strong
believer in the power of every human being to adapt to misfortune or
difference.

Guilt can keep a person from entering into a relationship. Low
self-esteem can be another. If a person feels unworthy or damaged in
someway that may create a complex that means they will rationalise out
of entering relationships. I'm not sure if its guilt or some other
emotion that relates to my not getting in a relationship rational
because of the high likelihood that I will end my life (though I'm not
thinking about it now and am fairly far from that stage which is why I
can open up about it). Saving myself from guilt that I'll never
experience might be a better term. I understand the ripples of death and
suicide. At some point I made a decision that I wouldn't have a partner
(for a number of reasons) but the expectation of finding my own way to
peace meant that I couldn't burden anyone else with that was a major
one. I'm actually coming to question that now in recent days.

In the only relationship I've had in the last decade I got dumped fairly
regularly but we got back together fairly quickly. I understood that my
partner was going through a very difficult and stressful time and she
kept on lashing out at our relationship perhaps because she saw it as
the cause of her problems but I don't know why. I understood it as that
- the externalisation of her inner distress perhaps correctly or perhaps
as displacement. She had a diagnosis as well but I didn't understand
what it meant. It wasn't depression though. I became angry at the thing
that I thought was causing her distress but never at her because I knew
what she was going through. Eventually we did split up after we didn't
get back together after a breakup. It still hurt every time it happened
and at that time I couldn't do it anymore. I accept my failure in that
because I accept that I am human.

Perhaps if people understood that everyone finds relationships
difficult, not just those experiencing mental ill health, then perhaps
relationships could be a little easier. There's still a high stigma of
mental ill health and the externalisations of it and I don't know how
that will change. Its happened to me many times in the past. My madness
and the detriment its caused to my life mean that I'm worthless to some
people who measure their partners qualities on normal measures. Crazy
guys and girls are often lonely, but I think they get used to it because
its not just in amourous relationships from which they're excluded.

This may be an obvious form of the disability caused by mental ill
health according to the social model of disability. Thinking about it
now and extending the idea I was wondering if there would ever be a
relationships discrimination law. It would be an impossible law to get
through because it would infringe on what may be consider a personal
freedom - the right to fancy who you fancy. It would be impossible to
police. I envision some dystopia where there are quota that are needed
to be met every year for relationships between the different diagnoses,
cultures, ages and the like. Its an amusing thought though and one that
shows me a little of what utopia might actually be like but without
those rules.

The kindness of strangers

And the informal mental health system

On Sunday afternoon I met up with a good friend of mine and after they
headed off I went to a local pub to drown my sorrows and work out what
the hell to do with my so-called life. I picked a pub where its ok to
drink alone. Its the sort of pub where poor people go and most stay away
for its dingy atmosphere.

There was only one other guy in there chatting to the barman. He asked
me to play pool but I declined, preferring instead to work things out
for myself. But the guy was insisting I play pool so I had a game.
Hadn't played in years and I'm usually pretty bad but after a few beers
I can look like I know how to play. I think he just wanted to a play
pool and wasn't doing it out of some sophisticated understanding of
mental ill health and its presentation.

We ended up chatting and somehow the conversation got all about me. It
happens a lot. I chatted with this stranger and the barman about the
complex trigger and the things I had to work out. They had differing
opinions but were up for a banter about what was going on in my life. I
was pretty surprised about that but I know good bar folk. Anything
interesting is good banter. The barman was one of those sage's in the
rough. He'd seen much of life and many people through his job. He was
going through an experience akin to mine. We chatting till closing time
about my life, their lives and whatever other topic the conversation
flowed to as easily as the beer flowed out the tap.

The informal mental healthcare system has lots of benefits. There's no
waiting list to chat to a barman. There's the confidentiality of not
being known in that pub and the comradery of playing a game of pool that
does more in one session for client-therapist relations than a full
course of CBT could ever deliver. None of the guys I was chatting to had
degrees nor any mental health training whatsoever except from the best
educational establishment: the university of life or the school of hard
knocks as its also known.

