Just some stuff on schizophrenia, best practice and blah blah blah

I'm sure medication will continue to be used to treat behaviour and
emotion. One thing I will be suggesting is a review of research looking
only at the measures of the effect of major tranquillisers on delusions
and hallucinations. For many patients this is the core reason why they
accept treatment but the effect of the major tranquilliser on this core
patient measure is unknown because PANSS, BPRS and other measures have
many other factors which may mask the effect of drugs on these two
important factors.

What I am talking about is a retrospective meta-analysis only looking at
these measures. The value of this research will be allowing
psychiatrists to offer patients what they expect from a drug called an
antipsychotic. I hope you would agree that in lay terms psychosis is
about the internal experience of consciousness which is different from
the accept norms which is what is represented by the measures on
delusions and hallucinations. As far as I am aware in the half century
of the use of this drug this research has never been done.

If the research shows one drug to be better than all the rest then it
may be possible to seek new avenues in drug research which more
specifically target the neurotransmitter sites of the drug which best
reduces the delusions and hallucinations. In the one piece of
qualitative research I've read on the effect of clozapine even this
highly dangerous drug doesn't cease the delusions and hallucinations in
all patients.

I hope you would agree with me that this piece of research is worth
doing? By finding drugs which work on what patients want and are more
specific in their neurobiological action it is my hope that there will
be fewer side effects, less physical illnesses caused and patients could
have a better quality of life. It would also meet their expectations and
allow psychiatrists to meet their expectations. The review should also
be relatively cheap to do since there is no need to do a new trial.

I am working on the bit about black people and schizophrenia today. I am
saddened by the results of the Count Me In census. One of the best
resources in the area is the Sainsbury Centre for Mental Health Circle
of Fear report. If you are not aware of it I can send you a link. It was
written back in 2002 and made 15 recommendations, many of which have not
been followed through. These recommendations may be the way to change
the poor experiences of black people with schizophrenia in the future.

The recommendation I will make other than implementing those suggested
in the 2002 SCMH report is, I hope, a way to reduce the overdiagnosis
problem. It is based on this one study and a few other things I've
gleaned about the history of diagnosis and treatment.

Hickling FW, McKenzie K, Mullen R, et al. A Jamaican psychiatrist
evaluates diagnosis at a London psychiatric hospital. Br J Psychiatry.
1999;175:283–285
http://www.ncbi.nlm.nih.gov/pubmed/10645332

"Of 29 African and African-Caribbean patients diagnosed with
schizophrenia, the diagnoses of the British and the Jamaican
psychiatrists agreed in 16 instances (55%) and disagreed in 13 (45%)."

From my lay perspective the result from the abstract of this paper (I
admit I have been remiss and not read the full paper nor searched for an
open access copy) shows there is a factor of cultural bias in the
diagnostic practices of UK-trained psychiatrists. I could labour this
point further but I think the above quote from the paper says enough for
me to suggest that West Indian and African psychiatrists may need to
train UK psychiatrists and psychiatry students in how to diagnose
schizophrenia in black people.

I feel this is a simple recommendation which has not been suggested in
any of the documents I've read thus far. This novel approach may mean
that fewer black people will be misdiagnosed with schizophrenia and
therefore incur the ill treatment which is the basis behind the
significant amount of policy work in the area.

A quote about ADHD treatment which is relavent to so much other stuff in mental health

From
Baughman F (2006) There Is No Such Thing as a Psychiatric
Disorder/Disease/Chemical Imbalance. PLoS Med 3(7): e318.
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030318

"
All patients and research participants with psychological problems are
led to believe they have an abnormality/disease, biasing them in favor
of medical interventions, and against nonmedical interventions (e.g.,
love, will power, or talk therapy), which presume, as is the case, that
the individual is physically and medically normal and without need of a
medical/pharmaceutical intervention.
"

Th author is a professor and he's standing against the tide of
psychiatric tyranny. It is a dark trend to drug children and medicalise
childhood. It is one sanctioned by the mainstream of mental health and
psychiatry as well as political and educational establishments, but it
is immoral.

The author talks about the invalidity of the MRI scans and the science.
What he fails to note is that brain differences are not necessarily
deficits. This is the a tool of psychopathologisation: to call brain
difference a deficit.

Just as there is no normal level of serotonin in scientific terms there
is no normal brain. There are differences. Psuedoscince calls
differences deficits without the wisdom to know what it a deficit and
what is simply a difference.

Otherwise, according to this paper, taxi driving is a mental illness.
http://www.pnas.org/content/97/8/4398.full

From a discussion with an old friend who knows a lot more about
neuroscience than I do the differences in the brains of taxi drivers
after 15 years of driving a London cab might be due to more connections
being made between neurons in certain areas and less connections in
others. Why there is more in one area and less in another is an area of
interest to any scientists.

But using the methods of psychopathology a subjecti ve judgement could
be made that taxi driving is a mental illness. It clearly isn't but
there are observed brain differences.

My conversation with my friend reminded me of studies of brain volumes
in children with schizophrenia. The results are frightening even to a ly
person who is against the medicalisation of the human condition. There
are percentage differences seen in children with schizophrenia. It's a
few percent in a few years (can't remember the study but it's on the
blog somewhere).

It's the sort of evidence a psychiatrist might use to justify drug
treatment - though the drug treatment might be part of the cause of the
reduction in brain volumes.

But what if it isn't part of the supposed brain illness of
schizophrenia. What if the differences are due to the diffeerences in
the lives of children with schizophrenia. If a child is stuck in a
psychiatric ward instead of living a life which an average child would
live then their brain will end up developing differently. If the child
is excluded and isolated instead of enjoying the social contact which
many children enjoy then their brain will develop differently. If a
child is stuck at home instead of going to school then their brain will
develop differently. If a child has a more mentally inward facing
experience of reality and consciousness then their brain may develop
differently.

This doesn't mean the child is diseased. The disease is the society
which doesn't value these valuable and essential human types. The child
may be more thoughtful or soulful. The child may have more capability to
achieve wisdom. The child may not fit into the constructs of a diseased
society, but there is nothing wrong with the child no matter how much
brain evidence is used to call their type - the schizophrenic type - a
disease.

This is a good quote

"Psychiatry is the legal perpetration of abuse that is founded on the need
for power and control over others."
Susan Kingsley-Smith

And this was my retort
And replaces religion's role in society after it lost power during the
Industrial Age. The truth about behaviour and emotion which god provided
was replaced by the new truth of the (pseudo)science of psychiatry.

e.g., "why am I unhappy?" if asked to a priest would be answered by the
dogma of whatever religion or belief the priest had. If asked to someone
working in mental health the answer would be whatever dogma they
followed, be it the biomedical or psychosocial or spiritual or other
dogma. The truth of the answer would use the truth of god or the truth
of science even though, as yet, know of us have the true wisdom to give
any true answer about the human condition.

A damning conclusion from the last Count Me In Census

The subjugation of black skinned people is historically intertwined with
the mental healthcare system from early diagnoses such as drapteomania
to the advertising of the antipsychotic as a potent tool to suppress
black activists in America.

The modern system seems to feel some guilt for the situation and has
made attempts to rectify it. The success of these attempts are measured
by the Count Me in Census of ethnicity and mental health. The last one
happened last year and the report stated in its conclusions.
"
Overall, the results of the 2010 census show little change from those
reported for previous years. A detailed comparison between the 2005
baseline and the 2010 census is on page 32.

Although the numbers of inpatients overall have fallen since 2005,
ethnic differences in rates of admission, detention under the Mental
Health Act and seclusion – three of DRE's 12 goals – have not altered
materially since the inception of DRE in 2005:
"

Fuck. That's awful. Anyone who knows the torment and inhumanity of an
inpatient stay will know just how awful it is.
It's this awful.
"
67% of patients had been in hospital for one year or more; 31% for more
than five years
"

Can you imagine living 5 years of your life stuck in an NHS psychiatric
ward? I could barely stand one month under section. It was more hell
than I was willing to put up with.

Here's a link to the full report.
http://www.cqc.org.uk/_db/_documents/Count_me_in_2010_FINAL_(tagged).pdf
<http://www.cqc.org.uk/_db/_documents/Count_me_in_2010_FINAL_%28tagged%29.pdf>

Fuck. I hate thinking about mental health.

