ugh. One more thing.

The figure for number of people that died through the use of
antipsychotics in people with dementia. It's a question I asked myself
in a previous blog post
<http://imaginendless.blogspot.com/2010/07/there-are-real-mental-illnesses.html>.

It's 1,800 deaths a year
<http://www.nhs.uk/news/2009/10October/Pages/Antipsychotic-use-in-dementia.aspx>
in the UK. That's a lot. I think that's higher than the number of murders.

I should probably ask how the hell antipsychotics became used to treat
dementia patients enmasse. How did the medical profession allow this to
happen? They're not murderers. I know lots of doctors. They're people
doing their job and a very hard job. It just seems there isn't enough
oversight. It's a bit like the bankers. They're human but the unintended
consequences of their mistakes means people die.

It is a strong piece of evidence that should be enough for anyone to
work out that people who have to take antipsychotic medication for life
will have a reduced life expectancy caused by the chemical cosh.

In 2010 though there is no alternative based on the current paradigm of
research published in established peer reviewed journals. I suppose I
should get on and leaf through Schizophrenia Bulletin to see if there's
anything in there but I'm so tired and I haven't eaten and I just want
to cry but I can't.

I smashed up my laptop last night so this will probably be the last post in a while

I smashed it up while I was reading

A Systematic Review of Mortality in Schizophrenia
Is the Differential Mortality Gap Worsening Over Time?
Sukanta Saha, MSc, MCN; David Chant, PhD; John McGrath, MD, PhD, FRANZCP
Arch Gen Psychiatry. 2007;64(10):1123-1131.
http://archpsyc.ama-assn.org/cgi/content/abstract/64/10/1123

It shows the standardised (all cause) mortality rates or ratio (SMR) for
people with schizophrenia in a few countries. The UK and the US come out
worst. This isn't a repeat of the IPSS result that showedbetter outcomes
in the developing world. Countries like Norway have a lower SMR than
neighbouring Finland and a considerably lower SMR than the UK. Norway
has an SMR of 1 which I think means people with a diagnosis of
schizophrenia in Norway live as long as people without a diagnosis of
schizophrenia.

I don't know why it happens. There might be some information in the rest
of the paper. To my untrained mind the significant difference between
the SMR in the UK and US is pretty significant.

In my mind I think working out what the other countries are doing and
applying it in the UK might improve the reduced life expectancy and
perhaps there are solutions so people wouldn't be prescribed clozapine.
The research on it's own makes a clear point that there's wrong with
mental health services in the UK that can be improved and the reduction
in life expectancy may, perhaps, be enough to knock up a health
economics argument to get whatever is working in those other countries
implemented here.

Why did I smash my laptop?

Anyway, there'll be a hiatus on this blog. I fancy renaming it
"Futility" or pissing in the ocean but I'd just be projecting what I am.

Here's what the charity tragedy model really means

From
http://www.copower.org/leader/models.htm#tragedy

There's some good stuff on that page on other models of disability.

"
Tragedy/Charity Model of Disability

The Tragedy/Charity Model depicts disabled people as victims of
circumstance, deserving of pity. This and Medical Model are probably the
ones most used by non-disabled people to define and explain disability.

Traditionally used by charities in the competitive business of
fund-raising, the application of the Tragedy/Charity Model is
graphically illustrated in the televised Children in Need appeals in
which disabled children are depicted alongside young "victims" of
famine, poverty, child abuse and other circumstances. Whilst such
appeals raise considerable funds for services and equipment which are
not provided by the state, many disabled people find the negative
victim-image thoroughly offensive. In fact Children in Need has been
described as "televisual garbage … oppressive to disabled people" M.
Oliver quoted in C. Donnellan "Disabilities and Discrimination Issues
for the Nineties" 1982. Some go as far as interpreting the tragic
portrayal as a means of maintaining a flow of donations and keeping
able-bodied people in work.

The Tragedy/Charity Model is condemned by its critics as dis-enabling,
and the cause of much discrimination. Speaking on the BBC Everyman
program The Fifth Gospel (date?), Nabil Shaban said: "The biggest
problem that we, the disabled have, is that you, the non-disabled, are
only comfortable when you see us as icons of pity." Because disabled
people are seen as tragic victims, it follows that they need care, are
not capable of looking after themselves or managing their own affairs,
and need charity in order to survive.

From tragedy and pity stems a culture "care". Although highly
praiseworthy in many respects, it carries certain dangers. Numerous
charities exist to support and care for people with a particular type of
disability, thereby medically classifying, segregating and often – as
with the Medical Model – institutionalizing many disabled people. Over
400,000 adults in Great Britain are affected by institutionalization
Given the choice, many, if not most would opt for community life with
adequate support.

The idea of if being recipients of charity lowers the self-esteem of
people with disabilities. In the eyes of "pitying" donors, charitable
giving carries with it an expectation of gratitude and a set of terms
imposed upon the beneficiary. The first is patronizing; the second
limiting upon the choices open to disabled people. Also, employers will
view disabled people as charitable cases. Rather than address the real
issues of creating a workplace conducive to the employment of people
with disabilities, employers may conclude that making charitable
donations meets social and economic obligations.

This is not to advocate dismantling charities and outlaw caring,
charitable acts, which enrich our society and bring badly needed funds.
But we do need to educate charity managers and professionals to review
the way they operate and ensure that funds are channeled to promote the
empowerment of disabled people and their full integration into our
society as equal citizens – requiring our respect and not our pity.
"

I think I agree with this.

ooops

The poem (below) is an example of charity and tragedy. That's all.

A poem from the 19th century about idiots that I think is an example of the charity-tragedy model of disability

From
http://www.educatejournal.org/index.php?journal=educate&page=article&op=viewFile&path[]=48&path[]=44
<http://www.educatejournal.org/index.php?journal=educate&page=article&op=viewFile&path[]=48&path[]=44>

"
A mental blindness seals his eye
To this fair earth of ours;
He sees no brightness in the sun
No beauty in the flowers.

Sweet sounds that gladden other hearts
He seemeth not to hear,
The melodies of singing birds
Touch not his untuned ear.

Yet not upon him may we gaze
With cold despairing eye,
'Tis not decreed the idiot born
Must a poor idiot die.

Yes, 'tis a blessed charity
The fetters to unbind,
That hold the dull imprison'd soul,
The dark and hidden mind.

And God will surely give to those
His blessing and His love,
Who rightly use their better gifts
Affliction to remove.
"

It's in the last line where there's the tragedy. There's a model of
disability where blindness isn't something that should be taken away. In
that model society is made for blind people because blind people are
part of society and the diversity of the human race in an advanced
civilisation. If electronic engineers ever invent a replacement eyeball
it wouldn't be used. If genetics means no babies will be born who are
blind that science is never used. Society is adapted to the blind
instead, as it should be.

oh, yeah. And another thing for clozapine

For the children who end up on clozapine put them on the "Education,
education, education" programme so they have the best opportunites for
later life. Stick them in the best schools and the best universitites,
give them extra tutition and whatever else it takes to make sure that
these kids have every opportunity in the future.

I see this like electron tunneling through the poorer outcomes. In my
weird head it's like when an electron jumps through an energy barrier.
This was an effect that couldn't happen in classic science and it was a
surprise when it was discovered in the sub atomic physics that goes into
the development of Silicon-based transistors. It's like a person walking
through a wall instead of using a door. Or a match spontaneously
lighting without being struck. It just can't happen. But it does and I
reckon the "Education, education, education" programme is one
alternative or additional treatment that could be used for any child who
ends up on clozapine.

A short summary of what I can remember off the top off my head about clozpaine

I now understand why it is so beloved by the medical profession. It
has the highest capability to treat behaviours that are highly
undesireable. The capability to 'treat' the suicide rate may be achieved
by it's anti-aggression properties. I think it treats all the other
psychopathological problems that can cause psychosocial problems better
than anything else, for example stuff like thought disorder, but I'm not
sure on that. I still don't know enough about the measures. It is the
most powerful chemical cosh. I haven't found the research done in the UK
to show this but I think there is a very high level of non-compliance
with clozapine. Patients don't like taking it. There is research on the
use of clozapine and lithium in the US in children (two subjects, one 7
and one 12). Lithium is not used for it's psychoactive properties but to
boost the immune system, though it will still have the effect of
reducing and/or removing emotional range in these children. It's use as
an adjunct is common (I think) as a way to boost the white blood cell
count.

The blood monitoring halved the number of people who died from taking
clozapine. Afro-Caribbeans are at greater risk from agranylocytosis and
neuroptenia (a milder version that doesn't kill but is still an illness
and makes people vulnerable to other illnesses) but this is reduced by
lower thresholds for discontinuation of clozapine used by the Clozapine
Patient Monitoring Service.

It may or may not be the best drug at reducing the delusions or voices.
It's use is spreading and this may be off license use. It is a very
powerful chemical of behavioral control that could be used
illegitimately e.g. in high security prisons instead of seclusion. In
the only RCT in a (US) review clozapine was shown to be the best at
treating suicidal behaviours but did not affect the completed suicide
rate which seems contrary to the Finnish observational study that was
published last year which had a whopping great sample size though was
totally quantitative and showed the most dangerous psychiatric drug also
offered the longest life expectancy for people with a diagnosis of
schizophrenia.

But there is no conclusion from me and I have found no alternative. I
need to keep reading and I will do.