The wisdom, perhaps even the prescriptive instruction, offered to the
barman is something I've considered for the last few days: tell her you
love her. Its so simple and its so true to my core beliefs. My cowardice
holds me back and the social impacts of opening up about impossible love
are holding me back from saying anything. He got through to me in one
pub session better than most professional therapists did in a few.

I'm lucky that I can do that: walk into a pub on my own, get chatting to
a random stranger or barman, open up to them in a way that's interesting
enough to be pub banter but allows me to explore what other people would
do in my circumstances and benefit from the wisdom of people who have
seen more of life than I have. I end up having to leave out a lot of
detail but I share that with people who know me and are willing to be
bored by my opening up. My mask is hard enough that few can see what's
underneath and I can avoid their sympathy or the stigma of mental
illness and help-seeking in certain subcultures, because the barman
would have thought less of me had I said I was "depressed" or I needed
to talk about my problems.

Its this idea of an informal mental health system and as society
improves it becomes stronger. Few understand the informal system as a
form of mental healthcare but its an excellent one that many people use
every day without realising. Its failures is why a formal mental
healthcare system exists.

True progress in real mental healthcare will see the kindness of
strangers grow but perhaps that's just another stupid dream from a
hopeless romantic.

Recovery from depression

This is a very simple image. The blue represents the obvious and the
sunflower is a frequent image in mental health.

Recovery itself is a word I haven't taken the care to find a precise
definition for.

Does it mean the end of illness, i.e. the end of the symptoms of the
illness? Or the end of the need to treat, i.e. the individual no longer
takes medication or requires professional therapy? The former question
implies remission of illness but only through medication and/or therapy.
The latter supposes the point at which that is no longer needed and the
individual has coping strategies, self management technqiues and the
capability to survive the illness caused by society.

Or does it mean something else entirely? I imagine that many people will
have as many definitions.

Its a word of hope though. Its the light at the end of the tunnel for a
person who has been told they have a chronic and enduring mental
illness. I've known the pain of understanding mental illness as
something that never goes away. I never heard the word recovery and was
given the only hope of high levels of medication to solve my 'illness'
and even then I might relapse back into madness.

Depression

This dog reminds me of Churchill and he had a metaphor for depression:
the black dog.

I know little but snippets from his life. He was a drunk. He was a
fighter. He was hard and immoral when the time came, though in his
immorality (as with all) he did it because he thought it was right. I'm
specifically talking about the strategic bombing of Germany civilians.
He was a bad man but he was right for the time and its highly likely
that Britain wouldn't have been victorious without his dogged
determination, the dogged determination that comes from a life of
misery. His speeches were vital to the country's moral and while he may
not have written all of them his black energy rumbled through the
country with the strength that comes from suriving day after day of his
black dog.

He said one of my favourite off the cuff comments and is an eminently
quotable man.
"Madam. I may be drunk but you are ugly. At least I shall be sober in
the morning."

Human value

This poor soul is an advertisement. He still maintains his air of
dignity in the face of the profound shame of being a sign. He's probably
a student or an educated man come to the UK looking for streets paved
with gold.

Is it right that a conscious being, someone with awareness, will and a
soul is reduced to this. The man was ashamed of what he did but this was
all he could do to earn a living. He would probably have lived in
extreme poverty to have to debase himself such to earn enough to eat
doing this mindnumbing, spirit crushing work.

What humanity is there in this image? Only the soul of the human
standing resolute in the face of the stinking reality of the maladapted
society we live in.

As a participant in this image I feel a strange guilt. I took photos of
this man and his humilation. I am part of the same society that sees not
the beauty shared amongst us and the opportunity for work that makes the
best and the best use of all of us but instead blindly allows the
creation of jobs that demean. The modern evolution of the slavery.

This man is not meat. This man is not wood. He is alive.

What is mental illness?

I'm hungry.

I know I need to eat.

I can't eat.