A Jamaican psychiatrist diagnoses schizophrenia differently

Hickling FW, McKenzie K, Mullen R, et al. A Jamaican psychiatrist
evaluates diagnosis at a London psychiatric hospital. Br J Psychiatry.
1999;175:283–285
http://www.ncbi.nlm.nih.gov/pubmed/10645332

"
Of 29 African and African-Caribbean patients diagnosed with
schizophrenia, the diagnoses of the British and the Jamaican
psychiatrists agreed in 16 instances (55%) and disagreed in 13 (45%).
Hence, interrater reliability was poor (kappa = 0.45). PSE CATEGO
diagnosed a higher proportion of subjects as having schizophrenia than
the Jamaican psychiatrist did (chi 2 = 3.74, P = 0.052).
"

The sample size is small but it backs up the noting that UK
psychiatrists are diagnosing schizophrenia differently. This may be the
reason why black people are overdiagnosed with schizophrenia in the UK
and not the problem of the change in the diagnosis over the last half
century though perhaps this is still relevant.

It doesn't account for all the 9x overdiagnosis rate but it's probably
the most controllable factor...well...that and cannabis misuse. The
recommendation I'd make is for training practising psychiatrists as well
as all psychiatry students. I recvkon it'd work better than recommending
diagnosis be checked by a UK-trained black psychiatrist.

The overdiagnosis problem wouldn't be a problem if black people had good
experiences in mental healthcare or the treatments didn't often harm the
patient. The sad thing is treatment for schizophrenia is traumatic,
harmful, unethical and inhumane. I would guess a significant part of the
prognosis is caused by treatment and the diagnosis itself.

Email address for Louis Appleby

mental-health-czar@dh.gsi.gov.uk

CBT doesn't really work much and science in mental health

Lynch, D, 2010, Cognitive behavioural therapy for major psychiatricdisorder: does it really work? A meta-analytical review of well-controlled trials, Psychological Medicine
http://journals.cambridge.org/download.php?file=/PSM/PSM40_01/S003329170900590Xa.pdf&code=b62ffa4b898268608a9e7b504bdd5319

Cognitive behavioural therapy - changing the way people think and behave by using talking techniques from therapists - doesn't really work according to this high quality review.The review uses a different inclusion criteria to the 'mega-analysis' which is often used to show that CBT really does work.
Butler, A. et al. 2006, The empirical status of cognitive-behavioral therapy: A review of meta-analyses, Clinical Psychology Review
http://www.sciencedirect.com/science/article/pii/S0272735805001005

So which one is true? The massive review (the 2006 one) which includes loads of papers but has a weaker inclusion criteria and, if I remember right, doesn't include a funnel plot or the smaller review of higher quality trials (the 2009 one at the top of the page)?

I'm afraid it's the one of controlled trials. At least based on the current paradigm of evidence based medicine. Blindness is so important.

The double blind randomised controlled trial gained success when it showed insulin shock or insulin coma therapy to be as effective as other treatments at the toime for...think it was schizophrenia. At the time
the insulin treatment was considered best practice around the world but the introduction of random assignment to the control or active treatment group showed that, in fact, it wasn't the best treatment.

Time and again it's the reviews that select the highest quality trials which show treatments thought to work suddenly don't. The recent noteable example is electro-convulsive therapy or ECT. This barbaric
treatment is what I hope is the last in the line of psychiatric treatments which induce seizures. The history of inducing seizures to treat mental disorder can be traced back to the work of Hippocrates who
notices paitents who had malaria seizures also had behavioural changes. The recent Bentall and Read review on ECT picked high quality trials with long term follow. This treatment of last resort was shown to be as
effective on follow up as sham ECT (where no electricity is used to shock a person into a seizure) and slightly more effective during treatment.
http://www.mindfreedom.org/kb/mental-health-abuse/electroshock/ect-review-2010-read-bentall.pdf/view
(Link to paper at the bottom of the page.)

Many, many people have died because of this treatment. Some people who've had it done are major advocates of the treatment. This presentation on TED is an example.
http://www.ted.com/talks/sherwin_nuland_on_electroshock_therapy.html

The speaker may have gotten the same benefit from sham ECT and less damage to his brain.

And so back to CBT. The controls in the trials are as effective as this new dogma of treatment for all but depression where the evidence for it's effect is small. The effect size is far below what got the Improve
Access to Psychological Therapies scheme approved.then factoring in publication bias...that demon of good
research....which is the effect of trials with negative results being hidden...well it knows off about a third of the effect size of CBT studies.
http://bjp.rcpsych.org/content/196/3/173.full

In a sense it's saddening that there's few effective cures for mental disorder. Perhaps it's all the hedonic treadmill.
http://en.wikipedia.org/wiki/Hedonic_treadmill

Or perhaps it's the operational cluster of symptoms approach doesn't provide a good way to assign treatment to diagnosis?

I wonder if evil begets evil?

This is a very religious sounding title for a blog post. I'll just leave
it there.

To be or not to be...

The legalisation of assisted suicide

This will happen eventually. I may sound immoral for suggesting this but
it is based on the highest morality. It is based on the highest compassion.

It is unwritten that doctors kill patients whose suffering is endless.
It still happens.

It is not without unease that I write this final part of this document.
Opening the gates of assisted suicide could cause more harm than good
but I feel I've developed a basic framework for myself.

It is based on the avoidance of regrettable suicide. By this I mean to
show that I understand that some people attempt suicide and regret it.
My first (weak) suicide attempt was almost 15 years ago and I would have
regretted it.

I left a job I loved because I was suicidal and for a brief moment I
didn't want to die. I regret this. I should have kept working and waited
till I killed myself. Then the last two years wouldn't have happened.

I was pulled off the road early one Christmas morning and I regret that
this suicide attempt and the one before it weren't successful. In the
intervening period I have tried to contribute to saving other people and
bettering the mental healthcare system however I could.

But I have suffered during this time. I have suffered with more
intensity than should be wrought upon any human being. If the NHS or
anyone had any compassion they would end my life. Sadly this compassion
is lacking and I continue to suffer.

I would not want this to happen to anyone else. I only bear it in the
hope that whatevr is left of my life can contribute to the betterment of
the greater good.

But the greater good is not served by extending a human's suffering. No
one should have to feel how I feel and endure another day of life.

Prevention is, of course, better than cure but without a cure and in the
absence of a way to end this intense suffering by other means I want and
I deserve the gift of death.

I doubt the reader could understand. I do not ask this. I ask my wishes
to be respected and what I want is to be killed by the NHS. I would like
to die with the peace I could not find in life. I have earned little for
the work I have done since my Christmas suicide attempt but I have
earned this.

And I would want other people to have this right. Those who can not have
peace in their lifetime deserve the compassion of others to end their
suffering. Otherwise it is just a life of torture.

Would you want to inflict that on another?

Paper by Marius Romme on coping with voices

Romme, m. et al. 1992, Coping with hearing voices: an emancipatory
approach, British Journal of Psychiatry
http://bjp.rcpsych.org/content/161/1/99.abstract?sid=88ceb9a9-fa80-4357-9635-43aafb9fb4ea

This was the great leap forward which didn't become a great leap in
treatment. The experiences of coping voice hearers were used to infrm
new ways to help those who couldn't cope. The approach was about
empowerment rather than continuing the fostering of the power of
psychiatry over schizophrenics.

Is there a drug which helps with boredom?

Yes. Skunk cannabis.

Is there a drug which increases a person's sense of humour

Yes. Skunk cannabis.

Qualitative research as an option for treatment resistant schizophrenia.

This is an idea I'm deabting on whether I should include in my response
to NICE's schizophrenia guidelines.

It's a hokey idea at first but this crazy idea has some sense to it.

I see the opportunity of contact with a qualitative researcher as a
healthcare intervention as well as something which could be used to
further research into alternatives for the treatment of treatment
resistant or treatment refractory schizophrenia.

Part of this is based on the idea that qualitative researchers - at
least good ones - are good liseners and are non-judgemental. This should
be the same qualities that a good therapist has but...in my
experience...this isn't always present.

The value of a therapist may simply be social contact and stuff aligned
to this. Their therapeutic dogma may often have little value to the
patient. Being listened to might be a core part of any therapeutic value
beyond the mode of therapy itself.

The healthcare value is one part of this idea. The other is the research
value.

There needs to be progress in treatment for treatment resistant
schizophrenia without drugs or certainly without killing the patient
using clozapine. Current quantitative techniques have yielded little
else but this killer drug. Qualitative research may provide the
foundations of a new treatment. It may paint the picture of the
individual and their life and the factors of their life which lead them
to become a treatment resistant schizophrenic. This, in turn, would lead
to new treatments and new quantitative research and research methods.

