What the mental health system looked like 200 years ago: one of the earliest works on mental health by doctors

http://books.google.co.uk/books?id=l-oRAAAAYAAJ&printsec=frontcover&dq=Medical+Inquiries+and+Observations+upon+the+Diseases+of+the+Mind&source=bl&ots=L6DW8TZof8&sig=JPsgnUSiYMPwNW9Ycw4SXIgbNAU&hl=en&ei=sSTWS4yCJZT20gScrsXeDQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CA8Q6AEwAg#v=onepage&q&f=false
<http://books.google.co.uk/books?id=l-oRAAAAYAAJ&printsec=frontcover&dq=Medical+Inquiries+and+Observations+upon+the+Diseases+of+the+Mind&source=bl&ots=L6DW8TZof8&sig=JPsgnUSiYMPwNW9Ycw4SXIgbNAU&hl=en&ei=sSTWS4yCJZT20gScrsXeDQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CA8Q6AEwAg#v=onepage&q&f=false>
Medical Inquiries and Observations upon the Diseases of the Mind by Dr.
Benjaman Rush and the version provided for free by the wonderful people
at Google is from 1835.

There's a short section on the moon and mania which prompted the
previous blog post below but the interesting stuff is always going to be
in the treatments. (from around P170 onwards)

There's some other really interesting stuff that makes for food for
thought. A treatment protocol for mania and an interesting contrast to
modern evidence-based clinical guidelines.
1. "The first thing to be done [in the case of mania], to accomplish
these purposes, is to remove the patient from his family and from the
society of persons whom he has been accustomed to command, to a place
where he will be prevented from injuring himself....(snip).......The
effect of thus depriving a madman of his libety has sometimes been of
the most salutary nature by suddenly creating a new current of ideas as
well as by the depression it produces in his mind." This seems sensible.
In a time when the mad were truly regarded as repulsive and sub-human
many doctor's wouldn't have looked their patients in the eye properly,
preferring instead to treat them like a slave or an animal.

2. This starts with "A second means of securing a deranged patient's
obedience to the physician should be by his voice." Its a long way off
from the state of dialogue between doctor's and patients, advocacy and
involvement we see today. However I suspect that some mental health
professionals even today would prefer obedience in their patients.

3. A stern expression is useful.

4. The conduct of physicans must be dignified. No jokes - laughing at
them or with them - ever.

5. Be truthful. I can really understand the value of this. There is
nothing worse than being deranged and being lied to. The anger in that
state, the heighten sense of justice, the madness, whatever, gets much
worse when I'm lied to. It is worst when coming from a doctor.

6. A physican should treat the mad with respect. This is actually
progressive thinking 200 years ago. Its about humanity and its about
remaining human - remaining the person you are before the madness. In
the rest of the passage he goes on to say "The great advantage which
private madhouses have over public hospitals is derived chiefly from
their conforming to this principle in human nature which the highest
grade of madness is seldom able to eradicate." The principle he's
talking about is being able to retain that life and that sense of self
that comes through our routine lives: the plates we eat off; the
familiar objectsl the habits we have.

7. The encouragement of kindness as a tool for the physican to gain
their patients trust. His example was the offering of....fruit cake.

Its actually not a bad list. Not great but for an American doctor 200
years ago its exceptional thinking. Dr. Benjaman Rush was an exceptional
man and his Wikipedia page has more of his great deeds
(http://en.wikipedia.org/wiki/Benjamin_Rush).

But he also advocated treatments that today would be considered
inhumane. This was actually how I stumbled across this book in a search
for some of psychiatry's misdemeanours. Instead I found something
interesting and with a degree of humanity in a book I assumed was to be
riddled with horrors.

There are horrors. I've gotten to the part where I read about
"tranquiizers" except they're an alternative to the "strait waistcoat"
and "mad shirts" used at the time. It's a confinement chair where the
individual is strapped down during their mania. A horrible treatment.

Lunacy is a myth

http://www.gjpsy.uni-goettingen.de/gjp-article-owens.pdf
Owens, M. et al., Madness and the Moon: The Lunar Cycle and Psychopathology, German Journal of Psychiatry

Lunacy is a synonym of madness and comes from the same root as the word "lunar" though from the best modern science this simply isn't true. Several trials have looked at data and today there is no link between the moon and madness or what is known as the Transylvannian effect,
though there is a possible link between lunar cycles and physical disease.

In a review of 11 studies only 1 showed any correlation. In a very large study that look at all suicides over 10 years in the US there was no result. Hospitalisations don't increase and neither does violence in modern studys. One small, lower quality study showed no effect on
affective disorders but a strong effect on quality of life for people with psychotic disorders; its a fascinating result from the only piece of research mentioned in this paper however like swallows in spring it doesn't mean much.

The study is short and worth a peruse.

Social ugliness or mental illness?

This model is is beautiful. He is the epitome of the modern construct of
beauty. He is thin. His jaw firm, cheek bones strong and eyes that
pierce like stilletos on chipboard. Psychiatrists and therapists are the
photographers or the image makers of social 'beauty'.

A socially ugly person, for example someone with bipolar disorder, can
be given the equivalent of a paper bag for their 'ugliness' using mood
stabilisers. A "double bagger" (the andropist vernacular (aka misogynist
slang) for an ugly woman) could be given antipsychotics to make them
socially pretty so they don't scare people with the 'hideous' social
deformity of madness.

Their behaviours were deemed too much for society and the mentally ill,
like the Hunchback of Notre Dame, face either exclusion for their
ugliness or a chemical mask to cover their repulsiveness like that guy
in that film about someone with an iron mask. (apologies for the
misplaced pun there...it'll get cut in the edit) Psychology offers
alternatives to reshape the malformed into beautiful Adonis's like a
skilled cosmetic surgeon cutting away at the excess flesh and moulding
the abnormal into normal beauty, or the cosmetic surgeon doing
unnecessary surgery to make everyone look the same.

A repulsively physically ugly person will have worse outcomes in life
and were they born into a society even more vacuous than ours they may
suffer exclusion like the mad have suffered for their social ugliness.
The insanely ugly would be outcast by those who could not bear to look
at them. Cosmetic and plastic surgeons would be the psychiatrists
tending to the ill, i.e. those born with a physical 'illness' of
aesthetics that resulted in social and psychological impact in a time or
place that place very high social value on conformity to a physical ideal.

They would shape and reshape the ill and they would bring them back to
being normal so they could return to society, and all done in the name
of compassion. For the treatment resistant - the hideously ugly - there
would be novel and dangerous treatments available and the cosmetic
healthcare doctors would briefly wrangle over their ethics before
deciding to remove a person's face entirely, just as they might with
treating Siamese twins today.

But there is nothing wrong with being ugly because it is an irrelevant
judgement usually based on whatever nonsense notion is in the head of
the haute couture designers and fashion photographers of the day. The
valuation of physical beauty is a valueless judgement, though others may
see that lack of physical beauty or some sort of disformity does have a
strong negative impact. That's the curse of being mentally 'ill' or
physically 'ugly'.

The model in the photograph may be ugly to some. In a society of slack
jawed, obese and asymmetrical people he would be considered the freak.
That wouldn't mean he was one and it wouldn't mean he was ugly: its just
what the society at the time decided to label him.

Feel your bum

I assume you are sitting down while reading this. If standing up then
feel your feet. Not physically. With your awareness. Feel the presence
of your bum against the seat or your feet against the ground.

Had I not pointed it out you wouldn't have felt the sensation but its
always there. The mind filters it out. Its something that happens to
everyone. The information is there but only when consciousness is
directed to the feeling does it reappear.

I would guess that this is because the conscious mind can only handle a
finite amount of information and it's designed to filter out what is
superfluous. Without this mechanism the mind would be overwhelmed and
unable to process reality in real time.

This may be why you are unhappy...perhaps. The basic mind has been
designed to filter out what is everyday and perhaps the higher mind that
deals with life has a similar adaptation.

What you have in your life is amazing. To you it's normal. It's every
day. It would be a mental illness if you were capable of being amazed
and bedazzled by all the wonder of life on Earth and in your life every
day. The consequence is you don't see what is good in what is normal for
you.

I feel this is worth remembering.

The "....perhaps" is because it could also be to do with desiring that
which you do not have. Or other reasons. There are always many factors
in these things.

Isolation and better outcomes for mental illness

Isolation is often associated with mental ill health as a cause and a
consequence. It may also be a solution for mental ill health, perhaps.
There is a difference between loneliness and solitude.

It can be a consequence of the externalisations of the extreme internal
experiences. It is an unappreciated product of the stigma of mental illness.

I can see how it can be a cause. Solitude can lead to excessive
introspection. Lack of physical activity can lead to a biological low.
Lack of companionship may cause sadness.

