The stigma of mental illness and the opposite of the stigma

Two years ago when I was recovering from a period of schizophreniform
depression I became hypomanic and it was very pleasant. Lots of people
enjoyed my company and I went from a soulless, withdrawn husk to become
a socialable, fun loving and loving person. Last year I went into a
depressive state and wrecked my personal relationships, my job and
perhaps other important things.

I don't know what the antonym of stigma is. Acceptance is a neutral
term. Desireability may be the word I'm looking for. The desireabillity
of mental illness.

During the first hypomanic period I had boundless energy, could work
fast and excel in certain tasks. I was funny and perhaps entertaining.
This is something that people want to be and the sort of person people
want around. The unhappy me at the other end of the cycle is someone
who's undesireable and stigmatised. I was angry and I was venting and
displacing and projecting all over the place. I was reckless beyond sanity.

Perhaps this is just an experience bipolar people go through.
Depressives may not get that period of what is mental illness but what
is socially acceptable. It happened when I was at university as well.
There I'd get to know lots of people in my hypomanic stage and the
'craziness' wasn't craziness because it was acceptable. The things I did
when I was depressed still weren't.

I go through typical depression as well and that's acceptable - it's not
stigmatised as much any more but it's nor really something people desire
much.Those can be the easiest times for me with the least detriment to
my life.

People's interpretations

I stopped having a mobile phone a couple of months ago. It's strange
so people want to know why.

Some may think it's because i can't afford a phone but my old phone was
£30 on ebay and I was happy with it.
Some people may think it's because I'm paranoid and don't want to be
tracked. My phone didn't have a GPS unit though it's true my position
could be triangulated if my phone was on. However my location can be
tracked in other ways. I use an Oyster card. I live in London and it's
cloud of CCTV coverage. My IP address can be tracked. My first proper
job was working a remote imagery business so am aware of the resolution
of aerial and satellite photography and from my knowledge of computing
I;m also aware that all these sources could be combined with face
recognition algorithms and distributed computing.
Some people may think it reduces the unshared perceptions paranoia and
it does though this wasn't why I stopped having a mobile phone.
Some people may think that I barely used a phone - just to contact my
dealer - so decided I didn;t need one and there;s a small element of
truth there but it's not the reason. I may stop using electronic banking services to protect me from the unshared perceptions paranoia. I may also give up other things to get away from the distress the controlling force causes in my life. It's a hell other people couldn't understand and while I need to stay resilient to it as well there are things I can do to reduce the opportunities for the non-corporeal entity to fuck with my life.
Some people may think it's just to get attention. I can get that without
not having a phone.

Here's the problem. I don't know the reason. I can justify it but it
would be a lie. It happened again with my photography. I've stopped
doing that too. I think people need a reason to accept it happened.
Everyone has their own guess but I don't.

For some reason I think this is similar to death in a way. People need a
reason for why things happen. But it just happens.

People's interpretations

I've stopped having a mobile phone a couple of months ago. It's
strange so people want to know why.

Some may think it's because i can't afford a phone but my old phone was
£30 on ebay and I was happy with it.
Some people may think it's because I'm paranoid and don't want to be
tracked. My phone didn't have a GPS unit though it's true my position
could be triangulated if my phone was on. However my location can be
tracked in other ways. I use an Oyster card. I live in London and it's
cloud of CCTV coverage. My IP address can be tracked. My first proper
job was working a remote imagery business so am aware of the resolution
of aerial and satellite photography and from my knowledge of computing
I;m also aware that all these sources could be combined with face
recognition algorithms and distributed computing.
Some people may think it reduces the unshared perceptions paranoia and
it does though this wasn't why I stopped having a mobile phone.
Some people may think that I barely used a phone - just to contact my
dealer - so decided I didn;t need one and there;s a small element of
truth there but it's not the reason.
Some people may think it's just to get attention. I can get that without
not having a phone.

Here's the problem. I don't know the reason. I can justify it but it
would be a lie. It happened again with my photography. I've stopped
doing that too. I think people need a reason to accept it happened.
Everyone has their own guess but I don't.

For some reason I think this is similar to death in a way. People need a
reason for why things happen. But it just happens.

A thought on children's mental healthcare

The obvious thing to campaign for is more non-pharmcological
treatments if the position is medicating children is the riskiest thing
to do in mental healthcare - the long term effects of overdiagnosis and
temporary disorders (decisions by society on what is acceptable and
unacceptable and to be considered a psychiatric disorder at the time)
can be of high detriment.

Immediately someone may assume that more psychotherapies and therapists
for children are needed. That's true. But the biopsychosocial model of
mental illness has 3 parts. The last part is ignored. Sociology and
children's mental health may not even be an area of research however it
may be what's needed to change the outcomes of childhood mental illness.

For example let's assume that a child is withdrawn. They spent lots of
time on their computer or with books. They don't play like other
children. They're not part of the clique at school. Other factors may be
added to that imaginary case and a doctor could diagnose depression. The
options in the future may be seeing a children's therapist.

I just wonder what the alternatives in the future might be? I can't
think of anything reasonable.

This thought process is partially based on reflecting upon the story of
the foster children in Florida and how antidepressants can change their
lives. Some of them may have been through such childhood trauma that no
therapist could get into their locked-in state. Drugs could be
unavoidable. But opther options could there be to stop the trauma
happening in the first place. This is why I'm considering these other
interventions but I wouldn't even begin to know where to start, except
of course I can reflect on my personal experiences of childhood distress.

Perhaps many others could do the same?

Coping with coming off self-medication

Anyone who's had an addiction to antidepressant drugs - legal or
illegal ones - will know how hard it can be to come off. The depression
can be subtle or it can be clear for anyone else to see.

A friend of a friend was recovering from alcoholism and sexual
addiction. It made him very unhappy and in the end the doctors
prescribed him antidepressants.

Self-medication drugs offer a different type of happiness. Skunk, for
example, is philosophers pain killer for the soul. Alcohol serves as the
creatives' emotional and thought enhancer., a very different happiness
from those that prefer a lack of emotions and deep thought.

The difficulty of coping with coming off prescription drugs is becoming
more recognised and the danger of ceasing dosage abruptly is well
recognised. It isn't with coping with coming off illegal drugs. In fact
there are foolish paradigms such as detoxing which can torture a person
who's b ben self-medicating for years. Pregnant mothers may also
experience a similar emotional pain during the lifestyle changes
involved during pregnancy.

Non-biological effects in the presentation of mental illnesses

This is a really interesting article. I'm surprised I didn't put it on
my blog earlier.
vhttp://www.nytimes.com/2010/01/10/magazine/10psyche-t.html

There's lots of examples of extraordinary cultural effects on mental
illness. The most interesting in my opinion is the change in the
presentation of anorexia in Hong Kong. The story (and the author's book)
report on a woman who dropped dead in the street. The media found out
she had a diagnosis of anorexia so they checked to find what this new
word meant. The checked the Westernised classifications - DSM and ICD -
for the cluster of symptoms to report the story.

Before this incident there were very few cases of people presenting with
the cluster of symptoms of anorexia but they were still given the
diagnosis because local psychiatrists saw how it presented differently.
The extraordinary thing is that after the media story the presentation
of the illness changed and more people began presenting with the Western
symptoms.

This is an interesting paper on the effect of exposure to television
vhttp://bjp.rcpsych.org/cgi/content/full/180/6/509?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=fiji&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
<http://bjp.rcpsych.org/cgi/content/full/180/6/509?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=fiji&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT>

The authors went to a Fijian island just before the population started
buying televisions. When they surveyed attitudes to eating problems and
body image they found very little prevalence of either of those but
after the introduction of TV they came back and found an increased level
of disorders.

What the authors didn't note is the effect of their research. Western
scientists with all the trappings of modernity (mobile phones, laptops,
brand labelled clothing) appear on an island and chat to the young
girls. They ask questions that may never have been asked before, like
how they felt about their body image compared to their peers. The effect
they observed may be because of the introduction of television to their
culture but it may also be because of the research the conducted, and by
doingso they introduced a Western mental illness to a mental
illness-naive community.

There are many other examples of how supposed biological illnesses
present differently. It's well observed that the levels of disability
vary from country to country.

A ramble of the quasi-science of mental health

A press release came out on Medscape about this recent paper.
http://www.medscape.com/viewarticle/727323?sssdmh=dm1.633691

I have to read the paper but the analysis on the press release is useful.

Piggot, H. et al. 2010, Efficacy and Effectiveness of Antidepressants:
Current Status of Research, Psychotherapy and psychosomatics
vhttp://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=000318293&Ausgabe=254424&ProduktNr=223864&filename=000318293.pdf
<http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=000318293&Ausgabe=254424&ProduktNr=223864&filename=000318293.pdf>

America has the advantage of massive research budgets, a huge population
and a population where mental health is much more part of the culture
than the UK. They can invest in very high quality trails such as STAR*D
and these become highly infleuntial across the world because few other
countries do similiar quality studies. In fact their research and
diagnosis system is independent of the rest of the Western world though
their diagnostic criteria (DSM) is commonly used in research across the
world.