At the moment this group of 6000-7000 schizophrenics are dying much
earlier than other schizopghrencs. I'm suer a psychiatrist would say
this is all part of their disease and ignore the significant evidence
that the drugs are contributing the invidiual's reduced life expectancy.
Bunch of cunts.

I think they're being killed by their treatment. This is why
alternatives need to be sought. These alternatives need an evidence base
but the evidence base system is totally fucked when it comes to
schizophrenia. And idiot could work that out.

but this idea is just a bit too mad...perhaps?

Tortured by god and tortured by humans

I decided to email one of the the authors of the paper below to understand why he omitted admission counts in his paper

This is what I wrote. I doubt he'll reply. I'm not a professional nor an
academic. I'm just Joe Public.

I'll put what I wrote to him here. I'm not sure why I'm putting it on my
blog. Perhaps it's just to prove to anyone that reads this that I can be
polite as well as fucking swear and curse like a cunt.

"
This Friday night I'm reading a paper you co-authored published in the
British Medical Journal. A copy was available from the Rethink website
and BMJ press website.

I'm not an academic nor have any professional training in mental health
research however I take an interest because of my personal experiences.

The trend of increasing involuntary admissions is something I noted from
looking at the figures for a short period of time a few years ago from
what was available online to the public. Your study takes this a lot
further.

In the discussion you dismiss the possibility that severe mental illness
has risen. I have to admit that I agree that this is very unlikely. This
would be indicated by a rise in first time admissions. If this rose then
it could indicate that severe mental illness was on the rise or, of
course, that the use of involuntary detention was being used on a wider
group of people (for example if hospitals became more risk averse and
decided to use a section of the Mental Health Act rather than allow a
patient to remain voluntarily).

A rise in the rate of readmissions, e.g. a rise in the number of people
who returned to hospital in a year or at any time after their first
admission, may be able to add more information to base your discussion
upon the reasons for the increase in involuntary admissions.

I assume this sort of detail was not available from the NHS Information
Centre. I assume you didn't follow this line of thought because there is
no admission count for an individual. Am I correct?

I'm also somewhat surprised that there were no graphs or data provided.
It may not have been relevant for the discussion however it is always of
interest to people like me to see the raw data. I remember hearing about
the Rosenthal expectations experiment but when I looked at the data in
original paper it seemed like the effect was only present for the
younger age group. This is a minor matter. It's just some feedback from
someone who reads these papers which I feel may benefit you in future
published work.
"

A study on involuntary admission to psychiatric wards in the UK over a 20 year period

The only two things which are interesting in this study are:
"The rate of involuntary admissions per annum in the NHS
increased by more than 60%, whereas the provision of mental illness
beds decreased by more than 60% over the same period; these changes
seemed to be synchronous."

Association between provision of mental illness beds
and rate of involuntary admissions in the NHS in
England 1988-2008: ecological study
British Medical Journal
http://press.psprings.co.uk/bmj/july/beds.pdf

The study authors make few conclusions and it's hard to from the data they have available.

I'm surprised that they didn't consider looking at first time admissions versus repeat admissions. Perhaps this data wasn't available from the NHS Information Centre or perhaps they didn't think to consider it. I'd also be interested to know if the rate of voluntary admission had changed. This data may not be relevant to the study but it's interesting nonetheless.

The reduction in the number of available beds means more people were looked after in the community. If these people became unwell again then they'd be readmitted so this would probably account for the rise in admissions.

The authors of the paper summarily dismiss the idea that mental disorder has risen during the 20 years covered. The evidence for this would be in the rate of first admissions, i.e. if mental disorder rose or the circumstances which lead to involuntary admission changed to covered more people then this would be reflected in an increase in first admissions.

The authors must have thought of this. I'm not that smart and medical researchers can't be that stupid.

What's also interesting is this text.
"Regression analysis indicated that the
closure of two mental illness beds was associated with one
additional civil involuntary admission in the subsequent year."

And also this text
"Between 1988 and 2008 the provision of mental illness beds in
the NHS decreased by 62%, from 166.1 to 63.2 per 100 000
adults (total numbers decreased from 63 012 to 26 430; fig 1).
During the same period the rate of involuntary admissions
increased by 64%, from 40.2 to 65.7 per 100 000 adults per
annum and exceeded bed provision by the end of the study
period"

At the end of the study period is around the time the Community Treatment Order was introduced into the medico-legal framework when the Mental Health Act was revised. This was aimed at reducing the number of 'revolving doors' patients (the term given to those who would leave hospital but be readmitted within a year.

The protocol was overused by an estimated 1000% in the first year. Give psychiatry a new tool of oppression and it would use it like a barbarian with a new cudgel.

I'm wondering if I've become a loser...

...or I've always been a loser.

It's just a cry for help

What a great way to dismiss a person's suffering. When I say great I
mean fucking disgusting.

People who say things like that have no idea what intensity of suffering
drives a person to think of suicide.

It's not just a cry for help. It's a soul crying in pain.

And no wonder those souls, those true souls, cry in pain when no one
understands.

It's Friday night

I'm alone, sober and have just wiped tears away from my eyes.

How much things have changed in two years.

I remember when I won a week's drinking from the physics department at Warwick University

I was never a good student. Didn't go to many lectures. Just learned
what I could for the exams and I always managed to pass.

There was one lecturer who I remember. He used to teach well. Rather
than just write things on the board and let us scribble down notes he'd
make us think and understand what we were learning.

He taught a course on semiconductor physics if I remember right. It was
a course which interested me and I enjoyed his teaching style. To engage
students in thinking rather than copying down the stuff written on the
board he'd regularly ask questions to push our thinking and test if we
were using the information.

To make us more earnest to try and answer these questions he'd offer a
reward. It started as a pint but no one won it. Then it raised to a
night's drinking and still no one was able to answer his questions.
Finally it rose to a week's drinking paid for by him but still no one
managed to answer the questions he pose.

One day he was teaching about semiconductor lasers. This was back in the
day when people used to have CDs for music and films came on a cassette.
DVD wasn't around but we were learning about the technology which went
into it.

One of the problems with the development of better optical disc
technology was the lasers had a very short lifespan. They needed to last
at least three years but they'd break before then. He asked us why and
he offered a week's drinking as a prize.

It was one of those occasions where my brain kicked into gear. The
carrot on the stick probably helped. He counted down as he waited for an
answer. Towards the end of the countdown I blurted out something. It was
something along the lines of, "the material which makes up the laser
breaks down."

He paused. Then he asked why and restarted his countdown. With
milliseconds to spare I blurted out something like, "the higher energies
of the blue lasers destroy the crystal structure which creates them."

He replied, "bugger."

My fellow classmates were gobsmacked that this drunken dopehead got the
answer right. I never collected my prize but the prize was ...for a
brief moment... being the smartest guy in the room.

I wonder if it was the drink and drugs which helped to train my mind and
train me. After all, while others learned in structured ways I had to
learn to learn on my own and with the 'handicap' caused by drinking and
not going to lectures. My lifestyle and life choices forced me to be
able to think independently. I'd spend my time joking about in the
Student's Union instead of studying but this taught me how to improvise
with the information I was given.

Those who went to lectures and studied hard got good degrees and good
jobs. I scrapped through university but I learned a lot outside of the
lecture hall and managed to get a well paid graduate job despite my poor
grade from my degree.

From university I got something better than a degree. I got memories
like this one.

Of course it's a mental illness...

Here are two examples of labels of mental illness applied to slaves (and
free black-skinned people in the time when slavery existed)
http://en.wikipedia.org/wiki/Dysaethesia_Aethiopica
and the famous
http://en.wikipedia.org/wiki/Drapetomania

It is immoral how the label of mental illness is used on people with
black skin even in modern Britain.
http://www.iop.kcl.ac.uk/departments/?locator=398&context=997#variation

A new type of antidepressant

http://en.wikipedia.org/wiki/Agomelatine

Though the efficacy versus other antidepressants has been limited in
high quality meta-analyses this new antidepreszant may have value for
certain patients because of the reduced side effects (at least what's
noted in the Wikipedia page) and effects on sleep regulation. It also
works faster and fewer patients drop out of trials from the side effects.

What's fascinating is that it works on a totally different set of
neurotransmitters to conventional antidepressants yet the effects in trials.