There's another aspect that I find hard to communicate. Isolation makes
a person dead to society. A person exists by interaction with other
people. Its a quality of existance. I still exist through this blog and
through the emails and Facebook messages I write. This isn't true
isolation. Were I to stop I wouldn't exist in the world. I would exist
in my life of course. I would continue to exist physically. However my
part as an individual in society would have ceased to exist.

Treating isolation is effective at producing better outcomes. Studies on
psychological therapies often use psychosocial treatments such as
befriending or support groups as comparisons and in high quality trials
they're often show to be as effective as therapy from a professional
psychotherapist.

It doesn't take much of genius to work out that its a lot cheaper to
fund support groups and befriending programs than train professional
therapists to use a single form of therapy nationwide. £17.3 million as
a boost to local third sector organisations and individuals spent over 4
years could, according to the evidence, achieve significant benefits for
those most affected by mental ill health and those with common mental
health problems. For a tenth of the cost of the IAPT program significant
gains in quality of life and well being could be achieved and there
could be the creation of employment and volunteering opportunities for
the large number of people on long term medical benefits. If permitted
earnings are still available with ESA then the cost of employing people
on benefits would be low and this may provide a healthcare benefit for
them as well. This could provide an alternative pathway to a return to
work. Its also a boost to the voluntary sector organisations who are
already offering these treatments but who may be facing reduced income
caused by cut backs in government public spending and reduced donations
caused by the banking crisis and bailout.

The hippocratic oath

Its ages since I've heard the Hippocratic Oath so I might be remembering
it wrong. The last time I heard it was at my sister's graduation. They
still use a modern version at the moment every doctor becomes a doctor.

Its actually pretty amazing in my opinion.

Make your own judgement.
http://en.wikipedia.org/wiki/Hippocratic_Oath#Modern_Version
"
I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in
whose steps I walk, and gladly share such knowledge as is mine with
those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are
required, avoiding those twin traps of overtreatment and therapeutic
nihilism.

I will remember that there is art to medicine as well as science, and
that warmth, sympathy, and understanding may outweigh the surgeon's
knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my
colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not
disclosed to me that the world may know. Most especially must I tread
with care in matters of life and death. If it is given me to save a
life, all thanks. But it may also be within my power to take a life;
this awesome responsibility must be faced with great humbleness and
awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth,
but a sick human being, whose illness may affect the person's family and
economic stability. My responsibility includes these related problems,
if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special
obligations to all my fellow human beings, those sound of mind and body
as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while
I live and remembered with affection thereafter. May I always act so as
to preserve the finest traditions of my calling and may I long
experience the joy of healing those who seek my help.

"

Its something I feel I'd want to take myself.

Its changed a bit from the original version.
http://en.wikipedia.org/wiki/Hippocratic_Oath#Original
"
I swear by Apollo </wiki/Apollo>, the healer, Asclepius
</wiki/Asclepius>, Hygieia </wiki/Hygieia>, and Panacea </wiki/Panacea>,
and I take to witness all the gods, all the goddesses, to keep according
to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art
</wiki/Medicine>; to live in common with him and, if necessary, to share
my goods with him; To look upon his children as my own brothers, to
teach them this art.

I will prescribe </wiki/Medical_prescription#History> regimens for the
good of my patients according to my ability and my judgment and never do
harm </wiki/Primum_non_nocere> to anyone.

I will not give a lethal drug to anyone if I am asked
</wiki/Euthanasia>, nor will I advise such a plan; and similarly I will
not give a woman a pessary </wiki/Pessary> to cause an abortion
</wiki/Abortion>.

But I will preserve the purity of my life and my arts.

I will not cut for stone </wiki/Lithotomy>, even for patients in whom
the disease is manifest; I will leave this operation to be performed by
practitioners, specialists in this art </wiki/Surgery>.

In every house where I come I will enter only for the good of my
patients, keeping myself far from all intentional ill-doing and all
seduction and especially from the pleasures of love
</wiki/Sexual_intercourse> with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in
daily commerce with men, which ought not to be spread abroad, I
will keep secret </wiki/Confidentiality>and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art,
respected by all men and in all times; but if I swerve
</wiki/Perjury> from it or violate it, may the reverse be my lot.

"

A good example of what the grass roots movement can uncover and something important about mental health policy I didn't know

This is information from a new blog I've come across from an independent
mental health campaigner.
http://www.zenasylum.com/2010/04/disability-discrimination-department-of.html

It warms me to see the work of the grass roots movement, work that's
rarely acknowledged and never funded. Its people who work tirelessly and
often alone but they have the passion and though unrecognised they make
an important difference. An inordinate amount of work has gone into this
issue and its one I hadn't heard about.

There's a lot of information on there gathered from a series of Freedom
of Information Act requests.
"

a previous response to a
question to Health Minister Phil Hope, the DoH stated

*" it was considered that offering a choice of provider or treatment to
service users with more severe and enduring conditions would not
always be appropriate."*

confirming that extending Patient Choice to mental health services
was considered and rejected on the basis of disability yet there is
no evidence that this decision ever took place within or was subject
to Equality Impact Assessment from the material placed in the public
domain.

At least not the material you redirected me to.

"

I'm going to get more information on this because it is a pretty
important thing if people are denied choice solely on the basis of
mental illness. That just doesn't sound right. How could mental health
services be excluded from this while Time to Change are banging on about
"mental illness is the same as physical illness."

A way to deal with anger

I've been trying to come up with things that might help me to read when
I'm next going through a mad, bad or sad phase.

One thought that might help is
/People are idiots, albeit very smart ones (myself included). /

Its's a statement on what it is to be human and an acceptance of our
failures and inadequacies.

Why does that help deal with anger? Well to understand a person as
fallible can make it easier to understand their misdeeds and the anger
that comes with it. People fuck up as much a truth as people get it right.

The important thing is the acceptance of fallability as a way to cope
with the causes of anger.

It's especially true in my life for dealing with large institutions and
organisations. For some reason I expect them to be more capable than the
individual, and when they fail in their ideology it is an unacceptable
failure. This may be a projection of my old own internal self-criticism.
Perhaps.

Anger must still exist though. I know that that's what I'll be thinking
when I read this. Too much acceptance can lead to no progress and closed
thinking.

Fucking balance. I hate it !!!

Criticising the critic and anti-antipsychotic evidence and how everyone seems to use to research to support a preconcieved position

"There is no significant body of research to prove that neuroleptics
have any specific effect on psychotic symptoms, such as hallucinations
and delusions. To the contrary, these remain rather resistant to the
drugs. The neuroleptics mainly suppress aggression, rebelliousness, and
spontaneous activity in general."

This is a statement that surprised me. It comes from this link on the
Mind Freedom website froman article called "Should the use of
neuroleptics be severely limited? " byPeter R. Breggin and published in
/Controversial Issues in Mental Health/.
http://lancaster.mindfreedom.org.uk/node/14

As usual its selective picking of evidence to support the author's
position. It's something that I'm guilty of and it's useful to see it.
It's noteworthy that a lot of the references are to his own work. (btw -
I highly respect the work of Peter Breggin).

The evidence he's brought to bear is powerful and its worth reading. The
author uses the evidence to question psychiatric practice and and that
is a vital part of the path to progress. There's an example from the text.
"
The neuroleptics are supposedly most effective in treating the acute
phase of schizophrenia, but a recent definitive review of controlled
studies showed that they perform no better than sedatives or narcotics
and even no better than placebo (Keck et al., 1989). One psychiatrist
(Turns, 1990) responded to these revelations with anguished questions:
"Has our clinical judgement about the efficacy of antipsychotics been a
fixed, encapsulated, delusional perception . . . Are we back to square
one in antipsychotic psychopharmacology?"
"

I disagree with some of his conclusions, certainly here:
"
If the neuroleptics are so dangerous and have such limited usefulness,
and if psychosocial approaches are relatively effective, why is the
profession so devoted to the drugs? The answer lies in maintaining
psychiatric power, prestige, and income. What mainly distinguishes
psychiatrists from other Mental Health professionals, and of course from
non-professionals, is their ability to prescribe drugs. To compete
against other Mental Health professionals, psychiatry has wed itself to
the medical model, including biological and genetic explanations, and
physical treatments. It has no choice: anything else would be
professional suicide. In providing psychosocial therapies, psychiatry
cannot compete with less expensive, more helpful non-medical therapists,
so it must create myths that support the need for medically trained
psychiatrists.
"

I know psychiatrists aren't bad people or ogres, yet I could say the
same of many human beings. I don't believe psychiatrists do bad things
with evil in their heart and money on their mind. I think they do what
they do because they think it's right. Who doesn't?