The press release shows the lead author of the paper is critical of the
evidence and the methods. The problem with all trials is their
theoretically perfect designs are open to criticism when they're
implemented. The science of mental health is far from a science like the
natural sciences so it's easy to criticise.

For example the author has used a meta-analysis. Very simply a
meta-analysis is a bit like finding out the average from lots of trails
but uses sophisticated techniques to make the average as accurate as
possible. A funnel plot is a technique used to identify publication bias
- where negative trial results aren't published - and with large numbers
of trails the effect of publication bias can be compensated for. The
criticism of the meta-analytic technique is it compares apples and
oranges, i.e. the trials are not the same but they're still averaged
together. Measures, statistical techniques, reference diagnostic
criteria and interviewing and many other of the aspects where trials
difference (because of siibjective choices made by the authors) mean
that meta-analysis doesn't compare things that are the same. The high
quality meta-analyses uses many techniques to overcome this problem but
still fall foul of the apples and oranges problem, and subjective
decisions by the authors of meta-analyses mean that combining results
from meta-analyses can also have the apples and oranges problem.

The press release has lots of information about the problems of finding
a scientifically reliable truth in mental health.

The last section is about the possible use of biomarkers in the future.
This is one of the fundamental criticisms of psychiatric prractice:
supposed biological illnesses are not detected by biological measures.
Depression is diagnosed by knowing how a person is behaving and feels.
The biomedical model - the one that the use of medication is based upon
- considers the problem of lack of efficacy in high quality
antidepressants trials to be a problem of inclusion of people who meet
the strict diagnostic criteria used in academic research but don't have
a biological brain illness.

In fact there have been different depression hypotheses for many years
but it's noteworthy how the authors consider the lack of efficacy to be
a problem of lack of correct diagnosis of biological depression. The
other hypothesis of depression consider it a non-biological problem and
as a reaction to life.

Netdoctor has a good page explaining just how complex depression is.
Endogenous and reactive depression are the types of depression the
authors of the STAR*D trial want to able to differentiation between. If
the biomedical hypothesis is correct then the former can be detected
using biomarkers and will always successfully respond to antidepressant
treatment.

Unfortuneately for researchers, doctors and patients the way depression
is diagnosed is through the cluster of symptoms approach which uses
operational definitions to define the symptoms. This approach was one of
the most significant advances in the science of psychiatry in the 20th
century. The work to create these definitions using positivitic methods
was one of the greatest works of humankind in the 20th century and it
brought mental health out of the doldrums of a pseudo-science to become
the quasi-science it is today. The approach is still flawed though if
biomedical theories of depression are correct.

My opinion is the biomedical paradigm still hasn't got it quite right.
Biomarkers may one day be able to identify people with a true mental
illness acording to Kraeplin's paradigm however even if this is detected
it may be a type of human being rather than a dysfunctional human being.

Thoughts on speaking about suicide

One thing that people may find difficult is me opening up about my
suicidality. It's hard to communicate it for a number of reasons.

The most important thing to remember is when I'm suicidal I rarely talk
about it. It's usually when I'm in a safer place that I'm ok to open up
about it. In my darkest times people just don't hear from me.

When I say I know I'm going to kill myself it's a belief that I will
take my own life one day. My battle with the non-corporeal entity in my
life is not going to end. We have peace at the moment but it doesn't
mean it will last forever. Nothing does.

It's hard to talk about with because other people haven't been through
what I've been through. My suicidality is complex and relates to suicde
attempts before I experienced psychosis. I think my earliest attempt was
at 19 or 20 but it wasn't a very good one. I'd wanted to die when I was
a child of course but I'd never thought about killing myself.

It's pretty normal for me to have thoughts of wanting to kill myself
(which I'm differentiating from thoughts of wanting to die but for many
people there may not be a relevance in the separation of concepts). I've
had those desires for a large part of my adult life. Other people have
wanted to die and experienced prolonged periods where they may want to
act on those desires too. Roughly 17% of the UK population will feel
like that at some point in their lives.

It's changed my life and how I live my life. But then it's obvious that
getting to the point where a person is ready to take their life is
something that's going to do that. I was never particularly normal but
it's made me even less so, except in certain microcultures where other
people have been through similar experiences. Thankfully being weird is
not an illness.

The hardest problem is existing between those two somewhat discrete
cultures, one where I can talk about it as if it was normal and one
where I can't. The greatest problem I have with the latter is the result
is usually compassion. It's what I'd hope it would be for someone else,
especially someone who's going through it for the first time. It's not
what I want though because I'm used to it. It's like getting compassion
for being able to walk.

The last paragraph may not make sense to some people. What I'm trying to
express is that people who talk about suicide and their suicidality may
not be looking to kill themselves nor for help or compassion because of
their suicidality. They may just be genuinely communicating with no
hidden agenda. I think I may get misinterpreted as someone who seeks
help by saying they're suicidal when in fact I may seek help when I'm
suicidal but I usually want no help for my desire to die. It's why I
have this blog but if I put all my thoughts on here then I don't get
them out in the real world and tell people my inner most thoughts in
real life.

That last sentence may not make sense but...grrr....this could go on all
night. I should probably get some sleep now.

Clozapine and treatment of schizophrenia

Outside psychiatry few people know what clozapine is. Within
psychiatry it is a highly valued treatment. It is the only drug named in
the NICE schizophrenia guidelines because of this percieved value.

The perception of value comes from three evidence-based things: it's
effectiveness measured with measures of the psychopathology of
schizophrfenia, the highest ability to treat suicidal behaviours and
it's superiority to all other antipsychotics. It's beloved for more than
that though and this element is about the psychology of doctors.

In the developed world schizophrenia has a poor prognosis - the worst of
all the major mental illnesses. It can lead to a therapeutic nihilism
that leads to extreme and ineffective treatments that risk the lives of
people with a diagnosis of schizophrenia. A diagnosis has been likened
to a diagnosis of cancer. Clozapine was the first of a new generation of
antipsychotic, the rest of which have improved patient quality of life
through fewer side effects.

The early studies showed very promising results and it was only the
unexpected problem of agranulocytosis that caused it to be withdrawn. It
was a mriacle - a new pharmocological treatment that, according to the
studies at the time, was very effective at treating something doctors
had found impossible to treat. It's why the psychiatric profession got
it back with mandatory blood level monitoring for the first six months
of use.

Clozapine is effective at a neurochemical level because it is like s
sawn off shotgun and works on lots of neurotransmitter sites whereas the
latest generation of antipsychotics are effectively sniper rifles. In my
opinion the neurochemical shotgun causes a lot of collateral damage,
though no new antipsychotic has been developed that's as effecvtive but
more selective in it's approach.

The evidence shows that people still die from agranulocytosis and a
small percentage develop a milder version called neutropenia. There are
other neurological problems. The list includes seizures, heart problems
and other documented risks. There's evidence that a lot of people who
are taking clozapine are dying much earlier than they should. Several
new stories were published highlighting this problem. Other research is
showing the negative effect on life expectancy of antipsychotics used
for conditions other than schizophrenia, for example the deaths in the
management of dementia. These risks have not been studied but there's
evidence that there needs to be a re-evaluation of the evidence-base for
the use of clozapine, alternatives for treatment-resistant schizophrenia
looked into and more care made available for people with treatment
resistant schizophrenia.

Of course many patients would prefer not to be taking clozapine. The
side effects are most likely the worst of all the antipsychotics. There
has been no independent research into the experiences and preferences of
UK clozapine patients. NICE's process does not involve high levels of
patient involvement. No organisation has chosen to be the voice for the
people dying on clozapine.

Thoughts on misery

About 4 years ago I was thinking about the 1 in 4 figure and thinking
why it wasn't 0 in 4. I knew the figure from Mind's use of the language:
"1 in 4 people every year experience mental distress." I thought why
aren't we working towards a society where the figure is 0 in 4 and no
one experiences mental distress.

The journey on that thought process about human suffering has been a
long and winding one. Originally I was confused by the biomedical
explanation: misery is a chemical imbalance. That's not true but it
kinda is as well. Chemicals seem to the best way at the moment for a
society that wants to eradicate misery. It is the path I chose myself
because of my long standing drug addiction and it was imposed upon me
when I was treated by psychiatrists.

The journey has taken me to many different ways of thinking about misery
and about mental illness (biomedical) and mental health problems
(psychosocial). It was important to understand the history of psychiatry
and pre-and extra-psychiatric mental health systems, to see that there
is an objective truth that's very hard to define and then there's the
subjective judgements on the objective truth of the human condition. The
subjective interpretations dominate mental health and healthcare. They
dominate conversations about misery too.

The two sides are misery is part of life or misery is an illness to be
removed from life. They're exclusive concepts. One accepts suffering.
One doesn't. I'm a mixed up hypocritic and I don't have clarity on which
camp I fall in. In my own life I accept a lot of misery and I don't
consider most mental illnesses as true illnesses. I consider the
suffering of people to be something I'm strongly against and I do what
is in my power to reduce that for everyone and anyone, and I fail.