Medication and psychological therapies

Psychiatric medication induces physical illness and there is a risk to life. This is true of many of the chemicals used in mental health. The worst are the antipsychotics but even antidepressants have been shown to caused Sudden Cardiac Death syndrome and suicide in some people.

Its doesn't take advanced knowledge of neurobiology to realise that none of the treatments are truly selective in the neurotransmitters and brain functions they target. That's why there are side effects unrelated to serotonin transmission or the treatment of unhappiness. This action outside the target sites affects other autoneurological mechanisms, some of which may regulate body function. Affecting this will change the way other systems in the body work and this could be a cause of reduced life expectancy. The dramatic effect of antipsychotic drugs is well established in the studies on dementia patients where life expectancy was reduced by half in very old people.

Medication is not a solution to mental ill health either. The drugs can remove symptoms but its just as easy to say, you're unhappy - go get high. Antidepressants are narcotics though they don't act as quickly as the illegal narcotics. Antipsychotics are a chemical cosh or straight jacket in pill form. Mood stabilisers remove a person's full range of emotion.

The solution of medication means that people never learn to cope with a life crisis and there's no need for healthcare to make an attempt to explore the deeper nature of the individual and understand the reasons behind their pain and suffering. Its probably because that wisdom has become in short supply over the last century as the convenience and effectiveness of drugs meant consensus thought focused on those treatments.

The safer alternative is psychological therapies but few people understand what that actually means, including myself. I think psychological therapies are like going to see a sage or a life teacher. Its not about offering an answer or a solution but helping the individual find the solution themselves. That paradigm doesn't easily fit simplistic outcome measures but that's a sign of the lack of wisdom that's so pervasive in modern society.

The solution to life's distress, unexplainable phenomenon, intense emotional crisis, life events impacting on mental health and ability to cope are treated in modern times by drugs because there are few true teachers of life left. The Royal College of Psychiatry's motto is "Let wisdom guide" but there's little wisdom in supporting state-funded opiates of the masses instead of helping people find the wisdom themselves to live life. It is a sign of psychiatists ineptitude however the wisdom has remained in the true psychologists remaining, the true sages.

Marathon

I really like this image even though its not very technically good. It
was shot at the 2009 London marathon.

I like high contrast black and white. When I started learning
photography I used Ilford HP5 developed in Ilford Ilfotec HC (their
press-orientated black and white developer) and often pushed the film so
grew familiar with that sort of print style.

This shot is slightly out of focus, the contrast is too high and the shadows need work but the
poor technique is made up for by a great moment and I like the composition.

Shot with a Canon 40D and Sigma 70-200mm at f2.8

A little on the biopsychosocial model

Unhappiness has many causes. The biopsychosocial model explains them in their entirety.

It seems pretty easy to do on the biological side of things. Eat little, move little, stay indoors and drink a lot. Its a sure fire way to prepare for another trigger. The psychosocial ones are used the most powerful but it varies from person to person. Its lucky that life's hard and cruel. There's lots of triggers to choose from.

The variance of the significance of the factors of the biopsychosocial model amongst individuals is high and I think changes with individuals over time. Biological factors may not cause depression in me like they would in other people but thats because I've become resilient to them through many years of living with poor eating habits, addictions and never going to the gym. I don't think that's the same for everyone though. I think I've been like that for a long time. When I took psychiatric medication I needed very high levels - the pharmacists would ask if I was sure these were for me because the doses were enough for two people.

The biopsychosocial model is the start of a truly scientific understanding of the mind though it may in truth be the spiritual-biopsychosocial model. Both of these are concepts far in advance of the current consensus work of psychiatry which focuses on diagnosis and treatment based on operational definitions. It ends up with a system that understands all the materials in the world as they are and not as combinations of indivisibile elements. The mental health periodic table o elements is so far in the future its hardly worth conceiving however it will be the leap the Humane Genome Project or the Mendeleev and Meyer periodic tables were in other sciences.

Medicalising lack of risk taking

Its understandable that a person would not want another human being to feel misery. There's is so much of it around. Many people don't like being miserable and would want care and concern. In fact many people may be miserable because they have a lack of care and concern from other people.