I know it can't be used but there is no alternative according to the
biomedical model of treatment and the behavioural control one. There
isn't the qualitative research I can find yet in the UK that speaks of
the patient experience of being medicated with the strongest chemical
cosh. The paper I've found on UK patient experience (published in the
BJPsych) was, in my opinion, not very good and biased. Obviously most
patients have little say in their treatment. All of them should probably
be informed of the risks and their carers too.

Honestly I don't know enough about the psychosocial model nor
psychological therapies and other sorts of non-pharmacological
techniques however the stuff that NICE looks at shows that nothing works
better than the non-therapeutic controls except medication (which is
compared to pill placebo rather than therapeutic placebo) in high
quality research using psychopathological, biomedical model measures
that are designed to be medication sensitive.

This is hard. I may be wrong. I may have wasted my time. I'm going to
keep going though because I'm arrogant enough to know that I'm right
that clozapine just can't be used, especially in children. It is
arrogance though and it is not a fact.

A prank that could be useful

I imagine this is sent out in the evening close to when people are
going to bed.

It's a simple prank. Turn to the person sitting next to you and say
"Isle of View".

That's the message. It has to be sent out in text form because the prank
is based on how those words sound when spoken.

In my mad little mind I see someone reading this then turning to the
person they go to bed with and accidentally telling them how they feel.
I don't know how often people tell each other "I love you" but it's
something that doesn't happen enough.

The problem with the prank is those people who can't tell anyone. Many
mentally ill people have problems with relationships. It's worse for
people with severe mental illnesses. While I am insensitive to the
loneliness that comes with my being in 2010 the misery of realising that
they have no one to say those words to may hurt some people.

Legal aid and the mentally ill

Psychological therapies seem to have survived the governments budget
cut backs. Lots of campaigners and the big organisations had a huge
impact in making sure mental healthcare was on the agenda.

It seems like the Legal Aid system is going to suffer though. It makes
up £2.1 billion of the Ministry of Justice's £9 billion budget.
http://www.guardian.co.uk/law/2010/may/18/legal-aid-cuts-ken-clarke

That's right. Justice and lawyers are very expensive.

Personally I think £2.1 billion is a total bargain for justice. Without
the legal aid system the poor are disadvantaged. It therefore becomes an
unequal system of justice. The system is also very complicated which is
why lawyers are needed to help people through it.

The mentally ill are also disadvantaged with less legal aid. It's not
just Mental Health Review Tribunals. There are many aspects of the law
and social welfare which impact upon the lives of the mentally ill.

I have a dear friend who works for one of the finest legal aid firms in
the UK. She's told me what happens when she's dealt with mentally ill
clients. She finds lots of people aren't even aware of their rights and
how the law protects them. A person may come in with a simple problem
but it turns out they have lots of legal issues. It might be for getting
a higher level of benefit which the person is legally entitled to but
their social worker hasn't sorted it out then it turns out that the
social worker hasn't sorted out something else.

The new funding system isn't set up to cope with that. She is trapped in
trying to help her client to the best of her ability and helping her
next client because any more time she takes doesn't come from an
unlimited budget.

Legal aid firms are struggling in this new climate and as the article
suggests they're turning to call centre techniques to manage the volume
and, I suspect, turning away people who may be complicated cases. That
means there may be legal aid services turning away mentally ill people
because they can't afford to deal with complex cases.

Any increase in the level of injustice caused by the new legal aid
system will affect the mentally ill more.

A thought about the future of psychiatry

Psychiatrist at the moment are really like GPs in the sense that most
of them cover a wide range of disorders. In physical medicine there's a
lot more specialisation and that makes sense. I'm not sure why it hasn't
happened in psychiatry. There are psychiatrists who specialise in
certain disorders or groups but there's no specialisms like there's
opthamology or geriatrics or whatever. If an individual wants to find a
specialist psychiatrist there really aren't many routes available.

There are real mental illnesses

Though even they have a strong psychosocial element.

Organic dementia. I think this is the mental illness that is a mental
illness like in the biomedical model, i.e. a real medical illness. It's
also part of life that as the human body ages the brain deteriorates and
it's untreatable as far as I am aware.

Well.....the mental illness isn't treatable at a biological level,.
Demented people are problematic though so let's use the word mental
health problem to describe the medicalisation of problematic states of
mind. Honest is so much better don't you think? The problematicness of
the old people with demenita can be treated by antipsychotics, but they
don't address the biological illness.

I remember a conversation with my poor, poor younger sister. She works
in geriatrics. She's going to be one of the best doctors ever, but don't
you dare tell her that. We had a conversation (one of very few) about
one of her patients. Her patient was an elderly man close to death. He
didn't know what was going on around him. His sense of the external
world and what was happening around them had been shattered through the
organic degeneration process associated with the human animal reaching
the end of it's life.

She was in tears and as usual I was a bit of a cunt. She was in tears
because the man had thrown hot coffee on her. The reason why I think my
sister is going to be a great doctor is because she's got a heart bigger
than her brain, and she's fucking smart. Even the most challenging
patient wouldn't be aggressive to my sister. Trust me on that.

I ended up trying to persuade her that the guy was lost and it was time
for a alternative intervention. Anyway, I suggested getting in some
homeopathic or alternative healer since she'd reached the point where
there was nothing she could do medically (apart from dose him up on
antipsychotics). Of course she was cynical at her non-medical profession
brother's idea but I explain that an alternative healer might look at
other things.

The patient who had spent most of his life working and being useful,
surrounded by friends and family and familiarity was suddenly in
hospital surrounded by doctors. He didn't recognise his family
consciously and may not have recognised his environment. It was my
belief that the man was still there, confused and trapped and suffering.
He was confused and that was why he got angry and tipped hot tea on my
sister. My sister told me he'd been a mechanic or an electrician and I
suggested giving him a screwdriver (which may not have been safe) or
something so he had a handle on who or what he was even if he was
confused and in pain.

Anyway, what was I talking about? Or yeah. There are real mental
illnesses in the truest sense of the word. The modern use of the term is
far wider and encompasses many things that are not really medical
illnesses however medicine now considers the obesity an illness..

However this difference has been somewhat been observed throughout the
history of psychiatry. I keep name dropping Kraeplian but many other
people had a significant influence on the development of the idea and
the concept of mental health and mental illness and what it has become now.

The biomedical model of mental health problems is the only way they can
be accurately seen as an illness however the idea of prognosis, i.e. the
poorer outcomes, is used to justify the alternative model of why they're
illnesses.

The rest is a necessary metaphor or way of understanding, because
without the social model of mental ill health and disability many, many,
many people who are disadvantaged because their emotions or their
behaviour is not cool or socially acceptable at the present time.

It's where the benefits system comes from. The privilege of the invalid
isn't extended to malingers. It is considered important that doctors
could identify the difference between depression and malingering or
laziness. One is genuinely an illness and that's why the privilege of
the benefits system is extended to them. That's why the cluster of
symptoms approach and operational definitions are useful. I'll use
myself as an example. Poor appetite alone, even if it's been going on
for a long time and is causing biological problems that look like
depression, is just one of the cluster of symptoms for depression. It's
not based on body image because I'm well aware I'm too thin and that's
not attractive in men. I eat kebabs when I'm drunk and I started to eat
meat again to try and boost my food intake so it's definitely not like
any of the other eating disorder/body image disorders that I've heard
of. It's killing me slowly though.

Anyway, it's my hope that one day mental illnesses like organic dementia
may be able to be reversed. It's a scary thought because it'll mean
people will be functioning past 100 years old. Until that day arrives
the problematicness of the mentally ill and the techniques society uses
to 'treat' the mental health problematic people are important.

Antipsychotics became used to treat the problematicness of old people
with dementia because these drugs make them easier to deal with for
carers and doctors. A significant study which thankfully prompted the
government to review its dementia strategy showed that the use of
antipsychotics in dementia reduced the life expectancy of old people
close to death by 50%.

That effect on life expectancy might be considered ok if the treatment
was genuinely treatment. Society leaves doctors to get on with making
good treatment decisions based on the evidence. Sadly the case was many
people in the UK were unnecessarily killed through the misuse of
antipsychotics because of that prized but little acknowledged effect
they have, the effect that's so well expressed by the term "chemical
cosh" though I still like the term chemical straightjacket.

I wonder how many people died for society's convenience?

Alternatives to medication or psycholgical therapies for depression

So depression usually stops after a year for 85% of people according to one study done ages ago. But people don't want to wait a year to stop being miserable and the state doesn't want people to be not working.

Some people prefer to wait for a natural recovery. They face a more painful path. A way to pass the time productively and retain their skills is to blog (if their work was the sort of thing that would apply to blogging). So a lawyer who was unemployed might put his energy into blogging rather than watching day time TV and when they returned to work they'd have their work capacity still there. The proverbial knife would still be sharp. I'm not sure if the material the person blogged on would be important or not. I've clearly blogged on mental health. Jack of Kent was unemployed for a short time and I'd guess he put his time into his excellent legal blog.

A return to work may still be difficult. It's why volunteering while depressed makes sense. (that's volunteering after the person's got 'used' to the depression). Volunteering is no stress, the individual gets some of the benefits of work without the pay or the problems that come with externalisation of depression in organisations. They get that bit of routine and they get to feel useful. They also don't get into the routine that can become the benefits trap.

This option sounds really harsh because it sounds like I'm saying people should volunteer while they're depressed. That's not what I'm saying but I'm sure it would make sense for the current government shakeup of the welfare system. I'm talking about keeping a person active in some way as a way to stop them plunging into deeper depression. Yes, there's an aspect of this which is like asking a person who's broken their leg to go and walk on it. It's not a fair example to use but it's true in the sense that a person with a broken leg walks on crutches and has a cast, and volunteering is sort of that cast.