The suffering of behavioural and emotional disorders is real however the
causes of the suffering aren't or aren't constant.The untapped area or
the area where there is most need for change is society itself because
it's maladaption is, in my opinion, the cause of the distress of mental
illness.

However even in a utopian society there would still be emotional pain in
my opinion. That's because emotional pain is part of life. This is a
discompassionate view of suffering but it is not without a lot of lived
experience behind it. The human condition is a wide variety of
experiences that are good and bad. The bad times are unpleasant and can
kill people. Those bad times also save a purpose for many people. Misery
has been my best teacher when it came to personal development.

I still have no answers..In many ways I have more questions,. It is
simpler to consider the end of misery in the same way as the end of
poverty: a vital goal that humanity should strive for. It's harder to
think about whether that's a good thing for society and the human race
and whether achieving a dstress-free existence is a goal or not. The
following question is then what is the goal when it comes to human misery?

There are still many ills in society, many causes of distress that
needed be there. This can be from the desire created by the advertising
industry, the desire that leads young girls, and increasingly boys too,
to diet themselves into a mental illness. Childhood bullying is an
experience many people have suffered and it's something that happens in
adulthood too. Various forms of exclusion for whatever reason - not just
mental health stigma -- can and are being changed.

Individuals may still suffer regardless. Develioped nations don't have
significantly higher levels of positive mental health compared to poorer
nations In fact the evidence (on Westernised measures) is many
developing countries have better mental health compared to the richest
nations. This effect may be an effect of the makadaption of the
post-modern, post-Industrial Age societies. The wealth of the most
piowerful nations in the world has not brought their citizens an
associated increase in happiness. In fact post-WWII Britain had higher
levels of happiness than during the boom periods in the late 20th century.

This thought process is futile of course. It is just a thought process
which many people will have engaged with and I hope they came to a
better answer than I have. I don't even have a conclusion. I wouldn't
have even started on the thought process unless I was miserable. May
that's the only conclusion I've got to so far.

A nice comment from someone to a fellow self-harmer

This was posted on someone's Facebook photo of their self-harm scars.
I thought it was amazing she could be so open with the image of her
scars. She's stronger than I.

The thread went into how the people who've stopped self-harming stopped
because of a supportive partner. I'm glad that I don't have one of
those. I'm never going to stop. When I started to self-harm it was like
anyone else - to relieve the pain. In the last few years it's for a
different reason: to fight back at the non-corporeal controlling entity
in my life (or god). It's not one of the approved methods to deal with
the controlling force. I'll continue to self-harm and I will eventually
kill myself - of that I am certain. The self harm and certainty of
taking my own life means I won't have a partner (an active decision),
and it means I can continue to be as I am: normal but really, really
fucked up.

"
we all have scars...some deeper than others...some may be more
obscure...but trust me, and as you do know, because I know you do...your
just that way...we ALL have scars...some hit harder, and hit home harder
too...some physical ones are terrible, but not near as bad as the
emotional ones, now they really can cut deeper than deep...but scars are
not always a bad thing if you look at it this way...look at how many try
so hard to look special, with peircings, tattoo's, mohawks, shaved
heads, long hair, even perky silicone breasts...they want to stand
out...mark their spot in life...and yet, here you are...you have real,
genuine scars of life...the tracks of tears, thoughts, emotions gone
array...let them not be a setback, but a reminder that your a woman of
experience and endurance and let them be a reality check of just how
genuine you are...that you have a value of heart and a spirit in you to
survive, and be better...and that through all your quests to stand
out...you have realized the one thing that makes you stand out more than
all else is your passionate genuine self as the person we all know as
our dear ...the one we all love and can relate to...and call a true
friend on here in so many wonderful ways...;-)
"

The paper on clozapine I wanted to read

Thanks to an independent campaigner and Wiki author I came across this
paper.

Moncrieff, J. 2003, Clozapine v. conventional antipsychotic drugs for
treatment-resistant schizophrenia: a re-examination, British Journal of
Psychiatry
http://bjp.rcpsych.org/cgi/content/full/183/2/161

Dr Moncrieff is a critical psychiatrist and this paper analyses the
science of clozapine. It's clear that the effectiveness of clozapine is
established however the science is questionable. Her conclusions are
that the science is not rigourous enough however it also seems from her
critical review that most of the science shows it is efffective. That
doesn't make it a scientific fact to a good scientist but the science is
enough to persuade most people that clozapine should still be used.

Her analysis doesn't go into the death problem. This is an important
question in all drugs: what's their risk to the patient's health. It's
unknown whether clozapine actually treats the supposed brain illness.
The effectiveness of clozapine is measured using psychopoathological
scales - the BPRS scale - however it's value is also it's abaility to
'treat' suicide. The Finnish observational study showed clozapine had
the most positive effect on all-cause mortality how a randomised control
trial showed clozapine was no more effective at 'treating' completed
suicide but was the most effective at reducing suicide attempts.

She's also mentioned that the papers analysed the data qualitatively and
quantitatively. In my understanding qualitative analysus seems absent in
most psychiatric research. The patient experience of the drug seems to
be left out. Research papers not rates of discontinuance of treatment as
a quantity but don't see the reality: many patients don't like taking
clozapine. The only peice of qualitative research published in the
British Journal of Psychiatry was by the manufacturers and wasn't a
great paper.

This paper is useful to dispel the power of the early trials that showed
clozapine's superior effectiveness over other drugs. It's a common
effect to find larger positive effect sizes in earlier papers about a
new treatment - pharmaceutical or psychological.

This paper was published a 7 years ago but NICE still continued to
recommend clozapine after 2 trials of other antipsychotics at standard
doses. It still continues to be beloved by psychiatry and even doctors
outside psychiatry are aware of the supposed potential of this drug to
treat treatment-resistant schizophrenia. This paper questions the
validity of the science but ultimately doctors are still human and can
belevev in the power of a treatment. Insulin shock therapy was another
dangerous treatment for schizophrenia that didn't hold up to good
science and it was the randomised controlled trial's first major success
to show what was considered the best practice around the world at the
time wasn't effective compared to other, safer treatments.

Thoughts on love, attraction and desire

I used to let myself fall in love because without it life's just not
life. I tried to kiss the joy on the wing but not fall with it as it
falls. I fell too hard the last time and have stepped away from allowing
love again.

My definition of love is important. For me it is an emotional high. It's
a painful feeling at the same time. It's confusing and complex. It's
simple and life affirming. It's a feeling many people may never have
felt for their partner.

Those people have a different love. It's not one I've ever known. It's
the stuff of films like Eyes Wide Shut. The love of a long term
relationship. I can imagine it's not like the burning feeling of love
that I enjoyed. It's not something I'll know.

Attraction and sexual desire exist as well. I get horny just like anyone
else though I I go through patches where even the hottest supermodel
doesn't turn me on. I find many women attractive - some may call this
low standards and others may appreciate it as seeing the variety of
beauty.I'm not afraid of letting people know that I fancy them or they
look good but that's something that's socially unacceptable. I end up
looking like a Lothario.

I think it's a shame that people can't be honest about their feelings of
attraction, desire and love. These are wonderful positive emotions.
Perhaps it's because some men use compliments as chat up lines. Perhaps
selective memory means people forget then men who give feedback and ask
for nothing.

Rainy day photography

I love taking photos in the rain. So far it hasn't damaged my
equipment though I take care not to have the camera out too long.
Usually I keep it under my jacket.

The water droplets make a nice change to the usual photos of flowers.
Interesting textures can be created. The bobbling of the droplets on
this image is a contrast to the straight line texture of the flower.

There water clears the dust from the air so photos look cleaner after
the rain. There's also the chance of a rainbow.

A good Madness Radio session from Dr. Joanna Moncrieff

http://www.madnessradio.net/madness-radio-bipolar-medication-myths-joanna-moncrieff

It's something many people have known for years. The biomedical theory
is bunk, however coming from a lecturer at University College London
means people listen.

She says what many people know: psychotropic drugs - legal and illegal -
are the same. Psychiatric drugs often make people feel bad but illegal
ones make them feel good. Weed or herbal cannabis is an antipsychotic
however people don't like taking prescription anitpsychotics.

This is well worth listening too. It's almost an hour long but it's
packed with lots of information and important arguments from a very
clever woman.

Perhaps I'm wrong about psychological therapies for the treatment of pscyhosis and psychotic disorders as a priority

At the moment provision of therapies for people with severe mental
illnesses is poor as it was for people with common mental disorder
before the IAPT programme. The evidence base for psychololgical
treatment of psychosis is poor in positivistic science reviews of high
quality trials but that doesn't mean psychological therapies don't work.

More importantly though is the journey through psychiatric care. It
starts from the moment of recognition of disorder or distress. It is the
entire journey that affects the outcomes. Psychological therapies are
rarely given early enough. What I'm talking about are interventions that
help at the beginning, for example in first-episode whatever (suicide,
mania, depression) that result in hsopitalisation.