My state of consciousness shifts again

I've noted a change recently in how I experience my thoughts and the
other thoughts within my stream of consciousness. It's something new.
It's the feeling of my thoughts, as in my sense of self or "I" or those
that are coming from me, are overlaid with the same thoughts (or voices)
that are from my other consciousness or the entity. It happens almost
like an echo and is different from the conversation or commentary that
usually exists. It's not constant but I've noticed it a few times over
the last few days. Its not something I remember experiencing before and
I've had a fair few different experiences of consciousness.

I'm not in the least bit concerned. Its unusual to experience some new
experience of consciousness but its happened so many times before its
peaked my interest and curiosity rather than made me fearful or
frightened of the change and what it could mean. I would like to know
the cause but I think that's beyond my current capabilities at the
moment. What change or changes in my biopsychosocialness (for want of a
better word, and missing out the possibility of spiritual or other
non-biopsychosocial and unexplainable-to-science cause) has caused this
change in perception of my stream of consciousness.

There's clearly not just one experience of consciousness shared by
everyone and there seems to be a few different states It seems fairly
obvious but its surprising just how many people assume that we all
experience our thoughts or our self in the same way. Or perhaps they
never consider it? It seems of little relevance except in
psychopathology and psychology. I think that's dumb.

A brief thought summary on the meaning of mental illness

Mental illness is about behaviours and emotions that are considered
disorders in different spectrums. A simple but useless summary.

Another paradigm is to look at the mental healthcare system as the
formalisation of human compassion. Depression is intense misery and the
informal systems such as society as individuals and systems outside
medicine don't cope with that very well which is why formal mental
healthcare is necessary and the medicalisation of behaviours that are
undesireable to the consensus at the time. Without the Poor Laws and the
Asylums Act or Lunatics act the mad would have continued to have very
poor outcomes like the Untouchable case in India. They would have been
homeless and outcast by society.

Alternatively, and unknowingly, the movement to medicalise and
hospitalise the mad was also the cause of the problems today. The mad
were removed from society in this act of compassion but the long term
effect was to still exclude this group from the human race. The
situation may have come about in response to the Enlightenment and the
fall of religion and its ways to 'treat' the mad. Foucault calls this
period "The Great Confinement" but he also notes the existence of mad
ships where the lunatics, vagrants and other unwanted were dumped in and
pushed out to sea with enough food to get them to the next town.

Foucault writes a lot about the idea of madness as a construction of
society but not a real thing in the way a broken leg is a real thing.
It's something I agree with. It does not mean it does not exist though.
Severe mental illness, i.e. emotions or behaviours that are
undesireable, stigmatised, taboo or other judgement by society, have an
impact on an individual's life course and using the measures accept by
psychiatry they have a negative impact. Homelessness, poverty, debt,
victimisation, exclusion, poor career outcomes, poor social outcomes,
poor relationships, shorter life expectancy are a few of the consequences.

The idea of illness implies that the illness is something real in the
individual rather than something that is a product of the largest social
"tribe", i.e. the illness is in society rather than the individual. An
example might be the worse outcomes in developed countries for
schizophrenia compared to developing countries (WHO IPSS study I think).
Depression and anxiety are highly prevalent but perhaps because people
have too much to worry about and be unhappy about, or perhaps the
materialistic solution to happiness promoted by consumerist, capitalist
culture is not working (admittedly the UK is an advanced capitalist
culture with strong socialist ideals).

Stigma or ignorance or whatever drives the fundamental social judgements
around what is considered acceptable and what isn't are the cause of the
illness as much as the individual. Possibly my favourite example to
elucidate this is the example of homosexuality which, for much of the
history of psychiatry, was considered a mental illness. The same
theories applied to other mental 'illnesses' of the time were also
applied to homosexuality, the same treatments used (and some rather
horrible ones just for homosexuals) and the patients told they had an
illness. And it would be evidence-based. The British Journal of
Psychiatry has over 60 papers published on homosexuality between 1855
and 1978
(http://bjp.rcpsych.org/cgi/search?pubdate_year=&volume=&firstpage=&author1=&author2=&title=&andorexacttitle=and&titleabstract=homosexuality&andorexacttitleabs=and&fulltext=&andorexactfulltext=and&journalcode=bjprcpsych&resourcetype=1,10&fmonth=Oct&fyear=1855&tmonth=Apr&tyear=1978&fdatedef=1+October+1855&tdatedef=1+April+2010&flag=&RESULTFORMAT=1&hits=100&hitsbrief=25&sortspec=relevance&sortspecbrief=relevance&sendit=Search
<http://bjp.rcpsych.org/cgi/search?pubdate_year=&volume=&firstpage=&author1=&author2=&title=&andorexacttitle=and&titleabstract=homosexuality&andorexacttitleabs=and&fulltext=&andorexactfulltext=and&journalcode=bjprcpsych&resourcetype=1,10&fmonth=Oct&fyear=1855&tmonth=Apr&tyear=1978&fdatedef=1+October+1855&tdatedef=1+April+2010&flag=&RESULTFORMAT=1&hits=100&hitsbrief=25&sortspec=relevance&sortspecbrief=relevance&sendit=Search>)
That range is from the first issue to a year after the change in DSM-III
when it was removed. There have been 16 since 1978
(http://bjp.rcpsych.org/cgi/search?pubdate_year=&volume=&firstpage=&author1=&author2=&title=&andorexacttitle=and&titleabstract=homosexuality&andorexacttitleabs=and&fulltext=&andorexactfulltext=and&journalcode=bjprcpsych&resourcetype=1,10&fmonth=Oct&fyear=1978&tmonth=Dec&tyear=2010&fdatedef=1+October+1855&tdatedef=1+April+2010&flag=&RESULTFORMAT=1&hits=100&hitsbrief=25&sortspec=relevance&sortspecbrief=relevance&sendit=Search
<http://bjp.rcpsych.org/cgi/search?pubdate_year=&volume=&firstpage=&author1=&author2=&title=&andorexacttitle=and&titleabstract=homosexuality&andorexacttitleabs=and&fulltext=&andorexactfulltext=and&journalcode=bjprcpsych&resourcetype=1,10&fmonth=Oct&fyear=1978&tmonth=Dec&tyear=2010&fdatedef=1+October+1855&tdatedef=1+April+2010&flag=&RESULTFORMAT=1&hits=100&hitsbrief=25&sortspec=relevance&sortspecbrief=relevance&sendit=Search>)
(This is another crappy search and I should use "homosexual" and other
key words to find the correct number of papers.)

Calling it an illness isn't a truth but its a way of understanding (- a
pedagogy?). Admittedly some of the conditions can be seen as an illness,
for example schizophrenia seems to have a biological component to it but
it may not be the same for everyone with a clinical diagnosis of
schizophrenia. The illnessses can respond to "medication" and there are
methods using talking and learning to change behaviour and help people
deal with their emotions. The latter is essential life wisdom though
many people don't see psychological therapies that way.

It can be seen as illness and treated like one. People can be considered
disabled without the social model of disability which has significantly
changed things since the 1970s. Doctor's refer to the "privelidge" of
disability and illness and they've found it hard to extend to mental
illnesses, certainly as the definiton has widened to include less
extreme conditions as mental illnesses to be treated and afforded the
same privelidges. Without them the outcomes for many people would be
much worse.

There is some life pain which is too much for an individual to bear and
no one but an expert can help. Psychiatry provides that expertise.
Medication and talking therapies also aid the suffering. They help
people through their pain and distress. They help people who are unable
to help themselves. It is in this form that the medicalisation of human
behaviours is also the formalisation of human compassion.

A summary should finish with a conclusion. All I know thus far is that
its complicated. It is important to see the truth and see the judgement
of the truth, and that will always be a personal thing which is why its
worth knowing at least both sides. Preferrably more.

A ramble on language, concepts and words, psychosis, schizophrenia, unusual states of consciousness, a bit about me, alternative treatment using supportive antistigmatic workpaces

This is about unusual states of conscious described by terms such as
"psychosis", "hearing voices", "schizophrenia", "schizotypy" and "ego
dystonia."

Words are important but concepts more. Those phrases mean different
things to academics and experts with experience by their understandings
are more refined than the public who may see all of those as the same
thing and probably not know what schizotypy or an ego dystonic state is.

The term schizophrenia has meant many things and definitions I've read
are poor. The medical model says its is a severe and dehabilitating
mental illness with a lot of causes and triggers experienced by
approximately 1% of the population. It is a state involving profound
hallucinations and delusions with extreme distress and dysfunction. It
is associated with many things however none of those are predictors in
the individual.