This is where I wonder and ponder about the validity of the measures of
depresssion and the diagnostic criteria. The cluster of symptoms
approach lumps in a lot of different types of depressiion into one group
which is meant to be homogenous. Essentially using this approach the
expectation of treatment is that one size does fit all. There are many
theories of depression and cause, for example exogenous and endogenous
depression (though this may be sorted out by the whole adjustment
disorder thing...I'm really not sure about this part), and may types of
depression but they're all lumped together in the research as one thing.

It's sort of like going all shiny metals are the same thing. Be it gold,
fool's gold or any other shiny substance a very basic chemist might
consider them all the same. With our advanced knowledge of modern
chemistry we know that different shiny materials are made of different
things - either elements or combinations of elements called compounds
(or amalgams and other stuff but essentially they're either combined
elements or mixed elements).

Let's say the basic chemist decided to try to take away the shininess of
a shiny substance using an acid. Without being able to understand that
the shiny substances were different they'd find similar results to what
antidepressant trials at the moment find. Even if they tried different
acids they'd find similar levels of effect. Some of the shiny substances
would lose their shininess and some wouldn't.

A modern chemist would understand why and perhaps, in the far distant
future, a mental health professional might understand too. There are
different depressions and different combinations of factors.

This antidepressant has a significantly different neurobiological action
to other antidepressants but doesn't really show itself to be much
better and, with time, I'm sure it will be shown to be only as good as
other antidepressants given the current methods of the pseudoscience of
mental health.

Perhaps if there was Major Depressive Disorder with a sub-type of
significantly disturbed sleep this drug might work better than SSRIs.
But there isn't. There's just one diagnosis for lots of different
experiences of misery.

Getting West Indian psychiatrists over to show UK and US psychiatrists how to diagnose schizophrenia.

This may be a good solution to the problem of the massive diagnosis of
black people with schizophrenia.

My concern is the UK psychiatrists are taught to diagnose a different
way. They're not diagnosing what was conceived by Bleuler as
schizophrenia but some new construct which evolved over the 20th century
(which is sort of what Metzl says I think) and is further biased by
their conditioning to become doctors, i.e. those few black psychiatrists
are....highly integrated/Westernised because that's what is necessary
for them to succeed and get into medical school. (This skews their
social norms and makes it difficult for them to make better diagnoses
than white psychiatrists because their conditioning means they're far
removed from true African or Caribbean culture.)

Where psychiatrists learn psychiatry has a significant influence on
diagnosis - more than gender or race or age. I wish I could find this
study. I read it as part of a significant piece of work I did into men
and mental health. I was looking for the influence of gender (of
psychiatrists and patient) on diagnosis or lack of diagnosis.

In the end I came across an American study done at a psychiatric
conference. Actors were given a predefined script and they were
interviewed by psychiatrists. These were psychiatrists who were under
test conditions so they would have resorted to their academic interviews
rather than what they would use in clinical practice every day (they
knew they were being trialled). The diagnoses were noted. The trial
showed that it wasn't what people might expect would be the variance in
diagnosis. It wasn't gender or age or ethnicity which was the majjor
factor. The major factor in the difference of diagnosis was where the
psychiatrists learned psychiatry.

This is why my idea of getting psychiatrists over from the West Indies
to show UK psychiatrists how to diagnose schizophrenia without being
racist cunts might be a good idea. Black UK psychiatrists are taught and
conditioned here so they may be little better than white UK
psychiatrists at not being fucking racist cunts. Those workin gin the
West Indies (and perhaps Africa too) might be better able to really
diagnose schizophrenia rather than be a bunch of racist fucking cunts
using the diagnosis to enforce local social norms.

Schizophrenia overdiagnosed in black people by 9 times in one significant UK study

I thought the overdiagnosis rate for black men was 3x or 9x. I've found a reference for the 9x figure. It's the AESOP study which was cited in the New Horizons strategy consultation document which also noted this overdiagnosis rate doesn't happen in the West Indies.

Fuck. What the hell is going on in the UK? This overdiagnosis problem is beyond biomedical cause. It's this sort of shit which gets psychiatry accused of racism.

There's something like a 2 times factor associated with migration (though this may not be causal, i.e. the people who migrate may have more flighty tendencies or more wander lust which may correlate with schizophrenia though the trauma which many migrants in the UK may also cause schizophrenia to express) which might ameliorate the charge of institutionalised racism. There may be other factors too however this is stil a startling figure.

9 fucking times more in this significant study. But not in the West Indies...

Here's the web link.
http://www.iop.kcl.ac.uk/departments/?locator=398&context=997#variation

Two papers are noted further down the page. Here's the snip of the text.
Variation in incidence and ethnicity

"
Many previous studies have found high rates of schizophrenia and other psychoses in the African-Caribbean population in the UK. However, many of these studies have been methodologically limited, and it is not known whether rates are elevated in other minority groups, including White migrants. We found that the overall incidence rate of psychosis in London was over twice that of Nottingham or Bristol. We found remarkably high rates for schizophrenia and mania in both African-Caribbeans. For example, schizophrenia was 9 times more common in African Caribbeans and 6 times more common in Black Africans than in white British people. Moreover, manic psychosis was 8 times more common in African-Caribbeans and 6 times more common in Black Africans than in white British. These findings held true for both men and women and were evident across all age groups.

Kirkbride J, Fearon P, Morgan C, Dazzan P, Morgan K, Tarrant J, Lloyd T, Holloway J, Hutchinson G, Leff J, Mallett R, Harrison G, Murray RM, Jones PB (2006) ‘Heterogeneity in Incidence Rates Of Schizophrenia And Other Psychotic Syndromes: Findings From The 3-Center ÆSOP Study’. Archives of General Psychiatry 63:250-258.

Fearon P, Kirkbride J, Morgan C, Dazzan P, Morgan K, Lloyd T, Hutchinson G, Tarrant J, Fung A, Holloway J, Mallett R, Harrison G, Leff J, Jones PB, Murray RM ‘Incidence of schizophrenia and other psychoses in ethnic minority groups: Results from the MRC AESOP study.’ Submitted.


A

I am in pain

It's a grey day and the darkness of night is almost here.

I sit on my bed typing and trying to find anything to fill my time.

My cat sits next to me and snores. She's lucky. I want to sleep but I
won't. Not for a few more hours.

I don't want to think or exist .It hurts inside and it hurts somewhere
else. Somewhere far deeper.

Deep within the recesses of my psyche I'm in so much pain. I thought I
was numb to the pain in there but it...it feels present tonight. There
is an erry stillness in my external reality. Inside I am feeling...a
feeling which words can not describe.

I feel like contacting the Samaritans but I feel there is no point in
words. There is just life or death. I want one because I don't want the
other to continue.

I haven't written about my wish to die because there's no point. There's
nothing left to say.

I suppose my worst fear is that I don't kill myself soon. That's the
other thing. If I don't then I'd have to keep living and that's not
something I really want to do any more.

Something which was hopefully stopped in the UK

http://www.theage.com.au/national/drug-trial-scrapped-amid-outcry-20110820-1j3vy.html
This is a news report of a trial which was stopped. The trial was for
early intervention for psychosis using antipsychotics.

In the New Horizons mental healthcare consultation they proposed
starting this sort of new treatment. The idea was to stop schizophrenics
being created by starting people deemed at risk on medication. This
would have meant many people who would not develop schizophrenia would
be drugged with these harmful chemicals.

If I remember right I pointed out that this was fucking stupid. I'm not
a qualified researcher nor have I any mental health or medical training.
I could work out this was a fucking stupid idea.

I hope it was scrapped from the final strategy. I never bothered to read
the final strategy. Thankfully some Australian mental health
professionals got in there and stopped the research getting done.

I hope there's people in UK mental healthcare who are just as ready to
protect people from this sort of shit from psychiatry. The drugging of
people at risk of schizophrenia is one of those terrible ideas, one
which could lead to people dying earlier for no reason and one which
could mean children are drugged with these nasty chemicals which cause
illness and unhappiness.

The fear of schozophrenia is what drives these idiot psychiatrists to
come up with more ways to drug people. Thay's because they're diots
who've not worked out how to help people with schizophrenia live better
lives. They think drugs are the answer...

What to do when a person loses the will to live?

This is an important research question. As the often bandied phrase
"there's no one size fits all approach" suggests it is not an easy
question to answer.

I would suggest that by the time it gets to the stage where a person
loses the will to live there's nothing that can be done, but I'm not
sure. As the other often bandied phrase suggests, "prevention is better
than"....getting to the point where this question needs to be answered.