I laughed at the idea of therapists in psychiatric wards because dealing
with an extremely unwell person can be difficult. However I was wrong
about that too. Good people can always get through to a person no matter
what state of mind they're in. My experience of wards was seeing
patients as nurses and therapists because that's the job they were doing
while the professional nursing staff stood as observers reporting back
to the psychiatrists and doing paper work. Where I was "Protected
Engagement Time" (where staff and patients interacted) for three hours a
day every week day was a significant improvement. That's how dire the
state of psychiatric hospital care is. I'd expect people need that sort
of care 24hrs a day and if it were available people could get better
sooner. Instead they're often left to rot on high levels of medication.

A better journey makes for better outcomes. The trauma of first time
hospitalisation can be ameliorated. The interventions used immediately
after hospitalisation can be scaled up to provide accessed to trained
professionals with lived experience of the condition to mentor an
individual at a vitally important stage. Like the Soteria paradigm,
first time hospitalisation can be seen as an opportunity to prepare the
individual to manage their condition long-term rather than just drugging
them and waiting for the drugs to kick in before discharging them.

There have already been small advances in the treatment of suicidal
crisis, for example the Maytree hospital. These are tiny and poorly
funded. These alternative paradigms of hospitalisation are desperately
needed for the best outcomes for the individual and society. People may
still need access to psychological therapies in the future to help them
through difficult times however it's the start of the journey where the
funds and the science, and compassion, are needed for the best outcomes.

Skunk's definitely a rapid acting antidepressant

In the last 2 days I've finished smoking £5 of skunk. I made maybe 15
or 20 spliffarettes from the blueys-worth.

I wonder if I feel so shit now because of the antidepressant effect,
because I haven't left the house for 2 days or because I haven't had a
drink for 2 days.

Whatever. It sorted out my eating habits. I've eaten 2 meals a day for
the last two days as well. Lots of junk food of course but proper food
in there as well. Usually 1 meal is a struggle.

I haven't felt particularly suicidal either though I've still not wanted
to get out of bed. Once I'm up though I get on with stuff. That's pretty
normal I feel. The still wanting to die thing isn't so normal but I'm
used to it.

Economics versus compassion

The financial crisis and change to a right wing government have
created be the greatest test of this question in the UK.

My guess is that economics will win out in government policy however the
evidence may prove me wrong. I remember reading a paper on the
recession's impact on physical and mental health in America. The paper
showed a decline in physical health on the measures used with its lowest
point a year after the recession tipping point. To my surprise the data
showed mental health had the opposite trend.

The authors interpreted it as an increase in social or informal mental
healthcare. American culture has a high sense of personal charity in
the absence of a modern state welfare system. The public stepped into
the breach.

I hope the same happens in the UK until a new government is elected.
True wealth in Gross Domestic Happiness terms is compassion, in my opinion.

Hypothesis testing

This is one of the fundamentals of traditional science. It's actually
quite a fine art.

Simple it's saying something absurd then proving it right using evidence.

An example comes from Roman times or whenever when armies used to sling
rocks at a besieged city. Conventional wisdom said that rocks would fly
until the energy ran out, then they would drop immediately. Some
scientist (Archimedes probably) said that the rocks start with an energy
and it reduces slowly so they follow a parabolic path.

The conventional scientists used their equations but the rocks kept on
missing the target. They went too far. Their hypothesis was incorrect
but they clung to it like a faith. The scientist with the new idea of
how force, mass and acceleration combine with gravity to make objects
flung from catapults follow a parabolic path had his hypothesis
confirmed because his strikes hit the target again and again.

In modern times it seems obvious that mathematics could determine the
right settings for a siege engine. It was absurd when the first military
scientist suggested the idea.

Hypothesis testing is just the beginning of what's know as positivistic"
methods in science. It's a concept I find hard to explain but I hope to
do a few more posts on it.

Empirical data for anti-stigma programmes

This thought comes from a Rachel Perkins interview for The Guardian.
http://www.guardian.co.uk/society/2010/aug/25/mental-health-treatment-rachel-perkins-mind

She's obviously woken up on the wrong side of the bed before the
interview. It's a rant I'd be proud of.

I could take exception with many bits of the piece but I'm letting the
end of the piece be a trigger for some thinking.

Here's her lashing out at anti-stigma programmes
"
In particular, Perkins gives short shrift to anti-stigma campaigns,
which have attracted substantial funding in recent years. "I don't have
any evidence that they [work]. I prefer not to use the term stigma,
because it attaches to the person. We don't talk about the stigma of
race. We talk about racism. The problem with anti-stigma campaigns is
that they identify the class of people by their impairment," she says.
"I want to see some empirical data [that they help people to get] a home
and a job. The bottom line [is] I want to change behaviour."
"

There's two bits I'm going to pick on. The second is the bottom line
described in the last line. She sounds like a tyrant but she's totally
right in her honesty in what the mental healthcare system wants to do.

I'm not surprised she hates anti-stigma programmes - and what she's
talking about is Time to Change. They are the opposite of conventional
mental healthcare. They make people less 'ill' by changing society's
expectations of mental illness. They reduce stigma thereby reducing
distress. They do not work on the disorder spectrum though they may
impact on it because reduced distress may lead to reduced mental
disorder. A person at peace is less undesireable or socially ugly
compared to a person in mental pain. T2X represents the antithesis of
her bottom line.

She's totally wrong about the lack of empirical data but it's here where
it gets interesting. T2C is evidence-based and it is a sort of
experiment. They hypothesis is anti-stigma programmes to do work. The
measures are the DISC scale developed by Professor Graham Thornicroft.
It's been through several revisions - I think it's on version 9 or 10 -
and it's been validated as a meaningful scale. T2C is having a
measureable effect on discrimination and stigma though it may not meet
its targets of 5% changes in stigma and discrimination.

Rachel Perkins would have T2C measured on psychiatric measures. In her
grumpy statement she wants bheaviour controlled, not accepted. She wants
the individual to be turned into an automoton for the modern (and now
becoming traditional) factory ethic rather than valued as they are.

T2C is not driven by the same measures that are becoming an imperative
but historically weren't: employment. It's driven by compassion and an
understanding that society is unequal, and continued behavioural
modification practices will not solve this.

What are the measures though? Prof. Graham Thornicroft is the UK's
expert but he's one of few research psychiatrists looking at the great
leap in mental healthcare: the change of society rather than the
individual. There is a lot of work to be done in the area of measurement
of the three areas he identified: ignorance, prejudice and
discrimination. There's even more to be done to heal society.

Empirical measures will take the finest minds available. Measuring
people takes the finest minds and measuring society is even harder.

Just how bad is life in the UK for people with a diagnosis of schizophrenia?

(from the presentation slides of Graham Thornicroft - just found it on
the net somewhere)

EPSILON Study Schizophrenia: Employment Rates (n=404)
People with a diagnosis of schizophrenia who were students or in employment
The Netherlands 18%
Denmark 15%
Spain 20%
Italy 23%
UK 5%

Source: Thornicroft G., Tansella M., Becker T., et al & the Epsilon
Study Group (2004) The personal impact of schizophrenia in Europe.
Schizophrenia Research, 69, 125-132

(The original paper is not open access though was written in conjunction
with a Mr P Farmer at Rethink.)

Measures are important when considering psychological therapies evidence and treatment of psychosis + distress is important

I've just come across a research brief of a paper.

CBT does not improve relapse rates in people with recently relapsed
psychosis
Evid Based Mental Health 2009;12:14 doi:10.1136/ebmh.12.1.14
http://ebmh.bmj.com/content/12/1/14.full

It's about a piece of research that was published in the British Journal
of Psychiatry last year about CBT, family interventions and psychosis.
It's a single blind randomised control trial with a reasonably good
sample size and even an effort to stratify the carers' sample.

The briefing explains that CBT doesn't affect the relapse rate nor does
family therapy. I'd like to go into the paper to see what the PANSS
scores were like (PANSS is the commonly used psychiatric measure of
psychosis). Relapse is seen as a significant failure. I think the reason
relapse is considered an important psychiatric measure is because the
cost of hospitalisation is high. CBT did not have any effect on the
other psychiatric measures used to describe schizophrenia apart from one..

CBT does reduce levels levels of depression seen in these patients in
this high quality study. They used the Beck Depression Inventory (BDI).
It seems that with individual CBT people with a diagnosis of
schizophrenia can, perhaps, be a little bit happier.

The psychiatric measures used in describing schizophrenia are
psychopathological and I feel are aligned with disorder spectrum of
mental health. The BDI scale is still pscyhopathological and psychiatric
(which is something I consider a failing) in design however it assesses
distress - the other spectrum of metal health.

The paper authors consider CBT not efficacious for the treatment of
schizophrenia.
"
Thus although individual CBT for persistent psychotic symptoms when
added to medication may confer some modest benefits in reducing
emotional distress, and should continue to be offered, it is not
efficacious in preventing further relapse among those recovering from a
recent relapse. Given the scarcity of therapist resources in this area,
this is a helpful piece of evidence for service planning and, to their
credit, it is a conclusion that the authors propose without qualification.
"

I need a piss. Where's the nearest research psychiatrist's face?