Experiencing psychosis, hearing voices, schizotypy or ego dystonia is
not schizophrenia. Psychosis can happen in many illnesses - physical and
mental. It can be induced by drugs, or a "psychosis-like" state - the
differentiation is because psychosis is an internal experience and
drug-induced psychosis can be psychosis (temporary delusions and
hallucinations) but look like it to the external observer. Schizophrenia
is considered by the medical profession to be a lifelong illness with
expectations of high levels of detrioration on a wide number of
measures. The medical model also considers it a brain disease. In
earlier posts I've highlighted a brain imaging study in children that
showed those with a schizophrenia diagnosis according to DSM-IIIR have
higher rates of grey matter loss than other matched children. I need to
read more about this I'm afraid however I suspect that not every person
in the UK who has a diagnosis of schizophrenia shows the same brain
matter loss patterns. There is a large amount of variability in a
diagnosis and traditional concepts of enduring diagnosis and poor hope
of recovery are less true nowadays but there is still desperate need for
progress in this area.

Some people who have experienced psychosis may get an diagnosis of
schizophrenia later on which is why the DSM-V revision is including the
controversial pre-psychotic or psychosis risk syndrome (I forget its
name in DSM-V but those two terms are what are used in the literature)
diagnosis. The controversy is about the medicalisation of what is a
normal state of being. I'm not going to go in depth into what is a
complex question (what is normal?) at this juncture but to explain that
the medicalisation of the human condition has always been about a
decision about what is normal and what needs to be treated and it runs
the high risk of overdiagnosis.

Hearing voices may precisely mean auditory hallucinations however in
mind there is some confusion over whether the term also includes people
who have thoughts in their stream of consciousness that are not their
own. I believe that this state is described as ego dystonia but I am not
very sure. Confusion ensues with the addition of the concept schizotypy
which, as a concept, is now becoming an illness when it was considered
normal through the new personality disorder schizotypal axis and
pre-psychotic risk syndrome. This is another concept I have limited
understanding of however the point of this information is two-fold. Ego
dystonia, schizotypy or experiencing auditory hallucinations, hearing a
voice in your head, having an inner dualogue or dialogue are not
schizophrenia either, They are one or two of the cluster of symptoms
in the official diagnostic criteria but there are other criteria that go
to make a diagnosis of schizophrenia and these are states observed in
people with other diagnoses, for example bipolar or schizoaffective,
puerperal psychosis or depression. Confusing the picture even further,
some people would consider that the experience of hearing voices was
just a different experience of the stream of consciousness - a
misunderstood alternative state of awareness.

The other point is about the problems of concepts and language. The
internal experiences described my mental health terms and labels is very
complicated and the words are assumed to be communicative. They aren't.
"Schizophrenia" in the minds of far too many people is totally
misunderstood and the problems caused by language are a barrier to
promoting a better understanding of this condition amongst the
consensus. In the book Madness Explained by Richard Bentall he robustly
criticises psychiatry's ability to reliably diagnose schizophrenia and
the program How mad are you? makes the same point in a public-friendly
format so theprofessionals are little better at understanding the concepts.

The other states I've described such as schizotypy and ego dystonia are
not, in themselves and at this current time, illnesses however are
experienced by people when they are ill and can cause high levels of
disability and distress to some people. I first heard the term "ego
dystonia" in a paper written by Professor Marius Romme published in the
British Journal of Psychiatry around 1992. It was about his study of
hearing voices copers however after the interviews he noted that all the
copers had an ego dystonic state and implied that this was different to
hearing voices. I took it to mean what I was going through which was the
perception that not all the thoughts in my stream of consciousness were
my own and that they were coming from something else. There were times
that I felt controlled by this something else - the effect was not just
on my stream of consciousness. It affected my body parts and I felt
parts of the external world were being controlled. There are times when
it was like living in a nightmare. I would guess this is psychosis,
delusion and probably paranoia. I'm still unsure whether its enough to
get me a diagnosis of schizophrenia. Many people would require more
information to make that diagnosis, like my psychosocial functioning and
length of severe delusions.

The public are unaware of the high number of people who have psychotic
experiences or unusual states of consciousness. It is not something that
is spoken about so the assumption is that these experiences only have a
poor outcome. Copers don't talk about it in UK society because it will
make them look mad. I self-disclose a lot and in doing so I find more
and more people either know people who've been mad or have experienced
madness themselves.

A large part of the severe disability of schizophrenia is caused by the
social disability assocatied with the various states of mind covered by
this term. I dealt with the worst of it without medical care of any form
though I worked in an unusual workplace and I'm tough at times. The
workplace environment had very low levels of mental health stigma and
had good mental health awareness. I withdrew from social functioning as
much as possible because I was unable to understand changed reality and
while I could handle the paranoid psychosis with all my conscious will
there were times where I didn't have the strength. What that means is
that even though all my senses were telling me that people could read my
thoughts or had information about my life that they couldn't have my "I"
would push against it all to say that it wasn't true.

It was the only way to survive the external world. The workplace
environment was like no other. It was a workplace first and foremost,
and not recognised as a form of therapeutic community or healthcare
environment. It came with all the stresses of a normal workplace, the
interpersonal strain, politics and management (and employee) idiocracy.
However the culture and the people were unlike other places. I was
befriended, I think, by someone who would go out with me. I'd withdrawn
from my old friends because of a percieved and real sense of guilt and
shame for things I'd said and done when I was in a long crisis as I came
off the medication and I was seriously thinking of killing myself at the
time so it would be better that they forgot me. That small bit of social
contact was perhaps the most I'd have during this phase. I continued to
come into work whenever I could and many times in a state where my
manager would have preferred me not to be in the office for my health
and their sanity but I continued on as this husk of a person just
turning up to work and interacting as little as possible.

I think they thought I was pretty weird (and I still think they do but
I'm ok with that) but were much more accepting of me than other
workplace environments would be, and that's something I can't be
thankful enough for. I was bereft of hope for a long time. There were
days that the knowledge I was going to kill myself soon anyway were the
happy thought that got me through the day. My consciousness had been
shattered and my experience of daily life was like living a distorted
nightmare that felt completely real. Medical services would have
sectioned me and drugged me up. I'd have probably ended up on a section
3 at least, perhaps.

After some time the every shifting but intense psychosis started to fade
and I noticed a return to feeling my senses working again as they used
to. It was slow but gained apace. My mood lifted and that was a
wonderful time for someone who had been living in hell. Happiness is
most easily defined, perhaps, as the state after intense misery because
it is never clearer.

My state of conscioussness has calmed. It is my belief that I am a lot
wiser, smarter, tougher and perhaps more sensitive through this
experience having through it the way I have done over the past three or
four years rather than had I have sought help from psychiatric mental
healthcare. I must admit I've recently attempted to engage with services
to get a therapist so I'm not saying that NHS mental health services are
totally useless or without purpose. Its just what they would do to me in
my case and with the new medico-legal framework will have worse outcomes
for me, even with some of the terrible things I've had happen to me and
I did to myself while I went through this.. The experience has also made
me question the psychiatric paradigm of psychosis, hearing voices (etc)
and schizophrenia.

It is not an illness if a person is capable of living with a different
experience of consciousness. Some may consider it abnormal but that is a
value judgement just like the value judgements through old diagnoses
like drapetomania (slaves who kept on running away) or homosexuality.
The list of people who have experienced unusual states of consciousness
is lengthy and includes people like Freud and Jung....

.......I could turn this into a lengthy essay because there's more
information. I think I've made the point I started to make and rambled
on a bit more than I should. Its sunny outside and my brown skin is
looking pasty. I need to go outside.

Where have all the bloody teaspoons gone? research

This is possibly one of the most mildly amusing pieces of research I've
read and it's one I have the honour to use to make an important point
about the costs of this phenomenon to a charity.

I'm not going to detail this research. Its far too beautiful in its own
form and a useful learning tool for understanding research practice.
Geeks like me will love this research.

The case of the disappearing teaspoons: longitudinal cohort study
of the displacement of teaspoons in an Australian research institute

http://www.bmj.com/cgi/content/full/331/7531/1498

Doctors clearly have a sense of humour as can be found in the responses.
http://www.bmj.com/cgi/eletters/331/7531/1498

Violence and schizophrenia - some science and some counter science.

I've written this post over the last few days. There's a lot of
information here. Skip to the last few paragraphs if you don't want to
read some really negative science about schizophrenia.

Fazel, S. 2009, Schizophrenia and Violence: Systematic Review and
Meta-Analysis, PloS Medicine

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000120

The editor's summary is worth reading.
http://www.plosmedicine.org/article/info:doi%2F10.1371%2Fjournal.pmed.1000120#abstract2

Its not a pretty picture. Here's some snips.
"
For men with schizophrenia or other psychoses, the pooled odds ratio
(OR) from the relevant studies (which showed moderate heterogeneity) was
4.7, which was reduced to 3.8 once adjustment was made for
socio-economic factors. That is, a man with schizophrenia was four to
five times as likely to commit a violent act as a man in the general
population. For women, the equivalent pooled OR was 8.2 but there was a
much greater variation between the ORs in the individual studies than in
the studies that involved men.
"
"
Importantly the authors found that risk estimates of violence in people
with substance abuse but no psychosis were similar to those in people
with substance abuse and psychosis and higher than those in people with
psychosis alone. Finally, although people with schizophrenia were nearly
20 times more likely to have committed murder than people in the general
population, only one in 300 people with schizophrenia had killed
someone, a similar risk to that seen in people with substance abuse.
"
"

What Do These Findings Mean?