Glossary of psychiatry

http://en.wikipedia.org/wiki/Glossary_of_psychiatry

Language, political correctness and why it's so hard working to better NICE's clinical guidelines

It's why it is hard for me to write what I'm writing to NICE via my MP.
Pharmacological treatments for schizophrenia are well evidenced. The
measures are flawed, at least in terms of what patients want and making
for better life outcomes, but I am not really equipped as a research or
scientist to do more than point out the error. NICE can only recommend
stuff which fits their paradigm and epistemology of evidence so really
it's been 2 years of work wasted but...well...I'll finish it anyway.

At least I discovered one thing which is important. There is no
review/meta-analysis which looks solely at the effect of drugs on the
delusions and hallucinations, the effect which patients expect from
antipsychotics. In the last half century this research has never been
done. At least from what I or anyone I know can find. If they did it
they might be able to find new pharmocological options which work on
what patients want, i.e. if they work out that it's quetapine fulminate
which has the most significant effect of all drugs on these two measures
then they can work out more about it's neurobiological action then make
new drugs based on this.

It also means the term antipsychotic can't really be used. The drug used
to be called a major tranquiliser. This may be all it does.
Antipsychotic is typical of the misnomers in mental health and
healthcare. This is why I'm so anti the politically correct movement.
They bugger about with words instead of focusing on the concepts behind
the words. "Afro Caribbean" is a good example. They've lumped two
different cultures together...because all black people look the same.
They did this because black is, apparently, a racist term. I may be
insensitive because of my valuation of concepts rather than language but
my interest in concepts, in my opinion, offers more value than those who
spend their time fudging language.

Those that fanny about with the language don't bother to understand the
science or the concepts. They assume they know what the concepts are and
they assume the science is correct.

The concepts in mental health are complicated. The concept itself isn't
nebulous. It's just not carefully separated into the underlying
principles. This is how so much maleficence can happen without
oversight. This is also why, in centuries to come, modern mental
healthcare will be seen as a bad thing. Normalising the human race and
judging behaviours as abhorrent or an illness is not the job of doctors
but the public buy into it because they know no different.

The part about getting the science right...well that's even more
important. The science is the purview of psychiatry and it is one of the
way this body exerts its power. To have never done a review of drug
treatments solely looking at their effect on the two core measurses
which patients associate with psychosis and schizophrenia is a
significant omission. I'm sure some psychiatrists would argue it isn't
necessary because schizophrenia is a much more complicated syndrome than
just something about the internal delusions and hallucinations. I'd
disagree and say that doctors are meant to be doing what patients want.
The internal delusions and hallucinations are also a signfiicant causal
factor in the behaviours which are pathologised by the operational
cluster of symptoms, specifically the negative symptoms, which are a
result of the extensive suffering of living with this internal hell of a
different reality.

I just want to cry

but I can't

Divided realities

Cannabis components antipsychotic

Randerson, J. 2007, Cannabis chemical curbs psychotic symptoms, study finds, The Guardian

http://www.guardian.co.uk/science/2007/may/01/drugsandalcohol.drugs

Isn't my favourite herb amazing? It also probably has far fewer harsh side effects than the chemicals used by psychiatrists. It may also have a lesser impact on life expectancy and cause fewer illnesses.

But Rastas and Sadus have know about the quality of the herb for ages. They try the drugs rather than read research. They'd be better psychiatrists than those cunts with a medical degree for this simple reasons alone.

Useful information on hanging

It's a bit more detail than can be found on the Wikipedia page on
hanging. It's far from my preferred method.

http://web.archive.org/web/20060426025804/http://www.richard.clark32.btinternet.co.uk/hanging2.html#causes

Cunts

Randomized Controlled Trial of Clozapine and CBT for First-Episode
Psychosis with Enduring Positive Symptoms: A Pilot Stud
http://www.hindawi.com/journals/sprt/2011/394896/

I hope I need say nothing more than cunts. How about fucking murdering
cunts? Nah. Sometimes one word will do.

Clozapine for first episode psychosis? I'd skull fuck the researchers
doing this pilot.

Loving a person who doesn't feel the same way is agony

The love I've talking about is a pure feeling. It is without reason or
ration. It is not stayed by ration nor made by sense.

It is an exquisite pain, a pleasant agony at best. At worst it eats my
soul away and blackens my heart.

I just hope she's happy without me in her life. I miss her dearly
and...and am unwhole without her.

Such is love and love lost. But this feeling is immutable. It is
constant as the North Star and burns as brightly. It is as seering to
the touch to feel my mind wander upon it.

Time is meant to heal this feeling but time only assures me it is true.

Cannabis combats cancer?

The herb is amazing.
http://www.nature.com/nrc/journal/v3/n10/full/nrc1188.html

The 4 continua of mental health

Mental health is not a nebulous concept. This is just an excuse so it
can be used for whatever people want to use it for.

There are at least 4 continua I can think of.
Psychopathology - the power of psychiatry essentially. This is what
mental health is defined as in psychiatric textbooks. So homosexuality
was an example of psychopathology. This s about behaviour and emotional
regulation.
Psychological distress - this is meant to be what psychologists are
interested in but from my experience - certainly of the NHS psychologist
who refused to help me - they don't give a shit and are just like
psychologists. This is what Mind use to further their work. This is
about emotional suffering.
Flourish - this is a new term coined by Dr Jo Nurse as part of the work
which went into the New Horizons strategy. It either means the person
reaching their potential for society or for themselves.
Individual measure - this is about what patients want. Essentially it
may be the simple question - do you feel better or do you feel unwell?
It may be associated with the psychological distress continuum for many
people but not all. There is also resilience to factor in. People may
also have their own models of madness, their own personal measures of
mental health and lack of mental health.

Dangerousness seems also to be something that some people want to
include in definitions of mental health. This may be part of the
psychopathology continuum as it evolves but is forced upon it by
sociopolitical forces. It is why the Mental Health Act was amended to
allow indefinite incarceration without crime or treatment made
available. It was the risk of "people with a dangerous personality
disorder" which is not a medical diagnosis nor a crime but a
medico-political concept.

It is fascinating to think that a century ago some people called mental
health "mental hygiene" so a person with poor mental health would have
an unclean mind.

In all of this madness it is important to remember that mental illness
is not a real illness. Psychiatrists simply used biomedical evidence to
support a preconceived position which came about after the creation of
the asylum system. I think older psychiatrists know they're not treating
real illnesses. They're just suppressing emotions and behaviour using
chemical means.

Of course in centuries to come people would look back at modern mental
health and weep. The public don't care about what it really means so
doctors can do whatever they want to them.

Schizophrenic - why the word is a good word to use

I chose to use this term because a schizophrenic is a type of person.
They are an important part of the human race's diversity who suffer
significant levels of disabilirty in 2011 Britian; in other time periods
and in other cultures the disability may be less or not even exist at all.

The noun is how schizophrenics used to be described in research and, in
my opinion, it is important the noun is used rather than to label them
as a disease or illness because this invalidates their fundamental right
to exist.

They are like homosexual;s in this sense. Homosexuality is not an
illness since the early 1970s in the US and the early 1990s in the UK
however before the revisions to the psychiatric diagnostic criteria in
US and UK cultures a century ago homosexuals were labelled as ill and
experienced disability and distress as a result of the social judgement
that they were abnormal. Thankfully the latter 20th century saw society
change and accept these people as a valuable and integral part of the
diversity of the human race.

An idea for the legaisation of assisted suicide for the mentally illl

Even with treatment 5.6% of schizophrenics kill thesmelves outside the
early stages (and 4.4% in the early stages). Manic depressives also
suffer. Depressives and other types want to kill themselves. 6,000
people a year are successful and in my view they're the lucky ones. I
hope to join them one day.

I applied to help from Dignitas. I offered a reasonable solution. I said
I wanted them to take my life in 4 years. The day wasn't relevant but I
picked a day which meant a little something to me.

It would have meant I would have had to suffer for 4 years. I think a
shorter period is much more compassionate. From learning - or hoping -
that Dignitas did help the mentally ill to contacting them took some
time. The reason was because I wanted to be in a good frame of mind when
I made contact rather than being in the throes of misery.

These are all to avoid the removal of capacity and free will which comes
with the labels and prejudices of mental illness. In so doing I created
a reasonable framework such that a mentally ill person could be offered
the same compassion as a terminally ill person. They could die with
dignity and predictability and reliability and plan for their death
rather than have to take a messy and unpredictable route.