Mental healthcare exists because people are miserable and don't want to be, and for some its decided that their willingness to handle misery is a symptom of illness in itself. It could be argued that depression is not an illness and perhaps in later life that's true but in youth a person with the wisdom of a senior may not live well their younger years.

The folly of youth is an important aspect of early development without which an individual may end up characterless and featureless. I've met many a dull individual who have the mental illness of never having taken a risk in their entire life. It means that person has never really lived, never really experienced the complete range of life's experiences which come from the trials and the tribulations.

And yet what I've done here is medicalised something that is different from me. I've medicalised a way of thinking or feeling that I think is odd and should be changed to how I think or feel. What is not normal to me can so easily be rationalised as a mental illness. Taking the above example further I could conduct research possibly using the established measures for impulsiveness reversed and show a poor prognosis.

We live in an age where anything can be justified using and abusing evidence.

An amusing name for a good idea

Sane Mind Rethink Foundation.....or Smurf.

Its an organisation that does exactly that: rethinks what sanity is and what mental health is, and what it should mean for mental healthcare practice.

It creates two memories that a person can associate. In theory in markets the other mental health charities and the major brands. That would be considered poor in marketing but would be clearly differentiated both in brand and in content of what it promotes.

Its not too clever a concept that it needs to be explained. It works without explanation too because the four terms make sense and make sense to the purpose of the charity. The acronym produces an amusing word. The whole concept should bring a smile to the individual hearing it for the first time and that should create a stronger memory and a positive association.

Just an idea.

Addictions

Current treatment for addictions is to achieve a state of abstinence as an outcome. This is a poor outcome. An addict can learn to manage their addiction. Many do. Probably many more than those who don't manage their addiction. I fall into the latter but I'm getting better at it.

The choice I made was to not let the drug control me but I chose a difficult path. Teetotallers can't enjoy what they used to enjoy with treatment for alcohol addictions. With new addictions like internet addictions becoming part of the diagnostic criteria there is a need for a different treatment outcome. Or will future mental healthcare attempt to make 'teetotalling' internet users?

Addicts are normal people and normal people enjoy themselves with all sorts of drugs, from alcohol to work. Yes, even work is an addiction that, for some people, follows the same patterns as a drug addiction. Teetotalling 'work' addicts would probably pick up a drug addiction or be prescribed a legal one to cope with the boredom.

A friend of a friend was diagnosed with an alcohol and sex addiction. He subsequently got a diagnosis of depression while successfully abstaining from both his old medications that salved his inner pain. The doctors prescribed him antidepressants.

The example is elucidating I hope on a point. Take from it whatever you will.

Treatment can also involve a 'cold turkey' and for some people it is enforced against their will. It is inhumane to force this on anyone. It is also exceptionally traumatic for some people even if they choose to go cold turkey. In the use of psychiatric pharmaceuticals its recommended that levels of medication be tapered off when coming off however I don't know if this happens with non-psychiatric psychopharmaceutical or other forms of self-administered treatment for unhappiness/filling the whole in your soul. I've seen people brought onto wards so they could get alcohol addiction treatment and that meant they felt severely unwell and went through painful withdrawal symptoms that were unnecessary pain.

The stigmatisation of drug use means that there is no representation for them, no voice amongst the professional campaigners fighting for other mental illnesses. This is why such an unnecessarily painful way to treat alcohol and drug addictions is allowed.

I can see why dual diagnosis is stigmatised of course: I do it to myself. This is why its seen as a self harming behaviour. Its also been explained to me as a form of obsessive compulsive by a therapist. The therapist was ethical at least. He worked in a drugs and alcohol counselling service and he tried to help me manage my minor addiction rather than push me down the 12-steps programme.

I doubt many people can even see dual diagnosis and addictions as a mental illness like any other. The stigma is different to the stigma of mental ill health because its redoubled by the public stigma against addicts and against drugs. I suspect that I wouldn't be popular if I espoused an alternative understanding based on personal experience rather than hearsay, biased media stories and what their parents told them.