These findings indicate that schizophrenia and other psychoses are
associated with violence but that the association is strongest in people
with substance abuse and most of the excess risk of violence associated
with schizophrenia and other psychoses is mediated by substance abuse.
However, the increased risk in patients with comorbidity was similar to
that in substance abuse without psychosis. A potential implication of
this finding is that violence reduction strategies that focus on
preventing substance abuse among both the general population and among
people with psychoses might be more successful than strategies that
solely target people with mental illnesses. However, the quality of the
individual studies included in this meta-analysis limits the strength of
its conclusions and more research into the association between
schizophrenia, substance abuse, and violence would assist in clarifying
how and if strategies for violence reduction are changed.
"

From two other recent high quality papers used in the NICE schizophrenia
annual evidence update 2010
(http://www.library.nhs.uk/MENTALHEALTH/ViewResource.aspx?resID=344920&pgID=1
<http://www.library.nhs.uk/MENTALHEALTH/ViewResource.aspx?resID=344920&pgID=1>).
I can only read the abstract of these two papers which is a shame.

Large M, Smith G, Nielssen O. The relationship between the rate of
homicide by those with schizophrenia and the overall homicide rate: a
systematic review and meta-analysis. Schizophrenia Research 2009; 112(1-3).
http://www.ncbi.nlm.nih.gov/pubmed/19457644
"
BACKGROUND: It is widely believed that the rate of homicide by the
mentally ill is fixed, differs little between regions and is unrelated
to the total homicide rate. METHODS: We conducted a systematic review
and meta-analysis of population-based studies conducted in developed
countries of homicide committed by persons diagnosed with schizophrenia.
FINDINGS: We found that rates of homicide by people diagnosed with
schizophrenia were strongly correlated with total homicide rates
(R=0.868, two tailed, P<0.001). Using meta-analysis, a pooled proportion
of 6.48% of all homicide offenders had a diagnosis of schizophrenia (95%
confidence intervals [CI]=5.56%-7.54%). Rates of other homicides did not
contribute to the heterogeneity in the proportion of homicides committed
by those with schizophrenia (slope=-0.055, P=0.662). CONCLUSIONS:
Homicide rates by people with schizophrenia are associated with rates of
all homicides. It is therefore likely that both types of homicide have
some common etiological factors. Accordingly, measures to reduce the
likelihood of a person committing homicide during a psychotic illness
should not only attempt to optimise treatment, but include attention to
those factors associated with an increased risk of all homicides, such
as improving the social circumstances of disadvantaged patients,
treating substance abuse and reducing access to weapons.
"

The pooled proportion of 6.48% is high. Its also linked to the overall
homicide rate in different countries. The authors say "therefore likely
that both types of homicide have some common etiological factors" and
I'd like to read the paper to see how they explored this.

Richard-Devantoy S, Olie JP, Gourevitch R. Risk of homicide and major
mental disorders: A critical review. Encephale 2009; 35(6).
http://www.ncbi.nlm.nih.gov/pubmed/20004282

It doesn't paint a pretty picture. From the above study's abstract.

"Mental disorder increases the risk of homicidal violence by two-fold in
men and six-fold in women. Schizophrenia increases the risk of violence
by six to 10-fold in men and eight to 10-fold in women."

On the plus side for some and bad news for others.
"According to studies, we estimated that this increase in risk could be
associated with a paranoid form of schizophrenia and coexisting
substance abuse. The prevalence of schizophrenia in the homicide
offenders is around 6%. Despite this, the prevalence of personality
disorder or of alcohol abuse/dependence is higher: 10% to 38%
respectively. The disorders with the most substantially higher odds
ratios were alcohol abuse/dependence and antisocial personality
disorder. Antisocial personality disorder increases the risk over
10-fold in men and over 50-fold in women. Affective disorders, anxiety
disorders, dysthymia and mental retardation do not elevate the risk.
Hence, according to the DMS-IV, 30 to 70% of murderers have a mental
disorder of grade I or a personality disorder of grade II."

The result that the homicide rate for schizophrenia is also associated
with local homicide rate is interesting perhaps. None of that gets away
from the small increase in chance of being killed by someone with this
diagnosis. The risk is very small and far greater than the public
perception which is /every/ schizophrenic has the potential to kill. In
fact the greatest risk is the risk to life through suicide and I would
guess that people with this diagnosis account for a high proportion of
the 5706 suicides in .2008 in the UK.

None of that makes it any easier for a person with a diagnosis of
schizophrenia. These are comparisons of risk and though homicide is a
terrible thing it rarely happens so the reality of the risk is very low.
It is also not a predictor - a diagnosis of schizophrenia does not make
a person homicidal (or at least most people). The homicide and gender
statistics show men commit the vast majority of murders in the UK so
there is more risk from being male than from a schizophrenic. Neither of
those is a risk though. The probability of a person being killed by
another person in their lifetime is very low. It is mathematically true
to say that the risk is higher for being killed by a person with a
diagnosis of schizophrenia. That's undeniable. However were research to
be done on other labels that say nothing about the individual and who
they really are, for example "Black" or "Black male" or "male" or
"drunk" or "addict" or "psycho" or "axe-wielding" those could be shown
to be more risky than people with a diagnosis of schizophrenia. In all
those cases it applies that it is not a useful predictor of a person's
behaviour and the rational expectation would be to feel safe around a
Black, male, drunk, addicted, psycho schizo with an axe. Yes. I think
this extends to feeling safe around people with axes, in general (oh the
academic caveat emptor! lol).

A piece of information that can counter some of the science is the
studies showing the estimated lifetime prevalence of psychotic
conditions to be in the order of 10% however I've not read that study
and from other studies (I also haven't read) covered in another post the
stigma is attached to the word "schizophrenia" is much higher than the
word "psychosis" and the studies are done on people with a diagnosis of
schizophrenia but not other psychotic disorders or sub-clinical
syndromes like schizotypy (though this may soon become a normal state
that is an illness through DSM-V). I am unsure if there is a
differentiation between psychosis and schizophrenia. I think psychosis
is a state of consciousness that is also part of schizophrenia but may
be lumped together in the lay perspective.

My opinion on changing language to change stigma

Someone's just recently reminded me of one of my white whales: the use
of language in mental health.

Changing words is part of the whole politically correct thing. Afro
caribbean is the new Black. Mental illness is a mental health problem.
Mental health is now well being. I may be being a bit anal about this
but by changing the words they are attempting to draw a blank slate on
the concept and start again which sounds great but isn't really.

A recent article in New Scientist by a psychiatrist proposed the idea of
changing the name of schizophrenia on its 100th birthday next year and
there's a campaign against the label of the word schizophrenia.
http://www.newscientist.com/article/mg19626256.200-comment-down-with-schizophrenia.html

The article mentions research about how changing the word affects how
people thing of it is significant and obvious. A study compared terms
like "stress-sensitivty psychosis", "traumatic psychosis", "anxiety
related psychosis" and "drug related psychosis" with the label of
schizophrenia and showed 63% of diagnoses patients had a negative
attitude to the label of schizophrenia whereas a only 16% had negative
attitudes to the other labels. Medical students were also twice as
likely to consider a better outcome for patients with the sub-type
labels. However its something that's fairly obvious. Change the name to
"Care bears" or "hot body" or "hopeful outcome disease" and I think the
results would be even more positive. Who wouldn't want Care Bears or hot
body? The term stress-sensitivty psychosis has little meaning to anyone
outside mental health so its clear that many people would consider it
better than a term they've heard of and has a stigma attached to the
consensus definition. Using words with positive assocations should have
even more beneficial effects.

I know that changing the language is the short term pragamatic solution
though and that's what the evidence cited showed. But when studies show
that people with Care Bears kill more than average or die sooner or
people work out that it means the same thing as that guy in One Flew
Over the Cuckoo's Nest had then people won't want Care Bears any more
and doctors will return to the same expectation of poor outcome.

The writer also noteably left out "paranoid psychosis" which I assume
would be one of the subtypes and an important one. With the splitting up
of the diagnosis the violence and murder rate for this group would be
exceptionally high - possibly higher than antisocial personality
disorder. And again the stigma would return, even with the linguistic
power of the label "Care Bears" to save the day. (I seem to be a little
sardonic today...) In fact I suspect that paranoid psychosis might be
one of the sub types in those studies but it was better to leave the
results in the article to make the point better. "paranoid" and
"psychosis" may have a stigma lower than "schizophrenia" however it will
still be significantly high.