This framework means an individual still has to endure the living
torture of life, the unique living hell that those who want to die have
to live with till they're finally successful in getting what they want.
Everlasting peace.

i just had another thought related to this framework. It is a reason why
it must be legal.

At all costs suicide must be prevented by society. To achieve this the
reasons must be known. As part of the framework the person must leave a
suicide note. This allows people to change society such that more people
don't end up killing themselves in the future.

Sadly Dignitas discriminates against the mentally ill and is,
apparently, being blocked by the legal system from offering the
compassion of ever lasting peace to those who so desperately need it.
Assisted suicide for the mentally ill isn't legal in the UK and there
are punishments for those who would have the compassion to kill me.

Such is the shit of a life I so want to leave.

Another message I just sent to the Prime Minister: an idea to help extend the life expectancy of the poor during the recession

I have tried to push this idea through other channels.

This is all about Big Society. "Inferior goods" are the products bought
by those who have no choice in consumption.

The food products are low quality and unhealthy. This is one of the
factors behind the reduced life expectancy of the poor.

Either ask the supermarkets to make their cheapest food products more
healthy or put a government subsidy in to add multi-vitamins and
minerals to inferior food goods.

In my opinion, this will help keep those who are poor and pushed into
poverty from dying earlier as a result of the recession. It may also
save the NHS millions in the medium to ultra-long term because this
simple idea will keep the poor that little bit healthier. There's
evidence to support this opinion.

Please help the poor.

PS - if you have any jobs going that would utilise my skills and help
the people please let me know. Cheers.

I'm just pondering what my ex-girlfriend would tell other people about me?

After I went through that period of psychosis where I found god and all
that crap I had spontaneous remission.

I fell in love with a girl and we had what I thought was a good
relationship except she kept on dumping me. We'd get together again
after a few days. After the fourth time she dumped me we met up just
before Valentine's Day and we didn't get back together.(I'm sure she'd
count the dumpings differently)

I was pretty straight with her and told her to "go fuck yourself" after
she accused me of not really loving her. She left shortly afterwards.
Once I'd finished my drink I left and went round her house with the
things I'd made for her as a Valentine's present. It was a framed print
of a photo I took the night we got together. I'd spent about an hour
working on the image. I'd also made a small donation to War on Want
which was part of the art of the print and my philosophy.

We had a good relationship after that. There were no bad feelings and I
even left a little leaving present which showed her that I still loved
her (when she left work).

I'm sure she has reasons to be annoyed with me other than our
relationship together but I just wonder what she tells other people?

I wonder this because I'm pondering what happened that night last year
when my heart was ripped from my body and pummeled, that night which
left me in pain for such a long time and caused me more grief than
anything else in the last couple of years.

A girl who was probably my best friend at the time had a birthday
celebration. I'd admitted to a friend of mine that I'd had feelings for
her, feelings beyond friendship. I ended up chatting with one of her
friends and someone I considered more than an acquaintance. We sat
outside the bar where everyone else was.

This was the day when this friend of my friend told me not to love her.
She told me it was the girl i loved who had asked her to not love her.

I asked the wrong question. I should have asked why I shouldn't love her
rather than who told her to tell me to not love her.

All three of these girls - my ex-girlfriend, the girl who told me not to
love the girl I love and the girl I love - are all friends. They're
reasonably close. At least two of them fancied me but that's another
story. Perhaps all three but I'll never know. That's not important.

What's important is why? I wonder if the reason I was told to not love a
girl I was intensely in love with and still am though it hurts more than
sticking a lit cigarette into my flesh was, in part, related to hearsay
from my ex-girlfriend.

I wonder if it was because of being bad mouthed? Or simply because the
girl I love had a boyfriend, a boyfriend who was better for her than I.
This is something I fucking knew and for all that it broke my heart is true.

I'm the Hunchback of Notre Dame and the girl I love...well....she's more
than Esmerelda. She is a precious flower and I would not want her harmed
by me no matter how much I suffer without her in my life. That's called
love but it...it eats me up inside every day.

I suppose I'll never know the truth but the girl I love knows the truth.

Could the treatment regimes be as much responsible for the difference in prognosis between schizophrenia, schizoaffective and bipolar as the conditions themselves?

Initially Kraeplin codified two distinct types: schizophrenia (dementia
praecox) and manic depression. After a while he saw these two types as
not distinct but perhaps the same type and as two extremes at the end of
a spectrum of the type. The type may be analogous as schizotaxia (which
really means a genetic predisposition for a person to exist on the
schizophrenia spectrum) and current genetic evidence is pointing to a
commonality between bipolar and schizophrenia rather than two distinct
types.

However evidence also shows that there are 3 identifiable prognoses
associated with schizophrenia, schizoaffective and manic depression. I
think the lead author is Tsuang if I remember right. It is assumed these
are a result of the expressed type (through the biopsychosocial model of
cause).

But what if a larger factor is treatment and treatment experiences?
Tsuang's research was done on data from the modern time of
psychopharmaceuticals as the primary way to suppress the human types.

Manic depression is treated with mood stabilisers to limit mood or cease
the feeling of emotion entirely. The side effects of these meications
are milder than the effect of drugs for schizophrenics. The major
tranquiliser is a horrible drug, at least the ones currently used and
abused by doctors. The side effects are horrible as are the effects.
Much more of the individual is taken away and it is much harder for the
individual to continue to function when shackled by these strong drugs
which tranquilise without putting the individual to sleep.

The question which is the title of this blog post could be asked even
better perhaps: how much of the negative outcomes are caused by
medication, treatment and treatment experiences versus the problems
experienced by valid human types in a dysfunctional society which
disadvantages them?

It is a question some psychiatrists might prefer not answered but it is
relevant to the lives of those who live with severe mental illness. They
suffer so much because of their treatment in the hope that it genuinely
makes their life better rather than harms them. The suppression of the
individual has been shown to be less effective than living in less
malformed societies, certainly from the IPSS results from the World
Health Organisation. Psychiatry has always focused itself on the
individual - a result of the biomedical training perhaps - but this may
be doing harm rather than good.

An idea or an ideal?

This is a great question posed by a very sexy friend of mine.

all those things which stand as principles, for example an organisations
values and mission statement or an industry's sense of Corporate Social
Responsibility, are usually one or the other.

An idea means it's just an idea. An ideal is something which, in my
eyes, is stuck to because that's the difference.

If it's an idea then it's worth nothing more than chatting about. If
it's an idea then there's no point employing people to make it happen
and there's no need to stick to it.

If, on the other hand, it is an ideal then it's something which should
be stuck to. For example Google in their founding vision - somewhere in
there - said do no evil or something along those lines.
http://en.wikipedia.org/wiki/Don't_be_evil
<http://en.wikipedia.org/wiki/Don%27t_be_evil>

If it is just an idea Google employees can sit and talk about it in the
staff pub. If it is an ideal they should fight tooth and nail to achieve
it, even if it means sacrifices.

I've just finished fasting for 6 days

Well...it wasn't proper fasting I drank tea with milk and sugar during
the day. I had a few beers. No where near my usual amount though.

I didn't eat any solid food for 6 whole days. Not one morsel.

Last night I had 3 Sri Lankan rolls after midnight.

I'm just wondering if I should do another few more days or not?

I was just leafing through a GP magazine called Pulse

There's so little in there about mental health. The one thing was a
report that antidepressants don't seem to work for dementia patients
according to a couple of trials.

In a way it's a good thing. I'm not sure mental health is so easily
described to GPs by medical texts or diagnostic criteria.

The simplest thing a GP needs to know is if a patient comes in and says
they're not feeling mentally well then they need to do something.
There's still this fear of malingering but that, in itself, could be a
mental illness if someone judged it so.

The real problem for primary care physicans is the time they have with a
patient. They need to rely on a handful of minutes to judge whether a
person is depressed or mentally unwell or whatever. The self-report
thing isn't enough in the sense that some people may be suffering in
silence. Unreported subjective unwellness sounds like an oxymoron in a
way. Hm...that line definitely needs some more thinking.

Anyway, GPs are ill equipped to deal with mental health for many
reasons, not least of which is their biomedical learning. There's also
their conditioning through medical school. It's a problem which Dr Liz
Miller is battling against I hope.

Doctors have to be tough bastards to get through medical training.
Imagine what it feels like to lose your first paitent? Imagine what you
become when you don't feel the loss? Doctors have to become resilient in
this way to save their sanity, just like snipers. After taking or losing
that first life the rest is a lot easier.