This single study shows that CBT can work for schizophrenia. It may not
address the 'cardinal' symptoms (Loren Mosher's derogarory term for the
pathological symptoms) but the evidence of this study says there is hope
for the distress of those shattered by the experience of unshared
perceptions.

Person with a diagnosis of schizophrenia or schizophrenic

I read far too much psychiatric literature for a sane person. I often see "schizophrenic" as a term to call a person with a diagnosis of schizophrenia. The psychiatric language is considered to be highly stigmatic because the term is a noun.

In my opinion it is a noun and for two reasons. I'm a depressive or a manic depressive or a schizoaffective (I don't know the noun for this) or a dual diagnosisive  (or this) or a mixed affective (or this). They couldn't determine my type but many psychiatrists have applied a label to my identity and personality and individuality. There are genetic theories that suppose my type is a genetic 'problem' that with the 'right' environmental factors can create a mentally ill person like me. The genetic theories and arguments used to rationalise homosexuality as a mental illness were turned back on themselves by homosexuality campaigners who used them to say that homosexuals were a valid part of the human race because of the genetic evidence.

The label of mental illness allows doctors to take away part of me, to change me into an automaton that isn't unwanted by society. It is to change the type of human I am into the type that is acceptable to society at the time.

It takes mad pride to say society is wrong to outcast my type, label us as ill and take away that which is still an essential part of the human condition: the symptoms of mental illness. It takes a sense of confidence in my very being to read the psychiatric literature that only seeks to look at what is wrong with my type and other types of human being, but it is an understanding tempered with the acknowledgment that in many people's eyes I'm an unwanted piece of shit.

(
A little history
Psychiatry was borne to help the outcast. Foucault explains this stuff better than I. Society has dealt with the mentally ill in different ways over time. During the change to the Industrial Age the mad became outcasts (without religion to contextualise their experience) and the idea of idiocy was created. They were the ones that did not have a perceived value in the new modality of civilisation. The creation of a massive asylum system, many of which were old leper houses, confined and saved the mad - an act of great compassion but one that hid madness from society and redoubled the idea of illness and unwantedness. The advent of psychiatric medication began the first step to rectifying that error in the development of a society full of and accepting of all types of human being. Anti-stigma programmes, the Disability Discrimination Act and other methods are continuing the change to an equal and diverse society.
)

(
A little on psychogenetics and more on the idea of types of human beings
My genetic arguments are not established by the evidence at the moment. There is no strong evidence at present for the idea of genetic types based on the current diagnostic system, i.e. the evidence shows limited associations for specific disorders linked to gene polymorphisms and evidence is showing disorders such as bipolar and schizophrenia may come from the same genetic route.

"Schizotaxia" is a term coined by Meehl in the 20th century to describe what he/she saw as a genetic state which environmental factors interplay upon to produce a human on the schizophrenia spectrum.Schizophrenia, schizoptypal personality disorder or schizotypy. None of these disorders or non-pathological states can be exist in an individual who is not a schizotaxic.
)

(
The greatest challenge in ethical application of psychogenetics
Only schizotaxics can become schizophrenics. One day people may be able to check for this type of human through genetic screening. The fear of schizophrenia would mean many parents would opt to screen for this. Given the treatment of schizophrenia in the past, certainly by the likes of Hitler (btw - I acknowledge I'm veering into an ad hominem argument against screening for mental illness by dropping Hitler's name in), policy makers may also use genetic evidence to remove the mentally ill. In my opinion it would still not stop us existing because when the screen programs stopped when they eventually remove my genetic type the chaos factor of evolution will recreate the type in the gene pool).

In so doing they are murdering a type of human being., a type that may be undesireable just like homosexuals were in the early 20th century. It may be one of the greatest moral challenges in the 21st century and beyond to never remove a genetic type of human being because at the time they are born there exists a social disability and stigma. Environmental factors are within the scope of change in a society that wants to remove my type and the safety of the diversity of the gene pool is assured.
)

(
Why it will reduce the capital of civilisation to remove the mentally ill through genetic screening
In my personal opinion the change from the Industrial Age to the Information Age (or whatever the third age of civilisation will be called in the future) means the schizotaxic type - the fundamental genetic type that can become a schizophrenic or not - may be more valued. The new age of society will be different from the one-size-fits-all approach to the structures in workplaces and other constructs of human cohesion. Production will move from mass to bespoke. Ideas and creativity are the new capital, not manufacturing capability. (The easiest example of the difference is Ford in the 20th century compared to Microsoft or Google in the 21st)
Art will truly take it's place as a valuable commodity for everyone.
)

Pain, resilience and me

Pain is pain.

The difference between physical, emotional and soul pain (and all the
other terms for the different types of pain) is noteworthy. People have
studied them and given mental pain as words as Eskimos have for snow.

Some people consider it a failing to be resilient to mental pain whereas
it's perceived that people shouldn't need to be resilient to physical pain.

My attitude of developing resilience through functioning while in pain
may have been caused by my upbringing. This attitude extended to all
types of pain.

oI played rugby. I remember one game where someone stamped on my foot
and the pain was unbearable. I played on. It was only my team mates who
saw the tears I couldn't hide who got me off the field. It's the
attitude that kept me going while I went through intense psychosis and
managed to keep working - just about - at my job at a mental health
charity. It's how I've learned to function through the pain.

People may think my attitude to mental pain is stigmatic of mental
distress - and I admit that I may seem self=stigmatic to the uninitiated
- however many people also go to the gym or run marathons. They willing
inflict pain upon themselves to get the endorphin rush, the feeling of
achievement and the physical/aesthetic value.

I don't run though. I don't go to the gym. I make my choices about the
pain I put myself through. I self-medicate so I don't endure the full
mental pain.

I admire the people who can go through the physical and mental pain, and
life, without any drugs for any pain whatsoever.

I fucked up

I've been trying to quit cannabis. Well, actually, to have an extended
period off it. Especially skunk - my favourite. I'd enjoyed other drugs,
and much harder ones. All the way up to the big scary one - the crack
cocaine. Just once, but it was so damn nice. Too good and way too
addictive. It never crossed my path again but...well...anyway.

I need my brain back. I need to be at my best because I want to put my
all to mental health. I want to cut back on my crinking too.

But here's the thing. I'm pretty unhappy. Doing charity stuff doesn't
bring me joy. I got over that. It's more complicated than that. I feel
this is a bit of the hedonic treadmill theory in action but perhaps I'm
rationalising something well. Perhaps not. I got used to the smugness. I
just wanted to get on with my job.

My rationalisation for my cannabis addiction is it's the best
antidepressant I've ever know, apart from all the other things I've
taken that make me chemically happy.

It's a dark mistress though but it's advantages can out weigh the
disadvantages. I need to cut back or stop, at least if I want to stop
being a waster and make a difference.

I've become really miserable without it.

So I've found it hard to quit. I've cut down to twigs and rubbing old
baggies with papers. It's negigible what I get out of those but it's
just like a person finding it hard to come off an of antidepressant or
antianxyolitics. It's just a habit that's hard to break. My soul pain is
different and hardly dulled by the strongest anti-depressants available
on prescription.

Last Friday I went out and scored a small amount of weed - enough for a
joint but I made a few spliffarettes and shared with the guys I was
chatting with. A small amount. A failure. Tonight I've scored £5 of
skunk. It's dealer skunk too - the sort of stuff they give you to hook
you in.

Fuck.

I just had a chat with a genius

Well she's a genius by membership of Mensa - a higher than average
intelligence quotient according to consensus measures of intelligence.

I was a bit disappointed though. She was intelligent as heck but she
didn't seem to be mad. Still, it's always nice to meet a genius.

More importantly that her intelligence: she's mental health sensitive
and she works for the police. That's more important. She's aware that
mental illnesses should be treated with the same compassion and
sensitivity as physical illnesses. I don't know exactly what she does -
she's not a street copper - but she's part of an organisation where
mental toughness is valued and the organisational culture may not
approve of mental health sensitivity. (That's a huge generalisation made
from limited experience and hearsay of course and some of the police
officers I've met have been mental health aware and compassionate).

Speaking about suicide

To the uninitiated speaking about suicide is a frightening thing.
People don't know what to say or do, not unless they're part of that
small community that can be open about their suicidal ideation.

There's a Facebook thread I'm currently commenting on. It's strange
because one of the posters echoes how I've been feeling. He's opened up
about his feelings of wanting death and his prayers for god to end his
life. I think many people wouldn't know what to do.

I opened up. I let him know that he's not alone in the way he feels. I
tried to explain how I live this suicidal ideation on a regular basis -
weekly if not daily, more weeks in the year than not, more than anyone
should have to suffer. I'm becoming more comfortable in removing my mask
and sometimes it's necessary to help people. I have a crappy way to
solve it: I'm used to it. I lied a little and said that remembering the
good times can come again can help survive. I also tried to push the
idea of social contact rather than internet contact.

This happened within an hour of me waking up. I wished last night I
could die and I didn't want to wake up this morning - that's how fucking
resilient I am to wanting to die.