As I'm reading another paper at the moment about intellectual disabilities I'm thinking (again) that so-called mental illnesses may exist because of the change in civilisation that happened around the time of the industrial revolution. Mass schooling created the automatons ready for mass production factory-type jobs and lives. It was a significant leap in progress to institute a medical benefits system that supported those that weren't automatons (I've replaced the word normal with automaton).

These two ways to keep a person active and minimise the occupational dullness that comes through inactivity are pointless because most people who are told they have depression take doctors advice and take drugs. I just imagine that one day when we're closer to utopia people will think about non-pharmcoological approaches and approaches that involve a therapist and promote DIY mental health.

A small amount on intellectual disabilities (or idiocy?)

I've just started reading a fascinating and really heavy research paper.

From 'Idiot Child' to 'Mental Defective': schooling and the production
of intellectual disability in the UK 1850 -1944
by Shereen Benjamin
http://www.educatejournal.org/index.php?journal=educate&page=article&op=viewFile&path[]=48&path[]=44
<http://www.educatejournal.org/index.php?journal=educate&page=article&op=viewFile&path[]=48&path[]=44>

She (I assume it's a she)
"
One of the problems with writing about intellectual disabilities is of
knowing how
to name the phenomenon and the people about whom one is writing. This
problem has been in evidence throughout the past one hundred and fifty
years.
There can be no absolute notion of what constitutes intellectual
dis/ability, since
the means of coming to know about it is historically and socially
situated. Unlike
some physical and sensory impairments, a learning or intellectual impairment
cannot be discerned in the absence of instruments of normalisation
(Foucault,
1975). This is not to argue that intellectual impairments, whatever we
choose to
call them, do not exist. But the means of separating those who can be
categorised as intellectually disabled from the general population has been
produced through a discursive field in which the (political) imperative
to separate
out the economically unproductive from the productive has prevailed.
"

It's nice to have something expressed so well (or at least something I
agree with expressed well by someone smarter than me).

A silly idea for a social marketing campaign

There's a group on Facebook that's campaigning for Facebook to be
turned pink for a week to raise awareness of breast cancer.
http://www.facebook.com/pages/Turn-Facebook-Pink-For-Breast-Cancer/119451101426996?ref=search

There's a more popular one for Alzheimers.
http://www.facebook.com/pages/Turn-FacebookTM-Purple-For-A-Day-To-Raise-Alzheimers-Awareness/239326438796?ref=ts&v=wall
<http://www.facebook.com/pages/Turn-FacebookTM-Purple-For-A-Day-To-Raise-Alzheimers-Awareness/239326438796?ref=ts&v=wall>

Wouldn't it be amusing to start one to campaign to turn Facebook blue?
It's the sort of silly thing that could work. People might see the group
and skip past it because it was weird, or they might look in the group
to see what it's about because it's quirky. I think the mental health
fraternity/sorority could all come together to find it amusing.

These viral stunts are really touch and go but this is a totally no
effort idea. I remember seeing Psychiatric Barbie viral through the
mental health community on Facebook. Sadly I can't find the page anymore.

Here's a somewhat similar blog.
http://psychiatristbarbie.wordpress.com/

The PB team had some great content and that's what got people into it. A
talented media creative could make the turn Facebook blue for mental
health awareness or depression awareness into a workable idea that could
get a message across too. It might make a few depressed people on
Facebook smile briefly, and if that's not a worthy result then I'm not
sure I know what a worthy result is.

As always, it's just an idea.

It's a beautiful sunset tonight

But I can't take a photo.

Instead I'm going to do something I haven't done in a long time. Look at
a beautiful sunset.

What to do about a pledge to stop hurting people with bad words?

I don't agree that the whole climate change thing is based on solid evidence but I go to things like climate camp and do my bit in other ways.

There's a pledge I'm having trouble signing. I encourage you to sign it.
http://www.stampoutstigma.co.uk/pledge/#pledge

"
Send a clear message that we should not hurt people with mental illness and learning disabilities by calling them names that are offensive.
"

To me the very labels themselves are offensive but I use words like bipolar and schizoaffective and dual diagnosis and mixed affective disorder.

I had to go through a long process to become ok with the labels and I became ok with all the labels. I became proud of being mad. That's not a journey many psychiatrists will help a patient through. I am mentally ill but that is me. I am mad but that is me. I'm a lunatic, idiot, moron, cunt. That's me too. I'm a self-hating loser. That's me too. And I'm so fucked up I'm proud of that, or at least that's what my mask shows.

The campaign is called has a tag "sticks and stones" and it makes me think the campaign's a joke.

Sticks and stones will break my bones but names will never hurt me. Wasn't that the thing I was taught when I was young?

I get hurt when people stop people using words. But perhaps that's because I'm insensitive to the negative connotations. I had to become insensitive to them because a psychiatrist once used a perjorative word on me once. He called me "bipolar". I had to learn to accept my madness, my irrationality, chaoticness and all other manner of negative descriptions of me.

For all those who think there's nothing wrong with being bipolar you're right. Totally right. However...the label means society doesn't want you to be how you are. Your 'type' is unwanted. Your periods of irrationality (mania) and laziness (depression) can be taken away along with your emotions through treatment. Once you're not longer yourself you're recovered and normal. Underneath the language of mental illness there is this perspective but I think I'm probably the only person who thinks like this.

And psychiatrists. What they read, write and learn about the mentally ill is totally different from "mental health problems". Their perspective is different from the patients. They call mental illness behavioural and emotional disorders. They read articles in journals like Behavior Modification. They treat mental illnesses like pedophilia (in the US). The language they use has gotten better over the years however the concepts behind the words are the important thing, in my opinion.

But perhaps other people are less insensitive than me. Perhaps by MPs using the word it means those children who watch party politics and are into the voting process might think that nutters are also anti-Semetic, racist, homophobic or worse still...they are Conservatives. I think "Conservatives" shouldn't be used either. It's a horrible word to describe horrible people...sorry. Inappropriate humour for a piece about something that I'm passionate about.

In all seriousness it is a very difficult pledge to sign. I want to support the campaign but the campaign is something that's against what I stand for. I genuinely like the song Original Nutter and have danced to it many a time. I also like the song Bonkers. If I sign the pledge it's like signing those songs away, because that's what the movement behind this campaign want.

There's 14.146 people who think the pledge is important. They want 100,000 to take the pledge? There's a lot of people who are of the same cause as me who would sign that pledge.

Do I throw away my integrity for solidarity with a common cause?

A bit of the history of UK mental healthcare and the word idiot

http://www.institutions.org.uk/poor_law_unions/imbeciles.htm

"
1913
The Mental Deficiency Act 1913
Four "classes" of Mental Deficiency were defined:

Idiot ~ unable to protect themselves from common dangers.

Imbecile ~ could protect themselves from common dangers, but unable to
take care of themselves.

Feeble-Minded ~ required care to protect themselves.

Moral Defectives ~ criminal or vicious personalities. Unmarried Mothers
also became absorbed into this category!

The Board of Control was established who took on the powers and
responsibilities of the Lunacy Commissioners.
"

The word itself has been around for much longer.
http://www.etymonline.com/index.php?term=idiot

nutter

Apparently this word is no longer safe to be used. The PC police have
come down on Nick Clegg called the Conservative group in the European
Parliament as "nutters, anti-Semites, people who deny climate change
exists and homophobes" but has apologised to Stand to Reason.

Admittedly lumping nutters in with the rest of those other extreme
pariahs and perjoratives isn't very nice. I'm assuming the word was used
in it's sense of craziness rather than foraging.

As a nutter myself I don't see anything wrong with the word. There's no
real negative associations with it like the word psycho. The thing is
I've got no problem with the word psycho either though. I'm also not
wholly bought into the evidence for climate change. I must admit I feel
marginally annoyed that I'm lumped in with homophobes and anti-Semites.

People forget that learning disabilities and/or people with low IQs are
part of the group called the mentally ill. Idiots often forget that. The
reason I used the word idiot there is because it describes a mentally
deficient person. Only a stupid person wouldn't know that. And a dumb
person wouldn't realise that I've used 3 perjorative words for mental
illnesses in this paragraph, words that can be used by the media and
politicians.

Has there been a movement to ensure those with learning disabilities are
protected in the saw way people people with a diagnosis of antisocial
personality disorder are? The answer is no. Mencap get on with whatever
they do and have been rarely noted to speak out against the use of
language. The Mental Health Foundation have little media presence and
may have a better sense of sanity when it comes to the importance of
words. Mind don't really do learning disabilities stuff. I'm not sure
what Rethink do.

If Nick Clegg had called the Conservative group idiots instead of
nutters it would have been ok. If the Sun prints a headline that says
"thicko" or the Daily Mail prints "stupidity" that's ok but psycho and
schizo aren't.

I don't want to loose the word nutter. It's not usually a perjorative at
least in my head. It actually has a warm and fuzzy feel to the word. It
wouldn't be something I feel particularly bad about.