Personally I feel that promoting social contact theory methods in
individuals is the way to change the stigma. What that means is people
who have experienced psychosis or delusions "come out" in public. Its
about people changing the perception of hearing voices and delusions
using the highest form of evidence used by most people: personal
experience. This is about individuals risking stigma and all that come
with it but I feel it will be the lasting way to rid the stigma. It
would be great to have a documentary like Secret Life of a Manic
Depressive to help people on their way. It significantly changed the
public perception of a diagnosis that could be seen as a Kraeplinian
sub-type of schizophrenia, so much so that it distorted the public
perception and made it a desireable state of the human condition.
There's obviously the need for a standard mass-media antistigma program
targeted at the most stigmatised mental disorders.

Alongside that there needs to be some sort of promotion of alternative
stereotypes and research into positives of schizophrenia. In Jung's
Psychological types (if I remember this right) he goes on about
schizophrenia at the extreme of a scale and that extreme is associated
with compassion and empathy or something. I'll have to find the bit and
reread it but its about real positive images to balance the negative
picture and quell the stereotype, rather than some fudge of language
that works for a couple of decades then the word has to be changed again
as is happening with Well being (or positive mental health as it used to
be known). Its about correcting the public perception of schizophrenia
such that they actually understand what it is and what the reality is:
the good and the bad.

Another way could be to censor the media who love to print stories about
psychotic killers, things that cause psychosis and things that prevent
psychosis but very rarely do they print positive stories about schizos.
I don't agree with censorship in any form though I understand that there
are salient reasons why there shouldn't be a free press and freedom of
speech and thought. Openmindedness and liberalism and all the value that
come with those ideals also come with a cost. However I've seen
something recently that might be an acceptable way to reduce the number
of front page stories and headlines about people with a diagnosis of
severe mental illness, most of which are negative stories that reinforce
the public stigma. The Sun newspaper was slapped on the wrist for using
"Schizo" in a head line. Their defence was it was used as a contraction
and my guess is that means they will have to use "schizophrenia"
instead. It sounds ridiculous unless you have an idea of what news
editors can think like. I can hear cries of "that's too many syllables"
from the sesquipedalophobia (fear of big words) news team and that's how
it'll keep stories about people with a diagnosis of schizophrenia off
the front pages.

The social contact theory solution is the one that is best in my opinon
at the moment however it may be a view based on the naivety that social
change can happen through this method. I believe it can but I'm not
sure. I feel it is the right method because it is about the truth of
schizophrenia. Its not about propaganda. Its about balance. Perhaps this
is a view based on previous roles working in information teams but its
also about my own endeavours to understand what the /concept/ actually
meant. In the end making a value judgement on schizophrenia is something
that I am incapable of: the truth is that it is something that exists
but can be looked at as good and bad and good or bad.

Someone else may think it better to wipe the slate clean and manipulate
the definition because the public don't know what schizophrenia actually
is. They just know it's bad. The evidence shows that what its labelled
by medicine can have an effect on the perceptions of doctors and
patients. The treatment of the concept itself, i.e. the value judgement
in the West that it is a medical illness, also needs to change because
studies have shown that local conceptualisations other than the
biomedical model of treatment for schizophrenia may offer better
outcomes, and better outcomes than can be had by changing a word that
will have to be changed again in another twenty years time.

Legal and illegal drugs in healthcare

The research into LSD's potential for treatment of mental illnesses
reminded me of a thought (covered in a post from earlier on today).

There are two types of drugs for the mind in society and people assume
that there's a clear difference: psychiatric drugs and entheogens.

Psychiatric drugs can be obtained illegally and used for recreational
purposes just as entheogens can be used as psychiatric treatment or self
medication. There are differences and the noteworthy one is the speed of
action. Noteably most entheogens act within an hour. Psychiatric
narcotics such as SSRIs take days to weeks to work as do mood
stabilisers. For antipsychotics rapid delivery is usually through
injection. For rapid self-medication users smoke weed.

The potential for enthogens to be used in mental health is only now
beginning to be re-explored.

Drug stigma created by images of drug misuse from their unregulated
recreational use and historical stigma combine to make this research
very hard to do. In the US there has been progress but the UK government
has a more draconian stance on drugs and doesn't tolerate scientific
arguments.

It's a shame because there seems to be potential in this avenue of
research. Cannabis research in the US has already led to the development
of 3 new FDA-approved medicines to help with treat obesity (Rimonabant),
provide pain relief for multiple sclerosis (Sativex) and increase
appetite in AIDs patients and nausea and vomiting in cancer patients
(Marinol) as well as the discovery of the body's own THC-based system
(endocannabinoid system) which is leading to novel treatments for other
physical illnesses and better medicine's understanding of the human body.

There's a short article from the Society of Neuroscience that covers
some of the medicinial potential of cannabis and has useful references.
http://web.sfn.org/skins/main/pdf/brainbriefings/BrainBriefings_Dec2007.pdf

LSD for mental health research makes a come back.

After the demise of the Harvard Psychobicilin project 40 years ago
research into hallucinogeons was trapped by the stigmas associated with
hedonic use of the drug. There's been a recent resurgence and there are
some preliminary studies showing promising results for the treatment of
mental illnesses.

From this blog article
http://historypsychiatry.wordpress.com/2010/04/12/ect-and-lsd/

I found a link to another article recently published in the New York Times.
http://www.nytimes.com/2010/04/12/science/12psychedelics.html

Which refers to the study
RR Griffiths, WA Richards, MW Johnson, UD McCann, R Jesse. 2008.
"*Mystical-type experiences occasioned by psilocybin mediate the
attribution of personal meaning and spiritual significance 14 months
later.*" /Journal of Psychopharmacology,/ 22(6), 621-632.

And that's available for anyone to read at
http://csp.org/psilocybin/

And may have been funded by
http://www.heffter.org/
"
The Heffter Research Institute promotes research of the highest
scientific quality with the classical hallucinogens and related
compounds (sometimes called psychedelics) in order to contribute to a
greater understanding of the mind, leading to the improvement of the
human condition, and the alleviation of suffering.
"

Simplified coverage of the impact of this research for the promotion of
entheogens is available on this useful blog page.
http://jonesthought.wordpress.com/category/entheogens/page/2/

Waterboarding as psychotherapy

http://psychiatryandhistory.blogspot.com/2009/05/waterboarding-as-psychotherapy.html
"
While we are properly horrified to learn about the use of deliberate near-drowning (waterboarding) as an interrogation technique, it is worth noting that for a period of nearly two hundred years the same procedure was regarded as a form of psychotherapy. The influential seventeenth century physician Jan Baptiste Van Helmont (1580-1644), originated this treatment after observing that a madman, who was revived following an accidental near-drowning, was relieved of his mental symptoms. The most influential eighteenth century physican Hermann Boerhaave. (1668-1738) mentions the use of submersion in the treatment of insanity but recommends it for only the most desperate cases. Boerhaave's student Jerome Gaub also discusses the treatment and attributes its efficacy to anxiety. "The most deeply seated mental defects and the most incurable forms of madness" he writes, "may sometimes be rooted out by anxiety." Perhaps, he speculates, this is "because the tormented and frightened mind is revived by the terrible punishment of her greatly depressed senses…." He cites "men with minds held captive by the violence of love or grief," who recovered their soundness of mind when revived after accidental near-drowning. He insists that the cause of this recovery is the "frightful torment that near loss of life from suffocation inflicts on the mind." Gaub acknowledges that "submersion therapy" is "a terrible remedy" but adds that it is "one hardly to be exceed in efficacy." Gaub took the trouble to attempt a medical explanation of "submersion therapy." He argued that "submersion therapy" worked by provoking anxiety, which he understood as a powerful emotion caused by bodily changes. The most frequent cause of anxiety, he felt, is interference with respiration, which hinders the passage of blood through the lungs and thus places life in jeopardy. These bodily events affect the "common sensorium" [where mind and body meet] so as to excite ideas in the mind that cannot be contemplated without horror and cannot be dispelled. The value of such shock therapy was widely recognized in the eighteenth century. "In mania," a Montpellier doctor wrote in Diderot and D'Alembert's encyclopédie, "therapy is directed to the body, in which it aims to produce a shock and a deep disturbance ." Such ideas even influenced Philippe Pinel, who cites Van Helmont. Although Pinel did not use "submersion therapy," he did include the role of powerful emotions like fear in dispelling fixed ideas as a component of his moral therapy.
"

The power of images

http://www.ted.com/talks/jonathan_klein_photos_that_changed_the_world.html?utm_source=newsletter_weekly_2010-04-13&utm_campaign=newsletter_weekly&utm_medium=email
<http://www.ted.com/talks/jonathan_klein_photos_that_changed_the_world.html?utm_source=newsletter_weekly_2010-04-13&utm_campaign=newsletter_weekly&utm_medium=email>

A great 6 minute video from Ted.com by Jonathon Klein of Getty Images.