Relationships

This is a photo inspired by another photo. I wish I could remember where
I saw it because I'd love to credit the photographer.

Its shot in Oxford Street one evening while out taking night photos.

Interpret it how you will. Explaining my own interpretation holds little
value.

A surprising result on love

I'd expected a search of articles in Google Scholar with "love" in the title to give a tiny number of studies compared to the number with "depression" in. In fact there are barely twice as many academic sources on depression as there are on love.

http://scholar.google.co.uk/scholar?as_q=love&num=100&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=title&as_sauthors=&as_publication=&as_ylo=&as_yhi=&as_sdt=1.&as_sdtp=on&as_sdts=5&hl=en

http://scholar.google.co.uk/scholar?sourceid=chrome&q=allintitle:%20depression&um=1&ie=UTF-8&sa=N&hl=en&tab=ws

However since 2000 there are just over three times as many on depression as on love.

http://scholar.google.co.uk/scholar?hl=en&q=allintitle:+love&as_sdt=2000&as_ylo=2000&as_vis=0

http://scholar.google.co.uk/scholar?hl=en&q=allintitle:+depression&as_sdt=2000&as_ylo=2000&as_vis=0

And drops back to around 2 times looking at sources from 2009.

There still significant. If I included "depressive", "melancholia" and other broad synonyms for intense unhappiness there may be a bigger effect.

The point I was going to make is that unhappiness is thoroughly medicalised however love doesn't seem to be. There'd be an interesting pub debate on whether is should be medicalised. In a way excessive love is - stalking may be considered a form of mental illness though I'm not sure under what diagnosis. I think there's a diagnosis in DSM-IV related to women who can't achieve orgasm. Liking sex too much is also in the American diagnostic criteria.

There certainly isn't a diagnosis for lack of love or avoidance of falling in love as far as I am aware. Living without that essential part of human life is something that many people live with, even people in relationships. The sadness of that makes me want to medicalise their sorrow, even if they don't recognise that they're missing out on a beautiful part of life.

The point I was hoping to make but I don't have the evidence to support it is that depression is medicalised because it affects people's work capability. A lack of love may cause depression but that is of little concern to medicine. It certainly offers no treatments. There are therapists who might advocate love as a treatment however they get struck off.

Would there ever be a society that could have "love leave" where a person needs to take time off because they've fallen in love and they want to enjoy that feeling and for it to blossom. I doubt I'd see that in my lifetime. It will be many decades before the shackles of Victorian conservatism and prudishness are overcome by progress towards the truer nature of humankind. The pub banter of "bet that person would chill out if they just had a shag" is where the wisdom remains.

I'm not sure if the barrier to a prescription of love (or sex in the jokey pub quote) becoming a regular treatment option is the prudish morality or the fact that the mental health care is becoming a system to keep people employed rather than anything to do with genuinely making life better for anyone. Certainly in the UK the people are seen as meat for the machine of society and improvements in mental healthcare are mainly in behavioural modification to get them back into whatever mindnumbing, soul crushing drivel that most people have to spend most of their adult lives doing.

Another post I have yet to write or perhaps I've written already is what I consider the next mental health system to be: unending, unconditional love for everyone by everyone. Its an insane idea but it comes from an understanding of why the second major mental health system (psychiatry) developed. Unconditional love for all means there would never have been the outcasts that were created as society changed during the Industrial Revolution/Age of reason. Homosexuality wouldn't have been treated as an illness. Psychosis would be an experience manageable in the community. Schizophrenia wouldn't exist.

I might as well as for heaven on earth....

What's love like for a mad person?

My head is heavy tonight. Its been one of those four seasons in one week weeks. Highs, lows, brutal crashes. My heart now feels torn asunder but the drink will salve that pain like it salves so many others. The medication of the hypocritical.

Last night someone asked me if I loved someone I shouldn't and I answered truthfully. It really hurt. The reason for the hurt is simply a realisation of what I already knew though, manifest through other people's paranoia.