There's a jungle anthem by Shy Fx (with Apache doing the MCing I think)
called Original Nutter and it's a tune that's well know amongst 'heads.
It has the lyrics
"
Wha mi tell ya, rude bwoy
Watch it now, man

Mi are di nuttah
Original madmah madmah mad nuttah
Original madamadamadamadamadamadamadamadah nuttah
Original madmah madmah mad nuttah
Original madamadamadamadamadamah

Mi are di nuttah
Mi badder than di bad bwoy Darth Vader feared
Let off da Jedi where you are, Skywalker
Inna Wan's school dem call mi troublemaker
"

http://www.justsomelyrics.com/1218573/Shy-FX-Original-Nutter-Lyrics

It sounds better than it reads though perhaps if you're a Radio 4
listener you might not find it your cup of tea.
http://www.youtube.com/watch?v=ACCDZlLLV0I&feature=related
<http://www.youtube.com/watch?v=ACCDZlLLV0I&feature=related>

Would the politically correct police censor art and music? Of course
not. I'm being paranoid. That would be bonkers.

Something about me which I don't know what to title

The hardest thing I find to understand about myself, or at least the
quasi-insightful part of me, is the willingness to be looked at upon
like a shit. It's not just family and society. I remember when I was
very young - at junior school and stuff - and played kiss chase with
people. I was never attracted to men then but I had no problem with
people assuming my sexuality incorrectly. Nowadays I'm safely able to be
attracted to men without any of the anxiety or distress of worrying what
people would label me.

I've not yet managed to get over my internal prejudices and conditioning
to have sex with a man, let alone kiss one. I've not wanted to penetrate
a man nor have I wanted to be penetrated. I've wanted to kiss men I've
met and I've grown to not fear of that internal feeling but I've been a
pathetic loser in never acting upon it. This feeling hasn't been a
burning desire to kiss a man, just a feeling. There's part of me that
doesn't want to hurt the kissee but the majority of it is being in me
being stuck in my comfort zone.

The stigma of being an arsehole

Lets assume there's a separation between a mental illness and an arsehole, which may or may not be true depending on the model of mental illness you choose.

An arsehole is a highly inflammatory word to use when debating mental illnesses, personality disorders and some separate type described as an arsehole. It is a highly stigmatised person who may have certain traits that make them disabled.

I'm going to say there's a total separation between an arsehole and a mentally ill person (and by mentally ill I include personality disorders because while they may not fit the pure Kraepilan biomedical model they fit every other defintion of mental illness and human behaviour that falls under the purview of the mental healthcare system, in my opinion). Lets also assume mental illness is an illness as well.

An arsehole, and I mean a real arsehole, is a heavily stigmatised person. Implicitly an arsehole is someone who is disliked - there are very, very few aresholes who are genuinely liked. Those that can bear an arsehole - because that's what it really is, not "be friends with" - exist but they may be few and far between. The arsehole will have lower social and occupational outcomes compared to a group of non-arseholes. They're a pain in the arse as friends and as colleagues, which is why arseholes end up where they end up.

Lets say someone did some research. First they come up a defintion of an arsehole that the academics can agree on. They may develop a scale of arsehole measures that can be combined to score an arsehole. Of course everyone's a bit of an arsehole so they create a cut off point where the person can be defined as a total arsehole. The results show the reduced social and occupational outcomes based on a controlled study that uses...that technique whose name I'm can't remember where they match the people in the control and experiment group. (sorry....a random joke again....they're called matched studies I think). They could develop an evidence-based, statistically based operational definition of a cluster of symptoms to identify arseholes in clinical practice. And then, of course, they could treat them and make them like the non-arsehole group.

When I use the word "stigma" I'm not talking about diagnosis. I'm talking about the symptoms - the behaviours and the experiences - that make up what are emotional and behavioural disorders (or mental health problems, mental health difficulties, mental health experiences, mentalness) in 2010.

My best friend

I was thinking about writing a piece to show how shit I am.

This was going to be an ode to drugs and alcohol under this title,
friends that have been there throughout the ruff and tumble. Those have
seen the really dark times as well as been part of the good times.
They've been the friends I've allowed myself to rely upon. They don't
talk back (often...just kidding) or have feelings I can hurt.

But then I thought about my other friend. It's something that changes.
It can be a knife, a screwdriver or anything that comes to hand. It's
the thing I cut with when I'm at my worst and . A strange friend that
scars me but helps me.

In the times when I don't get on with my entity or non-corporeal
consciousness it's these friends I've depended on to survive. Other
people simply wouldn't understand what I have to do to live through life
with this thing in my life.

It's pretty pathetic.

What do people who experience first episode psychosis want and what do antipsychotics provide?

I should go look for the research into what people want from
healthcare when they experience a crisis. Instead I'm going to guess.
I'm going to guess that most people who experience delusions or
hallucinations for the first time want them to go away, for example a
person who experiences hearing voices wants them to go away.

I just wonder if that's something that healthcare services are able to
offer? Clinical practice would be to start the patient on antipsychotic
medication. Doctors would tell the patient that this would help their
condition and reduce the voices or the delusions. However I'm not sure
that antipsychotics do that for everyone or for most people. I'm not
sure how much of the effect is from the effect of a doctor telling a
patient a drug will work.

A doctor may say to a patient that there's lots of evidence to support
the idea that antipsychotics treat psychosis. And there is in a way. The
problem is the research is actually into psychiatry's idea of
psychopathology, i.e. it's not just about the voices or the delusions.

The PANSS scale is one of the measures used in research into psychosis.
The positive and negative scales have 7 items each. Delusions is just
one of those items. Hostility, suspiciousness, grandiosity, excitement,
hallucinatory behaviour and conceptual disorganisation are the other
items on the positive scale. Blunted effect, emotional withdrawal, poor
rapport, passive-apathetic social withdrawal, difficulty in abstract
thinking, lack of spontaneity and flow of conversation, stereotyped
thinking.
There's some info on this in an old paper I read.
http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/13/2/261?view=long&pmid=3616518

I'm sure the other things are very important. I think the most important
thing is the reduction of the delusions for most people experiencing
unshared perceptions for the first time. That may be a reason why people
may willingly choose to take clozapine if given the opportunity.

This really fucks things up in a way. If people want to take a drug that
helps them and they know the risks then it's their choice. If it's true
that most people want to be rid of the delusions then I'm not sure that
a non-pharmacological therapy could do that (short of an exorcism
according to DSM-IV-TR).

I would guess that clozapine is the best at reducing the delusions
though I think it has other useful properties (which patients don't
want) which is also why it is used.

I read somewhere that 50% of patients discontinue treatment within the
first year. I'll have to find the reference for that. I don't need the
reference to guess that a high number of people taking antipsychotics
like clozapine would prefer an alternative.

Slow shutter and flash photography (or Nightshot mode)

Nightshot mode is available on most cameras. "Nightshot" is the Canon term. It sets the camera to expose the background while the flash lights up the foreground. Usually a picture taken with flash has a high shutter speed but the background ends up dark. This means a photo taken in a chic bar won't capture the cool lighting int he background. The high shutter speed makes sure there's no haze in the shot where camera shake means detail gets blurred. DSLRs on Av, Tv or M modes with flash act like using Nightshot mode.

No nightshot mode (Canon 40D, 28-70 f2.8L and 580EX flash bounced off the ceiling, unedited)



Nightshot mode. (I've used selective guassian blur (a Gimp filter) on this shot which is why their faces are smoothed)


If you want to get loco with nightshot mode there's a technique where you zoom the lens while the shutters open and the flash fires at the end of the shot (you may not be able to set second curtain sync on most cameras without an external flash). The zooming creates a streaks of blur radiating outwards totally optically and the flash freezes the centre of the image so it's sharp. The zooming must be smooth so it takes a lot of practice and trial and error to get it right. This technique also requires excellent handholding to get sharpness at very slow shutter speeds like 0.5 or 1 second. A beer to steady the hand definitely helps.

The shot below is done without editing. It's my favourite from around 400 I shot when I was experimenting with a technique that involved rotating the camera and zooming at the same time. The shot's taken on a Canon 350D with my beloved 28-70mm f2.8 L and 580EX flash. The zoom ring was held firmly and the camera rotated to get this effect. This image hasn't been edited.




It's a take on a technique know as light painting or light graffitti. The UK king of this is Micheal Bosanko (www.bosanko.com if remember right). It's where a camera is set on a tripod at night and the scene light with selective flash or bright light sources are used to paint with light. It's really photography as a medium but is also truly the epitome of the art and craft of photography.

What's it going to take to make society accept mental illness as normal?

A quote I like from a man I admire

"We are all in the gutter, but some of us are looking at the stars."
~ Oscar Wilde

I've heard it said before. Wish I could get my head out the fucking gutter.

Two papers I shouldn't want to read when looking for stuff on clozapine

It's papers like this that justify the use of antipsychotic medication using the best science available.

This is an observational study by a Finnish professor that prompted calls for clozapine to become a first line treatment. Ugh.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60742-X/abstract
11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study)
(full paper available here)

Here's another one showing the mortality risk
A Systematic Review of Mortality in Schizophrenia
Is the Differential Mortality Gap Worsening Over Time?
Sukanta Saha, MSc, MCN; David Chant, PhD; John McGrath, MD, PhD, FRANZCP
Arch Gen Psychiatry. 2007;64(10):1123-1131.
http://archpsyc.ama-assn.org/cgi/content/abstract/64/10/1123

If you want a simplified summary of these papers there's more info at the NHS National Prescribing Centre blog
Antipsychotic use and life expectancy of people with schizophrenia
http://www.npci.org.uk/blog/?p=423

Unfortunately they seem to have missed out a detail from the Saha review abstract
"
Conclusions 
With respect to mortality, a substantial gap exists between the health of people with schizophrenia and the general community. This differential mortality gap has worsened in recent decades. In light of the potential for second-generation antipsychotic medications to further adversely influence mortality rates in the decades to come, optimizing the general health of people with schizophrenia warrants urgent attention.
"

It seems the American researchers are more aware of the effects of antipsychotic on morbidity and mortality separate from treating the suicide rate. The 2007 review's recommendation in the abstract (I'll get round to reading the full paper) is a good one, and I think it's somewhat done through the regular health checks that were stipulated in NICE's schizophrenia guidelines 2009. I think it's stuff like that which is why Rethink asked their campaigners to ask local PCTs to comply with NICE's guidelines (which isn't happening a year on since they were published).