The 1 in 6 people in their lifetime will experience suicidal ideation is
an extraordinary figure. People are so afraid to talk about it though. I
understand there's a fear of risk, i.e. that an inappropriate comment or
remark may be what sends a person over the edge. In my personal
experience the likelihood of that is small to none. It's the risk that
'trained' professionals take. Training to deal with suicidal people can
come in many forms though. The first rule is the simplest rule and works
for many things: compassion, even if you can't understand.

The wind blows the leaves but it still has peace

This was a Rastafarian explaining a little of life to me. I am the
leaf as are you. The wind rocks us and the stillness is broken, but
eventually the leaf returns to peace.

The wisdom of the Rastafarians is becoming well evidenced. The hedonic
treadmill theory states the same thing. Good things and bad things
happen but their effects are transitory.
(http://dmschreiber.ucsd.edu/Teacher/SubstantiveTeachingAreas/CoursesTaught/Spring2008/192/Readings/Diener%202006.pdf)

The leaf returns to peace.

Thoughts on death

Some people fear it. Others look forward to it.

I wonder if either of those people who hold those viewpoints understand
each other. I certainly can't understand fearing death.

I will holiday when...

....I'm six feet under. Then I can rest.

Rethinking the relabelling of schizophrenia

I think the Japanese may have got it right in the sense that their
conceptualisation embodied in the word may be the most important
concept. Their term means integration or, importantly, social
integration disorder. Their previous term for schizophrenia was very
highly culturally stigmatised. Their culture is still very structured
and hierarchical so deviance from the social order had a much higher
stigma than in other countries.

The two original labels for schizophrenia - dementia praecox and the
"group of schizophrenias" (I think schizogruppen was the word used in
the title of Bleuler's paper in 1908 - were about conceptualisations in
the problems of the individual. The majority of psychiatric research in
the developed world has focused on the psychpatholgy of the individual.
Even today measures of psychopathology that may have little relevance to
the individual's prognosis are still studied and used.

Romme's reconceptualisation - post traumatic psychosis or whatever - is
important because it takes a psychological view of the problem and
considers the environmental factors that caused the psychosis, i.e. the
high level of childhood trauma seen in people who hear voices. This
lends to a more compassionate view than the biomedical model of brain
disorder according to one study. His work and the work of others' in the
progressive mental health field has, in my opinion, been the greatest
force of change in the mainstream treatment of psychosis, hearing voices
and disorders on the schizophrenia spectrum.

It's the consideration of the 'disease' or disability caused by the
condition needs to be addressed with the understanding of the social
model of disability. The International Pilot Study of Schizophrenia
showed better outcomes in developing world countries that didn't have
the expensive, research-driven psychiatric mental healthcare systems of
the developed world. The social model of disablitiy has been
successfully applied to helping people with severe physical disabilities
however it has not been successfully extended to common mental disorders
and mental illnesses.

The Japaneses relabelling and reconceptualisation offers the best hope
for this new aim in treatment. R D Laing has made this point better than
me. It's society and the structures that need to change as a healthcare
objective. The Japanese concept of Togo Shitcho Sho may be the next step
forward in progress.

Mental health research revisits what saints and sages have known for years

Mental health has taken over the role of religion in society.

I'm reading through a paper on "well being", the neologism for positive
mental health. I came across this quote from a book by a significant
author mentioned in the paper.

"The point cannot be overstated: Every desirable experience—passionate
love, a spiritual high, the pleasure of a new possession, the
exhilaration of success—is transitory"

I reckon smarter people such as Jesus and Buddha or Marley and Gandhi
have said stuff like that in far more eloquent ways. Of course they had
a mental illness so had a huge advantage when it came to understanding life.

The problem is the teachings of the religious icons don't make it into
politics. It takes economics to justify "love thy neighbour" and
"there's more to life than money" and all that stuff. People look upon
it as if it's some new found thing but the saints, sages, prophets and
seers (and the female biological gender equivalents) have been speaking
this message throughout human civilisation.

Thoughts on the pursuit of happiness

I was speaking to someone last week and stumbled across something that I hadn't thought of in a while: the hedonic treadmill. The model says that good and bad events temporarily affect happiness but a person usually quickly returns to a neutral state.

People fill their lives with the acquisition of things that have meaning to them. Often it's money, status, possessions or people (e.g. having a more beautiful girlfriend). Once these goals are achieved happiness results. That's the assumption. In fact what often happens is the happiness is short lived and the next goal comes up. This is the treadmill.

In my mind it is represented by a hamster in a wheel. It's the futility of desire. The satisfaction of achieving a target quickly fades and the next rung in the hamster's wheel becomes the new goal.

One aspect of the psychology behind this effect was explained to me by a drugs and alcohol counsellor. He spoke of the work of Jorge Luis Borges who wrote about labyrinths and mazes of life. Life itself is a corridor. The maze is a construct of the mind, the winding paths and twists and turns of the hedonic treadmill. Maze-dwellers travel through the maze seeking the end - the completion of their goals - but in the end they return to the corridor upon achieving success and the mind creates another maze with new twists and turns. This is a human trait.

Awareness of this effect is useful but troubling to me. This paper makes an important point.
"
The theory, which has gained widespread acceptance in recent years, implies that individual and societal efforts to increase happiness are doomed to failure
"

It's as though there is no hope for human happiness.

I've tried to live with a new understanding over the past few months. I don't remember who said it but
"
The secret to happiness is realising you don't have to be happy.
"

It's not a positive message nor one that's given me much happiness, but then I wasn't looking for it.

Reflecting on my conversation with the Rastafarians last night makes me think this quote is a more important idea. It's a quote from Bertrand Russell.
"
I've made an odd discovery. Every time I talk to a savant I feel quite sure that happiness is no longer a possibility. Yet when I talk with my gardener, I'm convinced of the opposite.
"

Most other people are more optimistic about the potential for people's happiness. There's a wonderful piece by Polly Toynbee published in The Guardian and reposted on this site where she speaks of her hopes that society will shift from a Gross Domestic Product-orientated measure of success to Gross Domestic Happiness. It was hoped to become a reality in the UK before the financial crisis and change in government.

In my own life I've eschewed the hedonic treadmill as much as possible. I've forsaken the wealth of my parents and the opportunities of wealth my education gives me. I've battled the internal desires to have more and want what other people have though it was yet another thing I failed at. It gave me access to valuing the small pleasures as much as someone else might enjoy a fine wine or dream holiday. Cheap wines taste like Chateauneuf du pape and discovering my local area is a substitute for the holidays I used to have.  Accepting my desire to have more was the same desire that millionaires feel when comparing themselves to billionaires helped me understand a little bit more about what was valuable.

My home is where I rest my head. My kingdom is where my feet touch the ground. My wealth is my brain, my heart, my soul and what I do with them.

Misery will come and go but it's the same for everyone.

Ketamine may provide a new option for rapid acting antidepressants

This is most amusing....Special K has been a recreational drug for
many years. This is the second study I've heard of where it's potential
as a mental health treatment is being investigated. Admittedly I haven't
read the study so this article has to be taken with a pinch of salt.
However it states
"
The authors note that ketamine also has been tested as a means to
rapidly treat people with suicidal thoughts, a benefit usually not seen
until weeks of treatment with traditional antidepressants.
"
http://www.bmedreport.com/archives/16378

It's not one I've tried intentionally. It may have ended up in Ecstacy
tablets I've taken. It was rumoured to be mixed in with "soap bar" -
cheap hashish resin usually imported from Morocco - to give a faked
monginess (sedation) that was a common effect from soap bar from
Liverpool about a decade ago.

I should probably get off my lazy arse and read the study. Modern
antidepressants work on serotonin neurotransmitter levels. I wonder if
what's normally used as horse tranquiliser would work on these pathways
or are there other neurotransmitters that help people get high?

Bah. Can't be arsed.

The text for the video below

"Here's to the crazy ones. The misfits. The rebels. The troublemakers.
The round pegs in the square holes. The ones who see things differently.
They're not fond of rules. And they have no respect for the status quo.
You can quote them, disagree with them, glorify or vilify them. About
the only thing you can't do is ignore them. Because they change things.
They push the human race forward. And while some may see them as the
crazy ones, we see genius. Because the people who are crazy enough to
think they can change the world, are the ones who do." ~ Apple Computer Inc

A short video with a positive message about craziness and genius

http://www.facebook.com/profile.php?id=1383114350&v=wall&story_fbid=1372541438580&ref=notif&notif_t=like#!/video/video.php?v=1470495322417
<http://www.facebook.com/profile.php?id=1383114350&v=wall&story_fbid=1372541438580&ref=notif&notif_t=like#%21/video/video.php?v=1470495322417>

Counselling from the informal mental health system

Last night I went to get some weed to smoke and managed to get some.
Just a blueys.

I then went and sat near a church with a beer. A Rasta asked me for a
beer and I said sure if he'd talk to me. He just spoke about things. His
friend came over and we got in an argument initially. I have very
different views of god to the Rastafarians. And pretty much every other
religion.