What is love is something for another post. Its an interesting topic debated by many philosophers and fools. I know its feeling and I think many people never do. I allow it to happen because it is a wonderful and painful feeling that makes life worth living and losing. Its part of life and misconstructed social norms mean the most beautiful of emotions is fettered by outmoded ideas of morality.

Love has a purpose. To bring two people together. To lay the foundations for a relationship. To unite two souls that once drifted endlessly alone through the ether.

It has no purpose to me other than the feeling itself. What point is there when when I fall in love I value that person and as soon as I do I know there's no point. When I fall in love I know that nothing can come of it because I know I'm not good for them. Only in moments of irrationality or mania do I make the mistake of having a relationship.

Some idiot counsellor would try and tell me that that's not true but I know better. I know I'm not a good person. I know that when I'm a mess I can be a real mess. I go through times where I lose the plot entirely, where my madness overtakes and there's nothing anyone can do. I have nothing to offer anyone in terms of the constructs of long term relationships. I fit few of the 'essential criteria' that people use to judge a person worth of a relationship. Self harm scars seem to only be attractive to a very small minority of people. And while I'm not suicidal now nor have been actively so in some time I live with the knowledge that I will take my own life.

My life is a total mess but its my life. I'd never inflict it on a person I love. I ask for no sympathy because I do ok without that hope. I survive and I thrive without that thing that others have and consider an essential part of existence, and I survive with a smile on my face.

But being accused by someone who barely knows me about something that is a silent burden for me is heartbreaking. Thank fuck for my true lover, my companion, my only friend in this sick twisted thing called life. Oh alcohol, I love you.

Depression could be useful

Here's a theory that fits the idea that mental illness can have a point, a purpose and a positive.

http://www.nytimes.com/2010/02/28/magazine/28depression-t.html?em=&pagewanted=all

Here's a summary from a blog post I found the article from.

http://smarterware.org/5371/the-evolutionary-reason-for-depression

Here's a great quote as well.

"The greatest happiness you can have is knowing that you do not necessarily require happiness." ~William Saroyanb

What value is there in an IQ test?

People value a construct of intelligence in modern society and one of the measures is IQ. Its probably not a correct measure but its a well studied one and well regarded. It differs somewhat from social or informal measures of intelligence which can revolve around a person's ability to recall information they've read before.

To me that's not real intelligence but I'm not sure what is. The relevance is also little. This is because IQ can change and people can learn. A person may score low at a certain point in their life on a specific measure, for example Einstein failing the Maths component of his early education, yet go on to score highly in later life, for example the huge amount of complex mathematics he worked through to derive E=MC2 (though he may have stilled scored poorly on a measure designed for students).

There may be a genuine measure of intelligence but its irrelevant. Most people today have an exceptionally high probability of achieving a genius level of intelligence given suitable opportunity and support as well as perseverance, or perspiration as Edison put it (genius is 1% inspiration and 99% perspiration).

There's a film from the early 1980's called Trading Places where a down and out homeless guy swaps jobs with a high flying corporate banker and vice versa. The evil boss bankers run this experiment to see if what I'm talking about is true. In the film it is. The black homeless guy is a better success than the white, well educated, socially conforming banker in the story. The banker ends up living with a hooker and lives the life of the down and out just as well as the black guy.

With mental health there are observed cognitive deficits for various diagnoses and these disadvantage many people going through the experience who don't discover ways to cope or get round it, for example schizophrenics who don't write stuff down to solve the working memory deficit problem. This disadvantage is rarely observed in the disability model.

To me this means that intelligence itself is not important or not as important as the capability to achieve intelligence. The latter is a function of the advancement of society rather than a quality that has value measuring in the individual.

There is also an element where people do have different intelligences (rather than higher or lower) so were Mozart to be stuck working as a computer programmer he'd fail miserably and were Bill Gates to be a farmer he might be a poor one.

Ultimately its the willingness of society to improve and utilise intelligence that's seriously lacking and while its great to know that people have an IQ its more important to use it. Opportunity for all is more important that measuring an individual's excellence or deficit.