In practice optimising the general health of people with schizophrenia may not be something I agree with. I assume it would involve a lot of behavioural modification or lifestyle changes that individual's preferring to make their own choices about their lifestyle wouldn't accept. That's current mental healthcare practice though. There's no reason why modern mental health care couldn't be improved to listen to what people with a diagnosis of schizophrenia want when it comes to behavioural modifcation to help them live longer then work with them rather than against them which is what can happen for a lot of people with severe mental illnesses.

The reason why I want to read the Finnish study (which I've read before) is because it has the data I want. The result is crushing to me of course because it's a bloody great piece of evidence. The author looked at a huge sample of the population in a purely quantitative analysis way. He defined mortality as all-cause deaths. What that means is he didn't differentiate between death by suicide and death by other causes. In my opinion suicide death is different from other forms of death. It would be useful to see the effect on suicide and the effect on other forms of mortality separated out by the different antipsychotics studied. I think there would be some surprising results but I wouldn't even dare to guess at what they were.

Basically what I'm trying to do is find a study somewhere that can actually separate out the lifestyle factors that lead to death and reduced life expectancy, the suicides and the influence on antipsychotic medcation on life expectancy. From the little bit of data I've had on the number of people taking clozapine for a long time and dying prematurely without killing themselves is quite high for the small number of people taking clozapine. I've already identified a number of other potential clozapine-induced factors that can lead to reduced life expectancy and death but it's just a list rather than a piece of evidence that directly says clozapine causes (a significant and measured or estimated) reduced life expectancy separate to clozapine-induced agranulocytosis and neuropenia. Hmm...perhaps I should read a book by Peter Breggin or something.

400 blog posts!

I've told just told a handful of people about this blog and not promoted it at all. Its been over six months now and 400 posts to a blog that no one reads.

As of today there are around 400 pages that link to it.
http://www.google.co.uk/search?hl=en&q=imaginendless&aq=f&aqi=g-s2g1g-s6g1&aql=&oq=&gs_rfai=
(400 of the 816 Google references would be links back to the blog).


Cool.

I wrote (typed) 20,000 words in 5 days once and I think it's because I'm mentally ill.

This is just a thing about thinking more than anything that's really
relevant to anything.

Some people might think that it was true.
Other people might think that it was true but wasn't because I was
mentally ill.
Other people would think it's lie.
Others just wouldn't really care or think I'm just a show off

Let's say someone did some research to find out the percentages. I guess
that
The people who think it's true, in general, may also think that also
think that I'm dangerous because I'm mentally ill
The people who think it's just me rather than my mental illness I would
hope would respond that they don't think I'm dangerous because of my
mental illness.
The group who don't believe me are the group I least trust. I think they
think I liar because they are likely to lie.
The last group are probably right. : )

It's impressive if it's true, which it is. It's actually 25,000 words
but I time stamped it as I wrote it so the Word word count of 25,000
words may not have represented the number of words. I also cut and
pasted another 10,000 words from stuff I'd already written to the total
word count on the file is somewhere near 35,000. The document was also
emailed to my friends and other people (like Jo Whiley for some
reason....(I was pretty manic at the time)) as I wrote it.

It's quite an embarassing document I've never gotten round to reading.
It's a stream of consciousness and it's an honest one. True openess and
honesty can be as socially destructive as mental illness.

Thought on Jerusalem syndrome

I've got to read up more on this.

This is something i came across when I was writing up an information
brief for someone who had to talk about mental health on a travel program.

It is a studied observation that some people go to Jerusalem or Mecca
and have an experience that is described by the mental health system as
Jerusalem syndrome. It's a type of psychosis (to use the medical
language) specific to the location. Of course many people have
epiphanies or intense spiritual experiences out there but this is a
mental illness experience.

What does it mean? Jerusalem (or Mecca) makes people mentally ill? Or
visiting a place to connect with g*d (the preferred Jewish way to write
it if I remember right) and achieving that connection is today called a
syndrome?

The psychiatric model of mental health, and even the biopsychosocial
model, make no attempt to understand the experiences that people go
through in terms of god, spirits or the other alternative perspectives
that people for severe psychiatric states of mind. People don't like to
consider that Abraham in the Bible would be described today a paranoid
schizophrenic.

It takes some delving into the psychiatry textbooks to find any
acknowledgement whatsoever of the role of divinity or spirituality.
Schizophrenia in DSM-IV is sort of caveated by the micro-culture the
person lives, i.e. if the person is born into a religious setting that
has a different explanation for these experiences then, technically,
it's not schizophrenia (I'm unaware if ICD-10 has this refinement).

The only diagnosis I'm aware that still hold some influence from old
treatments is Dissociate Trance Disorder, or spirit possession. 3% of
people who are in psychiatric hospital in India have this diagnosis
according to one study. The interesting thing is a treatments.
Persuading the spirit to leave (an exorcism?) and rubbing their body
with special lotions - the nature of which is unspecified - are two of
the options listed in the most recent psychiatric diagnostic criteria
reference manual (...which I've still got to return....).

I'll get reading some stuff on Jerusalem syndrome at some point.

To the friends that stay

You're members of the fraternity and sorority of mental health's
unsung heroes.

You're the truest friends and better friends that I could ever be, or
perhaps deserve to have.

"Through thick and thin"
It's a quality that the best friends and lovers share. And family.

In my bad times I can be a total cunt. In my good times I'm not much
better. Lesser humans, but humans none the less, would walk away. I hate
to admit it but it may be something that I'd do myself and I have done.
Those that leave me are probably the sane ones.

The friends that stay: you are saints. Thank you.

A little on the reporting of science in the media (and why I'm taking so long over the whole clozapine thing)

There was an paper that came out last year that I didn't bother to read.

Here are two articles by science bloggers who'd read the paper.
http://blogs.discovermagazine.com/notrocketscience/2009/02/17/more-on-propranolol-the-drug-that-doesnt-erase-memories/

http://dlmccaslin.wordpress.com/2009/02/17/a-pill-to-erase-bad-memories-not-quite/

They're talking about coverage of the media furore over a piece of
research that showed a heart medication could be used to selective erase
memories as a treatment for Post Traumatic Stress Disorder. Yet, as is
pointed out well in the second link, the paper did not say that the drug
erased memories. In fact the authors explicitly stated that the drug did
not erase memories.

The first link is a good piece of coverage of the story across the
world. Many featured in many mainstream media sources such as the
Guardian and the Daily Mail all stating that the research showed the
potential for erasing people's memories. This wasn't true. It did
however promote a public neuroethical debate and I think it may be the
first time that's happened in the UK so this ruin of science served a
purpose.

The first article shows how journalists use what they want from a press
release. The second article has an alternative take.

The reporting of science by the media is usually a joke, at least from
the scientific perspective. Usually it's enough for them to read the
abstract. Journalists are not trained in research though there are some
very highly skilled ones that do do a good job of reporting on science.

It's why good science bloggers are so valuable. While the mass media
have their big budgets, lavish offices and access to information
inaccessible to the public the bloggers often tower over them for good
(and by good I mean accurate) reporting of the research. The mass media
have a different goal to science bloggers: they look for stories that
will interest the public. An example of this was a study that showed
caffeine causes psychosis which got some media attention in the last
year or two. The study was a very poor quality prospective study which
looked like it was just a small post-graduate study. It was clearly not
a blind trial because when I searched for a copy of the study I came
across the research participant recruitment website which told people
what the study was about. Yet, apparently, this was of interest to the
public and was covered in an Independent article
(http://www.independent.co.uk/life-style/health-and-families/health-news/coffee-linked-to-hallucinations-1334727.html).

This could just be an issue of wasted paper but there's a two-fold
problem. The first is the problem of the wasted newspaper space. High
quality research, for example the Cochrane Colloboration systematic
review of Omega-3 fish oils for bipolar that show they don't really work
that well for mania but do for depression, is important but instead
small sample, single prospective, low quality studies about fish oils
and their potential to treat psychosis are published instead.

More importantly is the impact of poor research publicised by the media.
The best example is the MMR jab and it's association with autism.
Parents across the UK feared their children would become mentally ill.
Some paid to get the jabs separately while others lobbied for the NHS to
provide the vaccines as separate injections.

This is the first bit of the NHS Choices take on the doctor who wrote
the research. The rest of it's worth a look.
http://www.nhs.uk/news/2010/01January/Pages/MMR-vaccine-autism-scare-doctor.aspx
"
The doctor who sparked the MMR controversy was "dishonest, irresponsible
and showed callous disregard for the distress and pain" of children, the
General Medical Council (GMC) has ruled. The ruling has been reported by
many newspapers.