Images can change the world. Images can make a difference.

Government's aspirations for incapacity benefit

http://www.cicero-europe.com/Research-Analysis/Mental_Health_UK_Economy.pdf

This is a really interesting analysis I stumbled across in a search for
something else.

P11 has this graph.

This is what the recent changes in the UK's state welfare system are
about: the government's aspirations to get lots of people off medical
benefits. Its costing too much. Their aspiration is to get 1 million
people off incapacity benefit in a decade. 40% of people on IB have a
diagnosis of mental illness so there's going to be a lot of people
forced back into work or put on non-medical benefits if they can't work.

A short positive story from my life

When I was around 15 I was thrown out of home by my parents. They
couldn't handle me anymore. Its not surprising. I couldn't handle them
at the time either.

I ended up in a children's home in the Harlesden area. I still kept
attending the private school I went to. I started doing my GCSE exams
while I was in there. They moved me to a foster family within a month or
two and I finished my GCSEs. It was during this period I saw a
psychiatrist for the first time and they diagnosed me sane: a young kid
trying to be who they were in a strict home where that wasn't
acceptable. They may have thought my exams and the stress was making me
act out though I don't feel like that was a problem at the time. I
wasn't really interested in my exams or the grades. Being thrown out of
home was useful because all I could do was revise to keep me occupied. I
got very good grades because of that - so much so that the family were
more impressed with my grades than my cousin who got straight A* grades.

Within a a few months I returned home. After that my parents packed me
off to boarding school. I don't remember if I was already going to a
boarding school or not when I was thrown out of home. Like anyone else I
didn't really want to go but was accepting of any fate having gone
through the process of my life disintegrating. In the home I'd quickly
accepted a poor outcome. The two years at boarding school were two of
the best years of my life and I met some amazing people. The school I
went to took a lot of weird people and children that other schools
wouldn't take - children that I'm sure in the future may be given
diagnoses and excluded into special schools. It was a very liberal and
lefty school and very different from the two other private schools I'd
been to. I could grow and grow away from the rigourous standards of my
parents.

I applied to do a degree in Electronic Engineering. I applied to all the
top UK universities apart from Oxford and Cambridge (those just weren't
me) and was accepted by all of them. Through the interview at Imperial
College - the number 2 place in the world for my course - I was put in
touch with the Year In Industry scheme (http://www.yini.org.uk/) which
seeks "captains of industry in 20 years time" and gives them gap year
work experience and accelerated training.

I ended up working in Farnborough for the National Remote Sensing Centre
(now http://www.infoterra-global.com/). I ended up working as a
programmer for an image satellite data dissemnination system. The
project was for a state of the art imaging satellite called the ENVISAT
and it was a multinational European Space Agency project. I helped out
the programmers but also learnt a lot about programming and computers at
a very high level as well as seeing how a project is managed.

I usually summarise this story to "I know someone who was in a
children's home when they were 15 and programming for a European Space
Agency satellite when they were 18 so anything can happen."

I leave out a lot of important detail in the one line summary that makes
it less of a positive story but I still feel there is a postiive point
to be taken: anything can happen. There's a lot of bad things that
happen of course but sometimes its worth shutting that negative voice up
and just enjoying the hope that positive things can happen for you too.

Peace breaks out!

Wouldn't that be an amazing headline that might make everyone happy but
we thought we'd never read?

A superb talk by Steven Pinker.
http://www.ted.com/talks/lang/eng/steven_pinker_on_the_myth_of_violence.html

The first ten minutes offers a load of evidence to prove the point that
we live in a peaceful world but we don't realise it.

If you're ever unhappy about the world then perhaps take the time to sit
through the first half of this video. We live in peace. In a way we live
in the future. Its not a perfect peace but its getting better all the
time and its come such a long way in the last few centuries. It can
always be better of course but its worth appreciating what's here now:
imperfect world peace.

Comments on a talk about religon, demographics and politics

I went to a talk last night at the RSA (Royal Society for the
encouragement of Arts, Manufactures and Commerce) in association with
New Humanist magazine by Eric Kaufman.

The guy was talking about his theory that fundamentalist religous sects
could gain significant political power in developed nations by 2050
through increased procreation. Its actually a reasonably sound theory
based on birth rate trends. The West has seen a decline in birth rates
such that it's less than 2.1. People are living longer and immigration
keeps the population growing. This decline in birth rate is happening
all over the place but cetain religious sects such as Mormons, certain
Islamic groups or ultra-orthodox Jews have high birth rates and
significantly higher than the local population. These particular sects
isolate their offspring to the religious community and are strict in
rejecting any change from society so there is no contamination of the
ideology and culture and their is little loss from people leaving to
join mainstream society. These populations will grow much faster may
emigrate to the West. In America the right-wing Christian lobby is
pretty powerful such that there are attempts to get evolution not taught
in schools. And that's the fear: that science and/or rationalist dogma
will be inhibited. George Bush banned state-funded research using stem
cells because of religious reasons and not scientific ones so the
potential for this to happen is definitely there.

Is it a bad thing is also another question. Science and rationalism is
the new dogma in the post-Enlightment and its a good one. It provides
good answers. But it doesn't do everything. Its hasn't replaced the
teachings of religions in providing a guide to life. It doesn't provide
a sense of good or bad, just rational decision making and that can be
cold and unemotional. It can dehumanise humans and that's certainly true
in mental health in the past and possibly the present.

I am for more liberal, open minded and progressive thinking in all areas
and I'm not sure I'd swap the general liberal attitude of science today
for the constraints on science imposed by religons past and present, and
strongest in the religious fundamentalist groups. I'm a product of the
new religion of rationalism and science though I've found the answers it
provides in mental health are not as useful as the answers found using
philosophies other than positivisitic science. The dogma of rationality
and science also break down into sub-cultures each with their own
interpretations of the 'gospel' truth and to me this feels like some
truth of human nature: that even in solidarity we disagree.

How much research is indexed by Google Scholar with Love, Depression, Schizophrenia, Money and Silicon in.

A quick Google Scholar search shows 136,000 papers indexed with "Love"
in the title compared to the 242,000 papers with "depression" in,
126,000 with "schizophrenia", 83,200 with "bipolar", 110,000 with
"money" and 400,000 with "silicon".

Settings were to only search in the title (so author names wouldn't be
counted) through research from any time period. It excluded any patents
and searched in all categories in the Google Scholar database. This
could be extended to include other indexes and the counts averaged to
make the quality more robust but I think its more interesting to try
other words like "religion" (167,000), "politics" (308,000, "humour OR
humor" (36,100), "cheese" (47,100), "porn" (1,060 and rising to 6,120
with pornography and pornographic included).

This, I'm afraid, proves very little but there's probably a lot of
inferences that could be made from it. There's an interesting question
that it tries to answer. How much research has there been in indexed
academic literature on the spectrum of the human condition and how does
that compare with other areas of research.

Going through other elements like "carbon" (566,000), "iron" (385,000),
"hydrogen" 380,000 and "oxygen" (351,000) shows the levels of research
(indexed by Google) that have gone into the understanding of the
physical world. The mental world of our inner mind and the human
condition has been little studied in scientific literature in comparison
and most of the research is in mental health.

The comparison for all British Journal of Psychiatry papers every
published are "love" (39), "depression" (1178), "schizophrenia" (1784),
"bipolar" (206 - though this excludes papers on manic depression), money
(15) and silicon (1).

These searches could also be refined to use lots of key words, so the
example with bipolar would be to include "mania", "manic", "manic
depression" and "manic depressive."

Mildly amusing research on the word "mate"

From the Journal of Pragmatics. This is worth of an IG Noble award.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VCW-4XH566V-3&_user=10&_coverDate=05/31/2010&_rdoc=3&_fmt=high&_orig=browse&_srch=doc-info(%23toc%235965%232010%23999579994%231805709%23FLP%23display%23Volume)&_cdi=5965&_sort=d&_docanchor=&_ct=18&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c4151948d2f1003e9fe5d642a0b9fea8
<http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VCW-4XH566V-3&_user=10&_coverDate=05/31/2010&_rdoc=3&_fmt=high&_orig=browse&_srch=doc-info%28%23toc%235965%232010%23999579994%231805709%23FLP%23display%23Volume%29&_cdi=5965&_sort=d&_docanchor=&_ct=18&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c4151948d2f1003e9fe5d642a0b9fea8>
*

Rendle-Short, J. 2009,

*'Mate' as a term of address in ordinary interaction, Journal of Pragmatics.
This paper focuses on the sequential environment of the address term
'mate', contrasting the post-positioned 'mate' (e.g. 'hello mate') with
the pre-positioned 'mate' (e.g. 'mate how are ya'). Because 'mate'
occurs in a wide variety of situations and carries with it a range of
interpretations, it is an extremely popular term that can be used not
only when talking to friends, but also between casual acquaintances who
may never talk to each other again. However, it can also be negatively
interpreted, especially in ironic and antagonistic contexts. This paper
will argue that the interpretation of 'mate' is closely tied to its
sequential placement. When post-positioned, 'mate' overwhelmingly occurs
in openings and closings of conversations or following assessments,
agreements, acknowledgements and appreciations, presenting an attitude
of open friendliness towards the other person. This is no more evident
than when 'mate' plays a mitigating role following requests, advice
giving or even disagreements. However when pre-positioned, it changes
the sequential organization of the talk (as do pre-positioned address
terms in general), giving the turn first status. It will be argued that
it is only through understanding its sequential position that we can
begin to understand why 'mate' is sometimes interpreted as antagonistic
or hostile.