I spke to him of real wars. What happened in Sri Lanka. Like a typical
therapist he didn't listen to what I was saying but took what he wanted
from it to make his point. But I listened none the less. The gents sang
me Rastafarian songs I didn't understand but I sat and listened.

I spoke of my life and my heart and my pain, and they understood. They
even said "you have the depression" which I was surprised to hear. I
didn't think they'd use psychiatric terminology to label misery.

They were angry at me for my views on god but when they understood they
spoke to me and my heart. They explained to me my problem: I carry the
weight of the world on my shoulders. I wouldn't have it any other way.
It's yt another part of my dysfunctional character. It's fundamental to
my battle against god.

IT makes me miserable as hell underneath the mask. I take no pride or
good feeling from it, nor want it. It's not suprising I'm so miserable.

They tried to therapise me. They explain to me the value of life and of
joy. They explained the leaf has peace even though the wind rocks it.
They explain the wind but I didn't understand. Their wisdom was beyond
my stage in life.

This is the informal mental healthcare system. Two strangers who didn't
walk on by, who saw my pain through my mask and gave me what the NHS
still hasn't given me.

Try them then you'll understand why people buy them

A simple message for the UK's drug legislators.

What to do with a mosquito?

I sat in a pub last night with a mosquito buzzing around me. I
wouldn't kill it of course. That's just a waste. I blew on it when it
landed on my hand but it came back.

A thought occurred. That mosquito has a short life. All it wanted was to
eat. So I let it bite me. It didn't hurt me. And I've lost more blood in
other ways. At least this went to something good.

Sure. This morning my hand has a small bump but that will fade. I'm
happy the mosquito ate.

I suppose this piece is about living in harmony with the environment.
James Lovelock's Gaia theory and all that stuff. The blood loss and the
soreness this morning made little difference to me but it meant a good
meal for the mosquito.

And I felt good about something, something I'd done.

A significant quote

"Even the rich are hungry for love, for being cared for, for being wanted, for having someone to call their own."
Mother Teresa

Explaining to people they're crap may help them be smart and other things about intelligence

This is a counterintuitive result to the positive notions of
reinforcement used in modern teaching. It's from a paper I'm reading at
the moment.

People who score lowest in tests assume they do better whereas those who
do very well are more often likely to assume they did adequately or
poorly. The surprsing result in this study is showing a person their
incompetence can make them smarter.

"
It suggests that the way to make incompetent individuals realize their
own incompetence is to make them competent.
"

From
Kruger, J. at al. 1999, Unskilled and Unaware of It: How Difficulties in
Recognizing One's Own Incompetence Lead to Inflated Self-Assessments,
Journal of Personality and Social Psychology
http://gagne.homedns.org/~tgagne/contrib/unskilled.html

It's not about competence and incompetence per se. It's about the
ability to recognise incompetence and how to become competent.
Recognising my errors and falibilites - truly recognising them - gives
me the opportunity to correct them. People who estimate themselves to be
good at something may be less inclined to improve or recognise their
need to improve.

The study itself looks at 4 predictions. It's worth a read just to have
the effect of questioning your own abilities and competencies,
especially those things that you regard yourself as doing well in.

This isn't what I'd rate as a good study but I don't know much about
those evalutations. The important thing for this paper is what I'm
taking from it which is that I need to reflect on the areas I feel I'm
competent (few at the moment) and strive to do better in all of them.

The paper also once again shows me just how desperate I am to be
competent and good. My heart sank when I read the idea that my
estimation of competence may be an error. I may be stupid. That's really
bad for me. But it's good to have that realisation because it's
something I can work on. Accepting my fallibity and stupidity is the
start to changing it.

I wouldn't improve on something that is perfect...right?

I'm just getting down to the discussion bit and there's tons of
interesting stuff in there. This is why I love reading beyond the abstract.

The error in those who are top scorers is also important. They tend to
underestimate their abilities (I know, but I'm not underestimating so I
can be a top scorer. It's probably just low self esteem or something).
They assume tat everyone is like them - the false consensus effect - so
everyone will do as well as they do.

This paragraph is kinda cool.

"
More conclusive evidence came from Phase 2 of Study 3. Once top-quartile
participants learned how poorly their peers had performed, they raised
their self-appraisals to more accurate levels. We have argued that
unskilled individuals suffer a dual burden: Not only do they perform
poorly, but they fail to realize it. It thus appears that extremely
competent individuals suffer a burden as well. Although they perform
competently, they fail to realize that their proficiency is not
necessarily shared by their peers.
"
Of course all of this comes with the caveat that these are about
consensus measures of intelligence and competence and in real life
they're about as useful as a chocolate teapot. I remember the stories of
East London market traders being recruited to the City trading floors.
They had natural skills whereas those with degrees in finance simply
didn't and their education in the classroom wasn't as important as an
education from the school of hard knocks (or life).

--

This paper also relates to another aspect of my personal life. I often
don't understand why people don't like me. I can comphrehend why but at
the same time I find it hard to understand enough to change myself. I
lack social skills but when I try to do better it seems I just end up
putting my foot in it. Being misunderstood is common for a lot of people
I think. It's about making that step or return to social competence that
- at the moment - totally baffles me.

My misery is nothing

This was just posted up by one of my Facebook friends. I've never met
her and I don't know why she friend requested me whenever she did. She's
got the most friends I know - so much so that she has 2 accounts (the
maximum number of friends on one account is 5000).

It puts life into perspective. This is real life. This isn't what I read
in research papers.

I wish I had the words to make it better for her. And for her husband
too. In another post she explains he came off life support. If he's
conscious he must be in hell. She's in hell too. I can't imagine the mix
of emotions she's feeling, the volatility and confusing.

This is why mental healthcare exists. This is why it doesn't matter if
it's an illness or a problem or an emotonal and behavioural disorder.
This is human misery. Plain and simple.

"
I have an update. My husband came home last night, more drunk and
belligerent than ever. I told him he needed to find somewhere to live
because I'm not taking this crap anymore. He called me all sorts of
names, including a slut, etc. We were outside smoking. He went in. I sat
outside for a while, and when I came back in, he was in the process of
taking a HUGE amount of pills. I said, "Whatcha got there?" He wouldn't
answer just continued to choke them down with the water. I asked again.
And again. He finally said 'all of the clonodine, and whatever else was
in there". I said 'Oh really?" Went to check...yeah, all three bottles
of my prescription meds were empty and laying there without the lids on.
I came out and said "Well now I'm calling 911 and you can't stop me!".
He told me not to, to hang up. I called. I also vented my frustration
with the 911 person, telling her "I called 911 earlier in the day
because I KNEW something bad was going to happen...I didn't know what,
but I know my husband and how he acts, and bad vibes were just radiating
from him....remember.. the police couldn't do anything until or unless
someone got hurt.
WELL NOW MY FUCKING HUSBAND IS ON LIFE SUPPORT AT MERCY HOSPITAL YOU
STUPID FUCKS! (the police)...The doctor said he's not sure if he's going
to make it or not, he's on life support and a ventilator, said most
people DO make it through this kind of thing 'but...your husband is
really really sick'.
I have been crying all night. I wanted a divorce, not a funeral! FUCK. I
am angry at the police for not intervening earlier in the day. He has
BOTH a history of DV AND suicide attempts. When the officers arrived
along with the fire department and paramedics, the cops that arrived
were the SAME ones that dismissed me earlier. When I saw the female cop,
I just pointed at her and said "This is EXACTLY why I called you guys
earlier today - I don't call 911 out of boredom"....she just walked past me.
I've thrown up 4 times tonight. I can't deal with this shit. I'm too old
and have too many health problems to keep dealing with this kind of crap.
So,...thank you Redding Police Department...to protect and serve my
fucking ASS. To serve yourself and protect your own asses. IDIOTS.
I am OUTRAGED right now. The picture is just there so I could write all
this.
"

A quote on medication from Shakespeare

"O true apothecary! Thy drugs are quick. Thus with a kiss I die."
Romeo and Juliet

Have I got more stupid?

I'm finding it harder to read papers. I've had a skim through some of the older blog posts. They sounded smarter and I used more big words. And swore a lot less too.

Is it the effect of isolation, less stress, less drugs or some brain deficit? I've slowed down a lot over the past few months. I could whip through a paper quickly but now it's taking me ages to read a reasonably short paper on the IAPT scheme (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V5W-4WS2HYG-1&_user=10&_coverDate=11/30/2009&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1433582937&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4d3538d879039c6b22d4e007572e7565)

I was taught that mathematics is like a knife. Keep using it and it stays sharp. Leave it alone and it becomes blunt. I hope that's true. If I lose my intellectual capabilities then I've really got nothing left to offer.

People with a diagnosis of mental illness get worse quality physical healthcare

This is a review that was published in 2009.