The GMC said Dr Andrew Wakefield "abused his position of trust" when
conducting research into a proposed link between the MMR vaccine, autism
and bowel disorders. He carried out clinically unnecessary and invasive
tests on children without ethical approval or appropriate qualifications.

Wakefield also failed to disclose conflicts of interest to The Lancet
medical journal, which in 1998 published the research paper that sparked
the MMR scare. The paper has since been withdrawn by The Lancet and
discredited. The scare nonetheless led to a dramatic drop in MMR
vaccination rates and a rise in cases of measles.

The ruling comes after a two-and-a-half-year investigation by the GMC.
"

The reason I added the bracketed extension to the title of this blog
post is fairly obvious I hope. I'm desperately trying to get it right.

I just wanted help but they wanted to change me

I remember making a foolish mistake: seeking help from mental health
services. I attempt to get myself on the waiting list for psychological
therapies and even came close to taking psychiatric medication again -
antidepressants and perhaps even mood stabilisers - last year.

My capacity to make good decisions clearly fluctuates. I'd forgotten
that it was a system of control and behavioural modification. My
insanity made me think I might be able to get some help. Instead I was
told to wait another six months for another initial assessment and
self-refer to a drugs and alcohol service.

I was so desperate I almost gave in and allowed the behavioural control
system to change me. When people are desperate the behavioural control
system has it's best chance to work. It's a method I've heard used by
cults and other organisations: get them in when they're desperate and
make them into what we want them to be.

I hope I don't go so desperate for help that I have to go to the
behavioural control system again.

Instead I am learning to suffer alone and that's a useful lesson.

A useful table from a strange paper in suicide risk factors and schizophrenia, and a bit of personal experience

http://www.medicine.ox.ac.uk/bandolier/band139/b139-3.html
Schizophrenia and suicide

This is not from a peer reviewed journal but is a review of high quality
studies. It's quite a short article. The two tables are interesting.
It's easy to criticise this article of course but I'm too tired.

There are lists of factors associated with completed suicide in
schizophrenia in Table 2.

"
Recent suicide ideation, fear of mental disintegration, drug misuse or
dependence, recent depression, recent loss, poor compliance with
treatment, and history of suicide attempt all occurred much more often
with suicide cases than with controls (Table 2, which has odds ratios
from the paper as well as the more useful relative risk). Hallucination
was the only factor that occurred less frequently.
"

Table 1 is interesting because it's a list of factor not associated with
or with limited associations with suicide in schizophrenia. The results
in this table are contrary to what I knew. I think they'll be derived
from one of the papers referenced at the bottom of the article. I
thought delusions and command hallucinations were associated with
completed suicide, as was impulsivity. Perhaps they're associated with
suicide attempts, somewhat like the biblical story of Abraham (or
Ibrahim if you're Muslim) where the command hallucination stopped at the
point where he was going to kill his son.

It's been my own experience of suicide and self-harm related to the
other consciousness or non-corporeal entity that is part of my life and
my being for it to usually 'protect', e.g. consciously I'll aggressively
cut myself however there is an unconscious (external control) force that
holds me back from making a really damaging cut. It's like throwing a
ball as hard as you can but an invisible force holds back the hand as
the ball is thrown. My self-harm isn't ritualistic or done with care. It
is done with intent to fight back against the controlling force with the
only thing I seem to have: my existence. It also serves to show the
controlling force what it is doing to me. I've been prolific and
inventive with my self-harm techniques but have been held back from
serious damage most of the time.

There are a handful of occassions where the self-harm/suicide got pretty
serious. There was one night where I was going through a particularly
bad phase. It was during the period where the thought of dying was my
happy thought. I was self-harming regularly to fight against the
controlling force. Scar upon bloody scar covered my left forearm. I was
woken one night by my cat using her litter tray, but I knew it was the
force. It woke me up and I went straight to the sink in my room, grabbed
a knife and sliced my forearm. On that occassion it was as though my
entitiy was asleep or not holding me back. The gash was large and cut
through the skin to the muscle underneath. It's healed over now but the
open, unstitched scar is plain to see. It's about an inch wide by half
an inch.

What the fuck am I babbling about? Well....maybe most people with a
diagnosis on the schizophrenia spectrum's unconsciousness or controlling
entity or god or voice in their head or delusion or spirits or whatever
may not want the person to die even though they bring them to the very
edge which is why the factors for suicide attempts and completed suicide
may be different to what was expected.

I know I've got a lot more reading around to find out what the strong
evidence says.

Major US research into the effect of clozapine on the suicide rate

According to the paper in the previous blog post below this paper is
why the FDA approved the use of clozapine in the US for the treatment of
self-aggression suicidality in schizophrenia.

Clozapine Treatment for Suicidality in Schizophrenia
International Suicide Prevention Trial (InterSePT)
Meltzer, H. et al.
Arch Gen Psychiatry. 2003;60:82-91.
http://archpsyc.ama-assn.org/cgi/content/abstract/60/1/82?ijkey=5290613f22a2626ab1c95b6e19c3022a1a800280&keytype2=tf_ipsecsha

A case study showing clozapine's effectiveness at treating violence and hypersexuality

From
http://neuro.psychiatryonline.org/cgi/content/full/17/1/36
J Neuropsychiatry Clin Neurosci 17:36-44, February 2005
© 2005 American Psychiatric Press, Inc.
Clozapine Reduces Violent Behavior in Heterogeneous Diagnostic Groups
John E. Kraus, M.D., Ph.D. and Brian B. Sheitman, M.D.

How the fuck can I argue against a 'treatment' for this sort of behaviour?

I'm strongly against the use of antipsychotics as a chemical cosh or
straight jacket in pill form because it allows them to be used for
pretty much anything and clozapine will contribute to the individual's
mortality. I don't agree that violent behaviour should be treated by
medication but there seems to be no alternative. I really hope there are
psychologists out that that could read the description of Mr.C and have
some compassion for the human being who is lost in life and twisted by
the internal maelstrom. This description shows none of the humanity and
I bet he had a good side. But I'm wrong on so many things.

"
Case 3. Mr. C was a 30-year-old African American male who presented to
the hospital on petition secondary to medication noncompliance and
aggression toward other clients at the group home where he had been
living. Mr. C had been diagnosed with schizoaffective disorder in
adolescence and had multiple prior hospitalizations. He was considered
treatment refractory in that he had persistent delusions and thought
disorganization even with optimal treatment. He had a prior trial of
clozapine but did not have significant improvement in his positive
symptoms of psychosis and was ultimately switched to a potentially less
toxic medication. At the time of the current admission, his
antipsychotic medications were haloperidol decanoate 100 mg
intramuscular every 4 weeks, oral haloperidol 5 mg each evening, and
ziprasidone 80 mg orally twice a day. For mood lability, divalproex
sodium 1500 mg orally each evening had been prescribed. Mental status
examination on admission was notable for paranoia (e.g., the medications
were poison), delusions (e.g., the patient believing he was a
psychiatrist and was married to a billionaire), disorganization of
thought and behavior, and his attending to internal stimuli. He was also
described as "slightly belligerent" and "uncooperative." Early in his
admission, Mr. C required forced medications due to persistent
medication refusals. His ziprasidone was discontinued but haloperidol
and divalproex sodium treatment continued. The oral dose was increased
to haloperidol 5 mg twice a day, and haloperidol decanoate was increased
to 150 mg every 4 weeks. Mr. C required seclusion and restraint on
multiple episodes and had several transfers to a high-management crisis
unit. Six weeks into his hospitalization, haloperidol was increased to
10 mg orally twice a day. Four months into his hospitalization, Mr. C
still required episodes of forced medication secondary to noncompliance
and aggressive behaviors. In the 3 months prior to clozapine treatment,
he had nine episodes of violent behavior and required seclusion and
restraint nine times. These episodes included hitting staff with a chair
and attempting to stab staff with a broken comb. Coinciding with his
violent behavior were increased sexual preoccupation and associated
hypersexual behavior. Mr. C experienced penile soreness secondary to
excessive masturbation. Just prior to clozapine treatment, Mr. C
assaulted a nurse, grabbing her buttocks, pushing his body into hers
"belly to belly," and "grinding" his groin into her. Mr. C was again
transferred to the high-management crisis unit and clozapine was started
the following day, while haloperidol was discontinued. His final dose of
clozapine was 175 mg/day with a serum level of 356. While on clozapine,
he did not have further violent episodes nor did he require seclusion
and restraint. He was able to leave the high-management unit and return
to the general hospital population. Along with improvement in his
violent behavior, his sexual preoccupation diminished greatly, and he
was no longer medication noncompliant. Despite the improvement in these
target behaviors, he remained delusional with moderate to severe thought
disorganization. However, he improved enough behaviorally to be
discharged to a group home in the community.
"

Clozapine is associated with a threefold decrease in suicidal behaviours however the only RCT did not find a reduced risk of completed suicide

The abstract of
http://www.ncbi.nlm.nih.gov/pubmed/15653256

Schizophr Res. 2005 Mar 1;73(2-3):139-45.
Suicidal risk during treatment with clozapine: a meta-analysis.
Hennen J, Baldessarini RJ.