But I think that process leaves them unable to understand what it is
like to be a normal human.

The voice inside, psychosis and mania (and one of my coping mechanisms)

Observing these experiences from the outside is like diagnosing cancer
from outside the human body without scanners to see within. This is why
the psychiatric understanding of psychotic disorders like manic
depression and schizophrenia is so poor.

They must be able to see inside but they can't. That's why psychiatric
solutions have been so poor. It's why diagnostic criteria are very shit.
It's all about external symptoms rather than truly attempting to
understand the internal experience.

The fact that language is so limited in describing our consciousness is
another great barrier to understanding.

But, perhaps most of all, the greatest barrier is the fact that
psychiatrists haven't been through these intense experiences. The lived
experience psychiatrist movement will bring hope to those affected by
these complicated internal experiences because they've lived through
these experiences. These experiences can not be understood from the
outside nor can they be understood by reading most of the books or
research papers psychiatrists read.

Calling it a voice in a head is a poor use of language but it'll do for
now. I mean specifically the voice or thought you respond to in your
stream of consciousness. Just listen to it comment now as you read these
words. You might hear the thoughts "i don't have a voice in my head" but
by hearing these thoughts you are having an experience similar to voice
hearing but without the advanced state of awareness to recognise these
thoughts as different from your sense of self, the thing which is
listening to the thoughts.

Psychosis itself can take many forms but what I'm talking about here as
the link between mania and psychosis (superficially the hearing voices
aspect, not the other things which make them different such as mood or
energy levels) is the experience of the voice or thoughts.

In my hypermanic phase I had a voice in my head - something which I
observed as different to my own sense of self. This was when I was 25
and first hospitalised. It was not an unpleasant experience and unlike
what I went through a few years ago which left me with a forearm of
scars from ym battle against this controlling force (which did other
things apart from show its power within my stream of consciousness).
During the hypermania the voice said positive things.

The positive voice drove my ego upwards. Whether it was cause or effect
I had very high energy levels at the same time. I was in a super-powered
human state (or at least that's how it felt to me). I listened to the
voice in my naivety and it drove me mad.

There have been other times where the voice or thoughts in my head have
been negative and I've listened to them. This was not the same as the
experience which left me with my arm of scars. This is other times in my
life where I was low and the voice inside would batter my ego with
negative words and sentiments.

I still live with this problem every day. I doubt it shows much on the
outside but so much of my pain rarely externalises. Occassional
uncontrollable crying or aggression, infrequent outbursts or other leaks
from the inner maelstrom are the only signs. Most of the time I keep
these away from the view of those close to me so all they see is the
person they want to see.

My coping mechanism - the one I've had to learn to manage this madness
as best as I can - is to dismiss the positive voices. The experience of
forced hospitalisation was a significant trauma. Both times were
because, or were at least associated with, listening to the positive
voice. The second hospitalisation was a direct result of a therapist
working on my self-esteem. He took down the protective barriers I'd
built and in so doing he took away the internal mental blocks I'd built
to stop my madness externalising.

This is why if you ever got to know me - truly know me emotionally naked
rather than as the mask I present (which exists for various reasons) -
you would find a very sad soul who doesn't think much of themselves. The
positive thoughts are almost always pushed away to protect my sanity.

Could you imagine what that feels like to live with? What I am
describing here is a bad coping mechanism but one that works better than
anything else I've found. It means I can survive but I don't thrive. It
doesn't mean I'm always unhappy. It just means that, for my education
standard and compared to my peers, my life outcomes have been far worse.

There are also the times where I have to deal with the negative
thoughts. I experience a lot of negative thoughts at certain times and
in certain situations. They're pretty hard to deal with at times.
Certainly in the past they've crippled me and in a sense they still do
in the present. I don't thrive much.

Though I dismiss the positive thoughts to stay away from states of mind
which end me up sectioned I accept the negative thoughts. The way I
survive accepting the negative thoughts and rejecting the positive ones
is to side step the impact of negativity. It's very hard and I don't
always get it right but it's how I get by in this shit of a world. Call
it resilience if you will. I accept the negativity and just get on with
whatever life has to throw at me when I have the inner strength. It is
the feeling of feeling worthless but acting as 'normal' regardless of
the shitty feeling. It is feeling low but smiling on the outside. It is
feeling like a failure but never showing it in deed or action. It is
gripping the idea of just getting on with it regardless of how shit I
am. This doesn't always work of course and there are times when I lose
strength - on both counts of forcing away the positive thoughts and
accepting the negative ones.

There are times when I balance the two but these are rare. It is
evidence which allows me to accept any sense of positivity but I'm
discriminatory about accepting evidence. The important thing - to
society and external reality - is what I do on the outside. I don't
think the system gives a shit about inner pain. Just what externalises
and what people who work in mental health an recognise. (For example I
woke up today with crusty eyes. It might be hayfever or it might be me
crying in my sleep. That doesn't matter to the people around me as long
as I don't show it. Only if I couldn't hold back the tears in front of
another would they wonder if I was unhappy or depressed or whatever.
Such is the burden of carrying a mask.)

I still show arrogance and this is clear on my blog. This may be a
compensating thingie because of my inner negativity. It may also be
driven by the fact that I do value my analysis even if others don't. I
spend a lot of time working on my work, far more than most. In fact I
might be a bit slow in some ways but I compensate by putting insane
amounts of work in. I rarely rely on intuition if at all. I work bloody
hard to come to a solid conclusion.

So my conclusion to this poorly written piece with lots of mistakes I
can't be arsed to correct is that mania and schizophrenia are related
because the voice/thoughts inside are often involved. This is, perhaps,
in relation to ego. It can be where the external symptoms come from.
Though the external symptoms are different the cause is, for me, often
rooted in those thoughts which I chose to listen to or dismiss.

I assume this is what CBT for psychosis tries to deal with. I assume the
therapeutic model bases itself on controlling the inner voice and
reactions to the inner voice. I assume treatment is based on this sort
of thing and measured by success in dealing with this sort of thing
rather than focusing on external symptoms. I assume this because this is
what a good system would be doing as a form of treatment.

I assume wrongly....or do I?

Admittedly there are times I do rely on intuition. Sometimes this means
I get it totally spot on. Other times it means I totally get it wrong.
Theere are links between this idea of intuition and the voice or
thoughts other than our self, our "I", within our stream of consciousness.

More stuff on principles of equality

From
http://www.teacherneedhelp.com/chapters/chapsequal.htm

"
WE ARE ALL EQUAL

I am a Jew. Hath not a Jew eyes? Hath not a Jew hands, organs,
dimensions, senses, affections, passions? fed by the same food, hurt
with the same weapons, subject to the same diseases, healed by the same
means, warmed and cooled by the same winter and summer, as a Christian
is? If you prick us, do we not bleed? If you tickle us, do we not laugh?
If you poison us, do we not die?

-William Shakespeare

I am not a (Conservative, Orthodox, Reform . . .) Jew, (Orthodox,
Catholic, Baptist, Methodist . . .) Christian, (Sunni, Shiite . . .)
Moslem, Hindu . . . I am a member of the human family.

-Anonymous

We hold these truths to be self-evident, that all men are created equal;
that they are endowed by their Creator with inherent and inalienable
rights; that among these are life, liberty, and the pursuit of happiness.

-Thomas Jefferson

I leave you, hoping that the lamp of liberty will burn in your bosoms
until there shall no longer be a doubt that all men are created free and
equal.

-Abraham Lincoln

We must learn to live together as brothers or perish together as fools.

-Martin Luther King, Jr.

All human beings are born equal in dignity and rights. They are endowed
with reason and conscience and should act towards one another in the
spirit of brotherhood.

-UN Declaration of Human Rights, Eleanor Roosevelt, Chairperson

Let him who is without sin cast the first stone.

-Jesus

So what of all these titles, names, and races? They are mere worldly
conventions.

-Buddha

All of us share being human. The concept of shared, or common, humanity
is one of the great achievements of modern civilization.

Without goodwill, the idea of equality makes no sense. Without goodwill,
it is obvious that we are not equal. It is goodwill that informs us that
we are equal.

In the seventeenth century, when George Fox refused to doff his hat to
his "superiors," equality was a concept that empowered entire lives. As
Rufus Jones wrote of Fox, "The honor that belonged to God he would give
to no man, and the honor that belonged to any man he gave to every man."
(Rufus Jones, The Journal of George Fox (introduction) (New York:
Capricorn Books, 1963), 39.) In the following passage Fox himself told
of an incident before a judge who commanded him to remove his hat.