Mitchell, A. et al. 2009, Quality of medical care for people with and
without comorbid mental illness and substance misuse: systematic review
of comparative studies, The British Journal of Psychiatry
http://bjp.rcpsych.org/cgi/content/full/194/6/491?maxtoshow=&hits=10&RESULTFORMAT=1&andorexacttitle=and&titleabstract=quality+healthcare&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT,HWELTR
<http://bjp.rcpsych.org/cgi/content/full/194/6/491?maxtoshow=&hits=10&RESULTFORMAT=1&andorexacttitle=and&titleabstract=quality+healthcare&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT,HWELTR>

It's a sad and startling result.

These are the author's conclusions and I think they've been conservative
in them.
"Despite similar or more frequent medical contacts, there are often
disparities in the physical healthcare delivered to those with
psychiatric illness although the magnitude of this effect varies
considerably."

Here's a snip.
"
In one of the largest studies to date, Young et al identified 25 237
people with mental illness who had suffered a myocardial infarction.The
authors examined rates of revascularisation procedures (cardiac
catheterisation, percutaneous transluminal coronary angiography and
coronary artery bypass graft surgery) and mortality, stratified by age.
Those with a mental illness had significantly lower levels of all three
revascularisation procedures compared with those without mental illness,
with the lowest rates seen in those older than 64 years. With regard to
in-patient mortality post-myocardial infarction, in the older cohort
(older than 65 years) with mental illness there was a 21% lower
risk-adjusted likelihood of death (P<0.001) compared with those without
mental illness. In the younger cohort those with schizophrenia and
substance misuse had higher in-patient mortality rates (both P<0.001).
"
The standardised mortality ratio (SMR) in the UK is 5 for people with a
diagnosis of schizophrenia. It means they're 5 times more likely to die
than the general population. The UK has one of, if not the highest, SMR
in Europe. This paper shows the strongest reasons for that effect. The
review looks at other mental illnesses as well and the problem happens
across the spectrum.

It's late and I'm tired. I should have been asleep ages ago. It's lucky.
There'd be some serious swearing going on otherwise. Ah....fuck it.

The Dunning–Kruger effect and something strange about reading psychology stuff

I came across this effect and had to look it up.

http://en.wikipedia.org/wiki/Dunning–Kruger_effect

This is the first paragraph from the Wiki page.

"
The Dunning–Kruger effect is a cognitive bias in which an unskilled person makes poor decisions and reaches erroneous conclusions, but their incompetence denies them the metacognitive ability to realize their mistakes.[1] The unskilled therefore suffer from illusory superiority, rating their own ability as above average, much higher than it actually is, while the highly skilled underrate their abilities, suffering from illusory inferiority. This leads to the situation in which less competent people rate their own ability higher than more competent people. It also explains why actual competence may weaken self-confidence: because competent individuals falsely assume that others have an equivalent understanding. "Thus, the miscalibration of the incompetent stems from an error about the self, whereas the miscalibration of the highly competent stems from an error about others.
"

It's the effect of reading it though. I'm reflecting on where I've been incompetent but thought I was competent. It's made me self-aware and it's made me want to change. I just wonder if finding out about this effect has the same effect on other people?

Mental health and buildings

There's a Mencap campaign at the moment to get changing rooms for
babies as something mandatory in all public buildings.

I was wondering if there was something that could be done for those with
mental illnesses and for everyone.

I'm sure there'll be simple things already in there like ensuring
sunlight is available for everyone. It's an important thing for
everyone's mental health. Plants and greenery are also good for mental
health, and often not seen around enough. CCTV is the bane of the
paranoid. There's little that can be done about them apart from perhaps
hiding the devices. A "time out" or rest room which is made as calming
as possible may be useful in every workplace and large building.

I'd call for proper daylight lighting instead of those horrible
fluorescent lights. They're a little bit more expensive and would be the
same price as fluorescent lights if it became a mandated thing. It would
help a lot of people during winter I would guess. It may have the
benefit of improving productivity in winter too.

An anthem for those resilient to misery

Hard knock life by Jay-Z

http://www.youtube.com/watch?v=ekomM8aobQo

That's the thing about misery. After a while you just get used to it. It's just life.

I just don't want anyone else to have a hard knock life. Not like mine.

A fascinating site and an interesting quote

This is a great site full of snips from various mental health professionals across the years.

http://www.psychquotes.com/

‎"…Jesus Christ might simply have returned to his carpentry following the use of modern psychiatric treatments."William Sargant, British psychiatrist, 1974

At least I'm not totally paranoid

This image takes belief. It takes the trust that I didn't photoshop
this up and this genuinely happened. It is so unusual that it must be a
delusion or a lie....or it may have happened to me.

It did just now. There's no way I can prove this happened. I'm aware
that by putting this up and claiming that it happened I will be accused
of being a liar and...perhaps...faking my paranoia.

I was posting an image which had an important message on my Facebook
profile. As I flicked a couple of keys this came up. It's a Facebook
thing that normally pops up when there's unusual activity to check it's
a human rather than an automated program.

This one was most unusual. I didn't type the text in the box that says
"STOP BUGGING ME" and the message disappeared as quickly as it appeared
upon a key press.

Yes. I could have typed it there myself and done the screen capture or
faked the image. As you can see from some of my other images I'm fairly
competent with image editing programs. I don't have many readers who
trust me enough to know that this isn't faked.

Or better put, it's as fake as this image.
http://imaginendless.blogspot.com/2010/06/hardest-photos-ive-had-to-edit-in-while.html

What just happened to me would freak the shit out of anyone who hasn't
survived psychosis. The sad thing is that this sort of control or
manipuilation is not quite like real psychosis. There is a non-corporeal
force that does this stuff, and the most dangerous thing is to fuck with
that which fucks with my life. It'll fuck you right back.

A little on loneliness

People can assume that loneliness is a lack of social contact. It goes
deeper. I can feel isolated in a room full of friends. I'm not the only one.

The use of antipsychotics in children in America

This is from the blog of the International Hearing Voices Movement.
There's lots of things that could be taken from this but I'm taking what
i want to take from this.

it's a nicely balanced piece. The words of the health service manager
showing the positive impact of psychotropic medication is enough for
anyone to think that psychiatric medications should be used on chidlren.
I seem like an ogre to say that they should be denied anything at all
that can take them away from their terrible lives.

Children in foster care have suffered, and suffered like you'd never
know. I want to punch and hit me just thinking about this injustice. I
am thankful there is a system to help them but I still would want them
to be given a full life and not drugs.

But maybe a full life isn't available for these children and the misery
and pain experienced by children in the UK and in the US is just beyond
the sort of pain that anyone should suffer. If there is no money and no
compassion then drugs make sense.

It's the lives of these children that make me know I'm right to be an
antitheist. Maybe humankind's chemical answer to god's mistakes is the
only solution in a sick and fucked up world.

http://hearingvoicesmovement.blogspot.com/
"
In Florida, 81,961 children covered by Medicaid were on psychotropic
medications from January to June 2009, compared to 76,358 from January
to June 2008, according to the state Agency for Healthcare
Administration. Numbers for private health insurance companies are not
public.

Local agencies are seeing a rise in the number of children with
psychiatric problems, from severe anxiety to depression. They're also
seeing more young children who are 5 or 6 years old. The concern is
especially high in foster care, where a higher percentage of children
are given psychotropic drugs than in the general population.

The April 2009 death of a South Florida 7-year-old foster child, Gabriel
Myers -- who was prescribed several mind-altering drugs and hanged
himself in his foster home -- sparked a statewide review and
recommendations in November that will result in new rules and
legislation in the coming months for children under foster care.

"We must do better for our children," said Alan Abramowitz, former local
DCF administrator and state director of the DCF Family Safety Program
Office. "Medication is not the cure-all."

Adderall is the psychotropic medication prescribed statewide in foster
care to the largest number of children for attention deficit
hyperactivity disorder, DCF records show. Locally in foster care, the
main psychotropic drug being prescribed is Seroquel for mental/mood
conditions.

Some child advocates question whether medications -- some of which have
serious side effects such as suicidal thoughts -- are being used as a
quick fix to behavioral problems that children will grow out of because
their brains are still growing.

"It shouldn't take mind-altering medications to help children grow up,"
said Karen A. Gievers, a child advocate and an attorney in Tallahassee.
"It takes good parents to help children grow up."

Others say some children need medications to help them concentrate and
succeed in life. Some are being exposed to more violence at home and
dealing with issues not seen a decade ago.

"We get children who haven't giggled or laughed or smiled in years,"
said Shirley Holland, department manager at Halifax Health Behavioral
Services, the local community mental health provider for children. "Once
we add medication, it's like the light goes on. They experience life in
a completely different way. It doesn't mean the burdens go away, but
life is not so heavy."

MORE CHILDREN BAKER-ACTED
Halifax Health Behavioral Services has seen the number of children
admitted under the Baker Act as a danger to themselves or others almost
triple in Volusia and Flagler in a three-year period. The agency treats
about 3,000 children in all its programs -- more than half are on
psychotropic medications.

The reasons behind the rise are unclear, but some point to children
being subjected to more stress at home.
Holland said it would be unusual about 20 years ago to see a 12-year-old
who was psychotic, hearing voices and hallucinating, but "they are
younger than that now."
"