"
OBJECTIVE: Suicide remains a major cause of premature mortality among patients with schizophrenia. Evidence of reduced suicidal risk with available psychiatric treatments is limited, but emerging data suggest such an effect of clozapine in chronically psychotic patients, leading us to compile the reported evidence. METHOD: We searched for published studies with contrasting rates of suicides or attempts by psychotic patients treated with clozapine vs. other agents. RESULTS: Among six such studies, random-effects meta-analysis indicated a substantially lower overall risk of suicidal behaviors with clozapine vs. other treatments (risk-ratio 3.3; 95% confidence interval [CI] 1.7-6.3; p<0.0001). For completed suicides, the risk ratio (RR) was 2.9 ([CI 1.5-5.7]; p=0.002). CONCLUSION: Long-term treatment with clozapine was associated with three-fold overall reduction of risk of suicidal behaviors. However, available findings are quantitatively inconsistent, well-designed studies remain rare, and the only randomized trial did not find reduced risk of completed suicide. Additional randomized comparisons among modern treatments for psychotic disorders are required to clarify their impact on mortality.
"

Useful information about off-label prescription and the law in the UK (with cases)

From
http://pb.rcpsych.org/cgi/content/full/29/5/186
The Psychiatrist
Medicines information
Managing clozapine-induced neutropenia with lithium
Carol Paton et al.

"
Box 1. Off-label prescribing

The prescriber may be at increased risk of litigation if things go wrong

He/she will be expected, by the courts, to have considered the risks and
benefits of all treatment options, with due regard to the evidence
available (Bolitho v. City and Hackney Health Authority,1997)

The actions taken should be supported by a respected body of
professional opinion (Bolam v. Friern Hospital Management Committee,1957)

The prescriber's actions must be able to withstand logical analysis
(Bolitho v. City and Hackney Health Authority, 1997)

The prescriber may be criticised for not obtaining the patient's
informed consent (or the specific consent of a second opinion doctor)
"

Clozapine: Am I wrong?

I'm actually on the edge of tears.

http://www.ncbi.nlm.nih.gov/pubmed/14642024?dopt=Abstract
J Child Adolesc Psychopharmacol. 2003 Fall;13(3):401-4.

Clozapine-induced neutropenia in children: management with lithium carbonate.
Sporn A, Gogtay N, Ortiz-Aguayo R, Alfaro C, Tossell J, Lenane M, Gochman P, Rapoport JL.

Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA.
"
Abstract
Clozapine, an atypical antipsychotic, is the most effective medication for treatment-resistant schizophrenia, but its use is limited by the high risk of neutropenia and agranulocytosis. In children, the rate of clozapine-induced neutropenia is even higher than in adults. We report two cases of children 7- and 12-years old diagnosed with very early onset schizophrenia, who developed neutropenia when treated with clozapine. In both cases addition of lithium carbonate elevated the white blood count (WBC) allowing clozapine rechallenge. WBC and total neutrophil count remained stable long-term with coadministration of clozapine (400-425 mg per day) and lithium with the blood level of 0.8-1.1 microg/mL. This report supports the use of adjunct lithium for clozapine-induced neutropenia as a safe and successful strategy in children.
"

Clozapine and lithium used on pre-teens on America, and positive results from psychiatric research.

Apes, employment, diagnosis and business psychology

In the film the Planet of the Apes the monkeys (but don't call them
monkeys) are split by type into different roles. The smart orangutan's
are scientists, the gorillas warriors and the chimps...I don't remember
what they were.

So theres a nice analogy for mental health and life and/or employment.
Certain types may fit certain roles or certain people may fit other
people (to extend this to relationships). And by "types" I mean
psychiatric diagnosis.

I haven't read any psychiatric papers about this idea of fitting
diagnosis to role or whatever, i.e. the idea that a certain disorder may
be useful for a certain task or advantage specific activities. But
psychiatric research is at the heart of the idea. There's a theory of a
genetic predisposition to a person who becomes on the schizophrenia
spectrum. A person of this type could, through there environmental
conditioning become schizophrenic or schizotypy or schizotypal or
anything else on schizophrenia spectrum. It was by a guy called Meehl
and he called this pre-state schizotaxia. It hasn't been proved yet and
I think the word has become synonymous with operational defintions of
psychosis risk syndrome however the fundamental concept is interesting.
I wonder if people of this hypothetical type would end up in creative
industries.

The idea of personality type and role has been studied in business
psychology. Myers-Briggs is one system where personality types are
identified and this can be used to find the right person to fit a role.
I should get off my lazy arse and see if there's any psychiatric
research correlating Myers-Briggs or other business psychology measures
with psychiatric measures or diagnoses.

But the application of the business psychology and organisational theory
is very different to the Planet of the Apes. In the film type
"orangutan" were the scientists. They were never ever warriors. The
little bit i remember about how the Myers-Briggs personality types
(Reflectionist, Activist, theorist and pragmatist I htink) fit together
in a team. It's a mix that produces the best results or the appropriate
fitting of a mix of people to the roles within a team, division and
organisation.

So imagine one day when people can put on their employment form,
"depression" and the recruiter will think...hmmmm.....we need a problem
solver for that team. Or "paranoid" and the recruiter thinks fantastic:
we need smart people in our contingency planning team. Or better yet,
upon seeing "depression" the recruiter thinks...hmmm......we've got too
many manic types in that team and a depressive would be perfect to
achieve balance.

Thoughts on mental health by a rapper

"I'm too busy staring at stars". A lyric from Enimen.

I feel this is expresses part of my dysfunction, socially at least. My
life is in my head in thoughts and in thinking. It's not really outside
my head (if that makes sense).

The unknown heroes of mental health

The tomb of the unknown soldier is something seen in many cities. It
represents the men and women who were never found and are assumed to
have died fighting for whatever cause the war was purported to be about.

In mental health there are so many of those. I couldn't even begin to
namecheck (a term I think originates from grime music) every one of
them. The people who get recognised are the tip of the iceberg and under
the water there's a lot of people toiling in obscurity on their own
mental health, the mental health of others and the mental health of the
nation.

These heroes can be a person offering a smile or an attempt an
conversation with a stranger in need, it can be the person with a
diagnosis of schizophrenia that spends their spare time making sure
Wikipedia is up to date or the campaigner who works tirelessly for over
thirty years for those who are less fortunate.

I salute you!

When reading in the fringe it can be hard to stay openminded

From
http://www.alternativementalhealth.com/articles/ice.htm
"
Ice Water for Temporary Relief of Mania or Depression

The following comes from the American Academy of Family Physicians
http://www.aafp.org/afp/990501ap/quantum.html

Need a lift? Try a little ice water in the right ear. According to The
Brain in the News, an Australian researcher believes that people with
manic depression have a "sticky switch" in their brain, which keeps the
left and right hemispheres from switching into the dominant position
during various mental tasks. Normally, the left and right sides of the
brain take turns throughout the day, each performing separate tasks. A
sticky "switch" may cause one hemisphere be locked in position during
periods of depression and the other hemisphere to be locked in position
during periods of mania. Ice water in the ear is a traditional
neurologic test, which activates orientation pathways connected to
regions on the opposite side of the brain. Researchers found that cold
water in the right ear can temporarily alleviate depression and cold
water in the left ear can ease the symptoms of mania.
More on this can be found at http://bipolarodyssey.com/PostPubdata.htm
"

The rest of the articles at the International Guide to the World of
Alternative Mental Health seem a little more....reasonable. The thing is
I don't actually know enough about it and I'm too lazy today to read
further into it.

The rest of the article on the site can be found here.
http://www.alternativementalhealth.com/articles/default.htm

Lazy, disgusting or mentally ill?

I'm just getting into my pyjamas having woken up.

That doesn't make sense but I've been wearing the same clothes for the
last few days and sleeping in them too. I just got up.

Funny thing is last night I didn't drink or go out. I stayed at home. I
played computer games, watched a bit of TV, listen to music and wrote up
a few blog posts.

Ugh. How bloody normal.

Notes mental illness and disability

--

(the use of the word disability is in the consensus sense. I'm not ranting about how no one is disabled and it's the construct of society at the time which is where the disability exists. We're all equal and capable, etc, etc, etc.).

--

A person who's a thalidomide baby would be undoubtably be considered disabled if they lived to adulthood. These children were born with missing limbs and internal deformities after their mothers were prescribed thalidomide. Earlier this year the UK government apologised for licensing the drug. (http://www.thalidomideuk.com)

It is a clear physical illness. The detriment is physical. Even a Daily Mail reader can understand that the loss of limbs reduces a person's capability and causes suffering.

Many may not see mental illnesses as disabilities. Few would understand why schizophrenia is considered a serious disability. I'm not sure how many members of the unaware (mental health or social model of disability) accept mental illness as a disability.

Caelic's disease which is a gluten allergy is also conisdered a disability.

There is a hierachy of disability and "hierachy of disability" is an established term.

When considering the impact of the disability it is easy to see how Helen Keller is disabled. People may not be able to see that John Nash or Sylvia Platt's state of mind may be of a a comparable level of disability. Chronic severe depression and other severe illnesses make people want to kill themselves. This happens far less often that with cancer.

The the internal experiences which make severe mental illness just like any other disability are unseen. A person can suffer inside and not show on the outside, just like a person can cover their self-harm scars with clothing. The intense experiences that happen during periods of isolation are like a suffering that words have yet to be made for. For many it is an experience that can only be understood by going through it.

The mentally ill and malingers are the government's target for moving people off sickness benefit. I feel this decision would polarise people: those who understand and agree with the social model of disability and those who don't really understand how mental illness affects an individual's life.

In general people have sympathy for cancer patients, Thalidomide babies and people in wheelchairs. Few have sympathy for the lonely man sitting in the corner talking to himself. Few understand the internal torture. Fewer have compassion. The lack of compassion for severe mental illness is part of the disability. Even the medical profession give lower quality treatment to patients with a diagnosis of severe mental illness (a result from a review (or meta-analysis) published in the last year or so in the British Journal of Psychiatry).