Schizophrenia Annual Evidence Update 2010

http://www.library.nhs.uk/mentalHealth/viewResource.aspx?resid=344877&code=02bba06da977614010c8425cde9d6024
<http://www.library.nhs.uk/mentalHealth/viewResource.aspx?resid=344877&code=02bba06da977614010c8425cde9d6024>

The need for progress

Extreme treatments, treatments of last resort, dangerous treatments and
high risk treatments are all things that medicine and society should
work towards to stop using in mental health. Society also needs to
recognise that there are other ways to do change mental health outcomes
in mental health other than medicating or talking to an individual. The
loss of potential of the individual and contribution of the individual
through the effects of the symptoms of mental illness are a loss to
everyone. Society needs to change to see the value of those who have the
symptoms of mental illness and value their contribution just as this is
necessary for other groups such as the elderly and ethnic minorities.

A brief, insightful and amusing paraody of mental health

http://www.youtube.com/watch?v=jd4tugPM83c&feature=fvw
<http://www.youtube.com/watch?v=jd4tugPM83c&feature=fvw>

Cool beans! lol.

A study I haven't enjoyed reading showing loss of grey matter in children with a diagnosis of schizophrenia.

MAPPING ADOLESCENT BRAIN CHANGE REVEALS DYNAMIC WAVE OF ACCELERATED GRAY
MATTER LOSS IN VERY EARLY-ONSET SCHIZOPHRENIA
http://www.loni.ucla.edu/~thompson/MEDIA/PNAS/Schizo_article_PNAS_pdf.pdf
<http://www.loni.ucla.edu/%7Ethompson/MEDIA/PNAS/Schizo_article_PNAS_pdf.pdf>

At a mental health event a few weeks ago an advocate spoke to a doctor
telling parents their child's brain would deteriorate through
schizophrenia unless medicated using antipsychotics. I thought this was
bullshit like the "chemical imbalance in the brain" line. I may be
wrong. From this study which uses a small sample of patients, controls
and medicated controls with psychotic but not affective disorders other
than schizophrenia, it shows that a child's brain will deteriorate and
this is caused by the 'disease' process. I'm still not ready to give up
on the idea that psychosis may have other significance than brain
malfunction but its a powerful piece of evidence that it is a disease in
the classic sense of mental illness.

I'm not capable of assessing for quality. The small numbers would be
something I'd ordinarily take exception to but the authors suggest the
results are consistent. The loss in grey matter is also observed in
children without a diagnosis of schizophrenia or not taking medication
however it is significantly larger in children with a diagnosis. Clearly
the change from child to adult is associated with a loss in grey matter
but to a lesser degree than those who recieve a diagnosis of schizophrenia.

To the advocate I'd say that this paper is a research paper. The
diagnostic criteria used is DSM-IIIR which is not used in practice and
in the UK, so the results may not be applicable unless the same level of
rigour is used to identify schizophrenia. The paper also goes on to say
that schizophrenia is not only biological in cause and there are
environmental aspects. For the Psychosis Not Otherwise Specfied control
group the loss in grey matter was "subtle but significant" and none of
the group recieved a diagnosis of schizophrenia at follow up so getting
the diagnosis right is vital before giving a diagnosis of schizophrenia.

The thought I have is that many things could be looked at under the lens
of an fMRI scanner and many observations made about the way the brain is
somehow different. I'd be interested to see if there's been scans done
on people who have recovered from schizophrenia or have survived it
without medication. The latter group would be a useful control to see
the effect of medication on developmental neurobiology.

Information about the brain degeneration aspect of schizophrenia is
explained in a simpler form below but the study, though very complex for
anyone (like me) who knows little about neuroscience, is worth a read..
http://www.schizophrenia.com/research/schiz.brain.htm

An extraordinary result about untreated depression.

I came across this while reading a blog post from a superb blog.
http://www.madinamerica.com/madinamerica.com/Home/D6B7C500-5324-423B-BA01-C57B306C0F2D.html

From
http://www.madinamerica.com/madinamerica.com/Home/D6B7C500-5324-423B-BA01-C57B306C0F2D_files/The%20naturalistic%20course%20of%20major%20depression%20n%20the%20absence%20of%20somatic%20therapy.PDF
"
Our analysis of the subgroup of depressed subjects who
went without somatic therapy throughout the entire course of
their depressive illness yielded a median episode duration of
13 weeks-nearly identical to what Coryell et al. (1995)
reported in a separate cohort of subjects who did not receive
somatic treatment. Subseqent to the the first 3 months of illness,
the spontaneous remission rate appears to decrease dramatically,
though a substantial number continue to recover so that
by the end of I year, only 15% of the subjects who had not
received any antidepressant medication treatment were still
depressed.
"
Which leads the authors to say
"
If as many as 85% of depressed individuals who go
without somatic treatment spontaneously recover within 1
year, it would be extremely difficult for any intervention to
demonstrate a superior result to this.
"

Its not a high quality study though the analysis seems sound and its not
the only study to show a similar result including a meta-analysis by one
of the study authors.

There's another useful paper the blogger's has online.
http://www.madinamerica.com/madinamerica.com/Depression_files/Characteristics%20and%20significance%20of%20untreated%20major%20depressive%20disorder.PDF

Depression ramble

This ramble is on a lot of things. Its in part about language and
conceptualising depression and mental illness outside their medical
sense, and perhaps in their real sense. Its about treatment for
depression and another way of looking at things.
----
Depression is an affective disorder in psychiatric terms. Its also
unhappiness and misery in normal language.

Sometimes unhappiness happens for a reason. Sometimes it doesn't. The
difference is usually not clear and often not the the reason. 2 weeks is
psychiatric minimum for the cluster of symptoms it uses to define
depression though it caveats grief as a natural process and applies a
much longer time for unhappiness associated with death (2 years in DSM
if I remember right). Bereavement and the pain associated with it
defined as acceptable misery whereas any other form of misery is dealt
with by medication.

On the one hand treatment with antidepressants is compassionate. Its
society providing drugs that get people high and away from their
problems, and its a lot cheaper than alcohol and drugs. Antidepressants
also offer hope to those trapped in the deepest of miseries, or what was
traditionally defined as melancholia in Kraeplin's day. They are a much
better than an electrically-induced seizure, or electro-convulsive
therapy as doctors call it. Thankfully the majority of people don't get
to that stage.

Its easier than attempting to understand why an individual may be
unhappy or miserable. Its easier for the individual if the negative
feeling, or the emotional and behavioural disorder to use the
psychiatric language, is about a change process because that process can
be averted or the pain taken away by all sorts of drugs. It may be
easier for society to hand out drugs to deal with the unhappiness of the
masses rather than see that perhaps society isn't working. It may be
considered better by governments focused on productivity as the value of
an individual that a person stays working and the drugs mean they're
capable of doing that whereas the change process may mean they could
temporarily be in a state where they could not work or should not work.

The reflection and the soul searching that can be associated with
unhappiness, the depth of thought and the seeking of answers that can be
associated with unhappiness may be important to an individual's journey
through life however society is not designed to understand that people
need that time without the mental illness system, however the system
often moves to medication people far too quickly and mistreats something
that may have significance to the individual outside psychiatric
measures of mood.

A society where 10-15% of people are worred and unhappy at some point in
the year, or anxious and depressed, is a distressing figure in itself.
One option is to drug those people up and another is to offer them
treatments to change the way they think and behave. It is perhaps
something in the vision of modern government but far from a reality that
the other option is to change society such that people are less unhappy
and worried. The systems that have developed within society are causing
the suffering in individuals but to see that may be hard for politicians.

It will be likely be the next century where the 1 in 4 or 1 in 6 figure
is seen as a measure of the failure of society and a government willing
to understand that large changes are needed to correct the illness in
society that's causing the distress.