I heard about a psychiatrist who'd tell carers of people with a diagnosis of schizophrenia that they'd have been better off if they had cancer. I thought that was a riduclous thing to say and I thought it was another example of stupid psychiatrists. As I think about the hierachy of disability, the difference between physical and mental illness, stigma and the effects of the absence of compassion/understanding and the idea of disability I consider that he may have been correct.

The social detriment, disadvantage, exclusion. The broken dreams. Severe mental and physical illness share this.

Music speaks more than a thousand words.

Cry if you want to sung live by Holly Cole.

Onion Girl is another beautiful song.

I wonder if she's depressed. She sings like a person with lived experience. I wonder if she sings because she's got lived experience. I wonder if I love her music because she's got lived experience. I've been listening to her music since I was 18.

Flower

This was shot in daylight in someone's front garden near where I live.

This image is nice because the shallow depth of field works. The muted
colours is done by turning the original image black and white then
overlaying a colour version. I've blurred the colour version using
simple Guassian blur to give a diffuse quality. I'd prefer to have used
a wider focal length. a 50mm lens becomes a 80mm lens on the cropped
camera sensor.

This is an image effect I couldn't seem to get from Adobe Lightroom.
Lightroom's still the better choice for the professional photographer.
The digital noise reduction on Lightroom is considerably better than
with UFRaw though I've not searched extensively for open source
alternatives. It may be hard to find one however the latest version of
UFRaw (my personal favourite open source RAW converter) has built-in
lens correction algorithms for many Canon lenses (albeit not very easy
to use ones and probably nothing like as good as Dx0). I still feel the
quality from UFRaw and Gimp is astounding and they're both free.

I think Adobe have been careful to leave out features that are available
in Adobe Photoshop. Lightroom is carefully marketed as a photographer's
product. It lacks basic tools many photographers are used to, for
example layers, and this omission is to maintain the price and value of
the more expensive and versatile Adobe Photoshop. It's a shame because
if it ha all the features integrated the £230 price tag for Lightroom
would be an bargain. It's still a bargain with the high ISO noise
reduction and much, much faster workflow which is in part due to it's
dual processor-optimisation which is something that, alas, Gimp doesn't
have.

To put the price into perspective, some photographers value wide
apertures and fast film/sensors. A Canon 50mm f1.8 Mk II costs £100. The
next model up which eschews the exotic L-series glass of the top of the
range 50mm is the Canon 50mm f1.4 and this is around 3 times the price
of the cheapest lens, which is what I use. It's almost a license for
Lightroom on its own. In terms of light sensitivity and quality, the
same difference is visible in the difference between the entry level
500D and next model up which I use (the 550D is the very latest entry
level camera and the Canon 60D will be released this year) as is the
doubling in price for the higher quality at higher ISO camera - from
around £500 to £1000.

Learning to use the software is as important as taking the picture. The
RAW image is just the beginning just like the unexposed negative was the
start of the journey to the final print or electronic display.

--

Canon 50D & Canon 50mm f1.8
edited with Gimp and UFRaw

Ain't nothing but the blues

Some images from a Blues bar in central London.

I've written about blues music and how it may have been a coping mechanism for misery. It ain't called the Blues for no reason.

--

Canon 50D & Canon 50mm f1.8
edited with Gimp and UFRaw

The Sri Lankan suicide rate, research and hope for reducing the suicide rate in schizophrenia

One of the worst outcomes in life is suicide. There is more of it than
murder.

Sri Lanka was a country torn apart by a bloody and bitter civil war.
During the 1980s it had one of the world's highest (certified) suicide
rates.

(Worldwide trends in suicide mortality, 1955–1989
C Vecchia, F Lucchini, F Levi - Acta Psychiatrica …, 1994 -
interscience.wiley.com
http://www3.interscience.wiley.com/journal/119967514/abstract)

It was treated through research, through a sustained attempt to reduce
the deaths. I think it worked but I haven't got that far in my reading.

If I asked someone to tell me what's the most common reason people with
a diagnosis of schizophrenia give for killing themselves I wonder what
it would be?

Instead I thought I'd Google it.
http://www.google.co.uk/search?sourceid=chrome&ie=UTF-8&q=why+do+people+with+schizophrenia+kill+themselves
<http://www.google.co.uk/search?sourceid=chrome&ie=UTF-8&q=why+do+people+with+schizophrenia+kill+themselves>

The 3rd link is interesting. It answers the question for all suicides.
"
http://www.cmha.ca/bins/content_page.asp?cid=4-40&lang=1#killthemselves
<http://www.cmha.ca/bins/content_page.asp?cid=4-40&lang=1#killthemselves>
"

I think what they're talking about is the work of Shniedman. He was a
guy who came across a bunch of suicide notes one day then spent the rest
of his life researching suicide and suicide notes. As far as I am aware
he'd never contemplated nor attempted suicide but I don't know much
about him. He coined the term "psychache" for the pain that leads to
suicide as he saw it from his work.

Conceptually there's a difference between depression, hopelessness and
psychache but I couldn't explain it.

From
http://mec.sagepub.com/cgi/content/abstract/42/1/46
Differentiating Between Depression, Hopelessness, and Psychache in
University Undergraduates
Michelle M. DeLisle
Measurement and Evaluation in Counseling and Development, Vol. 42, No.
1, 46-63 (2009)

has this abstract
"
The overlap between depression, hopelessness, and psychache constructs
was investigated using 587 undergraduates. Analyses indicated three
correlated dimensions; among these, psychache accounts for more variance
in depression and hopelessness than these latter variables account for
in psychache. All constructs demonstrated convergent validity, but
psychache was associated with the widest range of suicide criteria.
These findings support that psychache is a leading variable associated
with suicide risk.
"

Back to the question and the search: (btw. I'm being incredibly lazy and
not looking for a proper piece of qualitative research or popping to the
British Library to make a proper attempt at this blog post).

The priory.com has a page I like on schizophrenia however it doesn't
look very good. It's not by the Priory group.
http://priory.com/schizo.htm

Interesting later in the text the author says
"
Bleuler, in 1908, criticised the use of the term dementia praecox,
because he said that there was no global dementing process. He first
used the term schizophrenia and said that there were four characteristics:
blunted Affect
loosening of Associations
Ambivalence
Autism
"

I'm not sure this is true. Those are just a memory tool for doctors with
cognitive deficits. lol.

There's a lot of interesting stuff on the page but this is what I was
after.

"
A sixth of people with schizophrenia die by their own hand, often in
response to psychotic symptoms e.g. second person auditory
hallucinations telling them to kill themselves.
"

I was hoping to find a reference so I could get more informatjon but
there isn't a link to qualitative research. There's 3 case studies
though which are probably more elucidating into what schizophrenia means
to doctors.

Onwards...

On the second Google page there's some advice for counselling
schizophrenia from a Christian minister who uses quotes from the bible.
There's a bit at the bottom that I like that I'll summarise.

F. How can we help?
1. Help the weak: Start by listening carefully.
2. Admonish the Unruly. (I don't like this one but I'll leave it in.)
3. Encourage the fainthearted family. Families need support, prayer,
respite, logistics.
4. Be Patient with Everyone!

One of the links is a very interesting post. I've been looking for
information to try to find a solution to treating the suicide rate in
schizophrenia. This effort here is an example of what I do on a Sunday
night. This is an example of the amount of information I come across
that I find interesting. The content of this post itself isn't important.

From
http://advancedcognitivepsychology.blogspot.com/2009/02/why-do-some-people-kill-themselves.html
Why do some people kill themselves?
Robert Pool

There's some more information about the history of what other people
thought was the reason people killed themselves.
"
A century ago, both the sociologist Emile Durkheim and the psychoanalyst
Sigmund Freud came up with sweeping explanations. Durkheim, not
surprisingly, saw the roots of suicide in social factors, such as a
failure to integrate into society, while Freud rooted his explanation in
instinctual drives, particularly what he called the death instinct. More
recent explanations have tended to focus on factors such as depression,
hopelessness and emotional pain, but none of them have had much success
in answering the fundamental question about suicide: why do some people
kill themselves while others in seemingly identical circumstances do not?
"

What I'm going to take from that is the "sweeping explanations", which
means to me at the moment that I must avoid looking at the question I'm
trying to answer in a simplistic way.

The question I was meant to be looking to answer is why do people with a
diagnosis of schizophrenia kill themselves? The answer "because of the
delusions" is a sweeping statement. It was noted in the qualitative
research on clozapine that some patients felt the delusions were reduced
on clozapine. I can see why a doctor may consider the use of the
chemical cosh if it actually did that. Sadly the research was funded and
done by Sandoz who also make clozapine and there was little information
there about the adverse effects.

I would guess using that the delusions are the factor behind the
suicides early on in the course of schizophrenia. I think the reason why
people kill themselves afterwards may be for the same reasons as anyone
else if their life ended up the way living with psychosis can make it.
Perhaps. Treat that and clozapine can be withdrawn again.

There's something else worth noting. These links are from the first 20
on a google search. When I used to do this for a living I used to check
more than that. The point there is that it's worth going further than
the first page. It takes a bit of luck and experience to know which
sources to checkout but it also takes a bit of...openmindedness to find
the useful information. The religious minster's page was one that a lot
of people wouldn't bother to check but there's some good stuff on there.