"Then got up a great rage among the professors and priests among us.
They said, 'This people 'thou' and 'thee' all men without respect
[refuse to use the plural form out of respect] and will not put off
their hats nor bow the knee to any man. But we will see, when the assize
[local court] comes, whether they will dare to 'thou' and 'thee' the
judge and keep on their hats before him.' They expected we should be
hanged at the assize.

"When we were brought into the court, we stood awhile with our hats on,
and all was quiet. I was moved to say, 'Peace be amongst you.'

"'Why do you not put off your hats?' said the judge to us. We said nothing.

"'Put off your hats,' said the judge again. Still we said nothing. Then
said the judge, 'I command you to put off your hats.'"

For his refusal, Fox was "taken away and thrust in among thieves."
(Ibid., 245-246.)

A similar incident is told by James M. McPherson in an excerpt from a
letter of a Civil War soldier: "We have tight rules over us, the order
was read out in dress parade the other day that we all have to pull off
our hats when we go to the colonel or general," wrote the private. "You
know that is one thing I won't do. I would rather see him in hell before
I would pull off my hat to any man, and they just as well shoot me at
the start." (James M. McPherson, Battle Cry of Freedom (New York: Oxford
University Press, 1988) 329.)

Cutting through the tangles of prestige and privilege to a concept of
common humanity is a high undertaking. As Thomas Jefferson said, "All
men are created equal," that is, no man is any other man's inferior, not
inferior to people of wealth, people of power, people of intellect,
people of talent, nor people of beauty. We share a common humanity, not
only under the law, but also person to person. The truth of common
humanity derives from the insight of compassion, that is, brotherhood,
and it applies both to the self and to others. Behind the Bible
injunction to do unto others as you would have them do unto you lies
compassion.

One of the greatest of men, Abraham Lincoln, had a profound
understanding of common humanity. When he visited Richmond just after
the Union occupation, he was followed by a cordon of black people, one
of whom fell on his knees in front of him. "Don't kneel to me," Lincoln
said, "that is not right. You must kneel to God only and thank Him for
the liberty you will enjoy hereafter." (McPherson, 847.)

The false idea that some people, overall, are superior and others
inferior is rampant in modern society. It seems to be fostered by almost
everyone, both those who think themselves superior and those who think
themselves inferior. Some part of the person is picked out and elevated
to an overarching position. Talented people, for instance, see talent as
making talented people superior. Rich people see riches, highly
intelligent people see intelligence, beautiful people see beauty, macho
men and highly feminine women see sexiness, industrious people see
industry, people from old families see family background, creative
people see creativity, people of strong character see character, clean
people see cleanliness, ethnic people see country of origin, religious
people see their religion, and amusing people see a sense of humor. Max
Weber put it this way: "The fortunate is seldom satisfied with the fact
of being fortunate. Beyond this, he needs to know that he has a right to
his good fortune." These people convince other people who are short on
the characteristic that this is, indeed, the standard for superiority.
If a person has several outstanding characteristics, he or she is all
the more convincing. Someone like Queen Elizabeth, for instance, with a
combination of great riches, prestige, and family background, is seen by
many, including herself, no doubt, to be a superior person, overall.

Shakespeare was onto this idea in his 91st sonnet:
XCI.

Some glory in their birth, some in their skill,
Some in their wealth, some in their bodies' force,
Some in their garments, though new-fangled ill,
Some in their hawks and hounds, some in their horse;
And every humour hath his adjunct pleasure,
Wherein it finds a joy above the rest:
But these particulars are not my measure;
All these I better in one general best.
Thy love is better than high birth to me,
Richer than wealth, prouder than garments' cost,
Of more delight than hawks or horses be;
And having thee, of all men's pride I boast:
Wretched in this alone, that thou mayst take
All this away and me most wretched make.
The assumption of superiority has a terrible history - kings and queens
who believed - and convinced others - that great riches were their
right, slavery in the United States, the caste system in India, Aryan
superiority in Hitler's Germany, class distinctions around the world,
the serf system in czarist Russia, religious groups that are owners of
"the truth," and so on. This history is reason enough to abandon this
terrible notion.

Treating others as equals is a natural outcome of goodwill. It is
goodwill that says to us, "This man/woman is another human being. We
share a common origin and a common destiny. Goodwill is what makes any
one of us the best that we can be."

Equal is life's greatest word. Not only are others equal to you, but you
are equal to them, as well. When you are equal, you can't be inferior.
Neither, it is true, can you be superior. You are neither. You are equal.

Here's a useful Wiki page for any American fighting for equality

http://en.wikipedia.org/wiki/All_men_are_created_equal

I don't know much about American constitutional law but this sort of
shit has got to count for something.

"
We hold these truths to be self-evident, that all men are created equal,
that they are endowed by their Creator with certain unalienable Rights,
that among these are Life, Liberty, and the Pursuit of Happiness. That
to secure these rights, Governments are instituted among Men, deriving
their just powers from the consent of the governed;
"

Sadly the pursuit of happiness bit might be part of the root of the
pathologisation of human misery but...well...nothing;s perfect, yet.

That's a pretty good fucking ideal to start a nation off eh? Got to love
revolutions for leaving behind ideals which those who live in peace
chose to ignore. Those who live in the wake of those who sacrificed have
what peace offers - the chance to sell out the principles of those who
fought until the next revolution scars the land and leaves behind those
same principles (though perhaps a little bit better with each evolution).

That's the problem with labels placed on other human beings

I'll repeat the Thai phrase which explains it so well.

Same, same but different.

They repeat the word "same" twice to reinforce the point.

If people considered schizophrenics as human and what happens to them is
a result of what they would do if their lives were shatter and they were
mistreated because of their way of being and their different internal
reality...shit...then maybe times really would change.

Those people who get to sit in judgement must realise that they're the
lucky ones. They're the ones who live a life of little suffering. It may
be valueless to the greater organism which is humankind but they get
peace. They get comfort from their conformity. They get the contentment
of fitting in with the status quo.

They sit in judgement of other people using labels concocted by
psychiatry. "different" might be the word which is an alternative word
for "mentally ill" because that's all the mentally ill are.

But they're not really. They're same same, but different. If we ever
forget that another human is more like us than
different...well...fuck...people do don't they?

They forget human is the primary label given to anyone. In utopia I
suspect this will be the only label.

Perhaps the cause of all wars, all suffering and all other bad stuff is
because of forgetting what the Thais say. It's when we forget that a
person is different to us that we allow suffering to happen or wars or
violence or slavery or other bad stuff.

The problem of psychiatric labels and psychiatric tyranny and torture is
all about this forgetfulness.

Same same but different. It's so simple. It doesn't even need any
swearing in to make a point. It's the solution to all problems of
disability....but perhaps I am being an idealistic simpleton in thinking
that humanity is anywhere near the stage of being able to understand
that we're all born equal and we'll all die equal. There is no other
truth...or nothing closer to the absolute truth than any psychiatrist
has come up with thus far.

schizophrenia, schizoaffective and manic depression

Homosexual, bisexual and heterosexual

None of these 6 labels which can be applied to types of people are
illnesses. They're just types of people who get fucked over in life
depending on whatever culture, time in history or environment they exist
in. (admittedly heterosexuality is, perhaps, the hardest one to include
in this example but I'm writing this piece after reading what seems like
bullshit about the Kraeplin's dichotomoy).

There may be neurobiological differences. A hundred years ago there
might be a different prognosis for all of these groups compared to
today. (That's irrelevant but I'm fucking tired).

They're all one and the same. Human beings being human beings. How they
become is through the (spirituo)biopsychosocial model as does their life
journey and outcomes.

What 5 out of 6 of these labelled types of people share is usbjugation
during the history of psychiatry. So much similarity but it seems
important to psychiatry to seek out differences rather than help people
live truly equal lives..

Would a paranoid schizophrenic measure or feel paranoid when dealing with an autistic psychiatrist

From what little I know of autism I hear that those people don't lie or
play tricks. From what I know of them they're honest in ways automotons
could only dream of being.

I wonder if an interview with an autistic psychiatrist would make a
schizophrenic's paranoia less? There are many reasons why I think this
might be possible. The first is obvious. There are lots of little tells
people give and while the conscious mind might not pick this up other
bits of the mind can. What if a totally honest person (therefore not a
practising psychiatrist LOL) wouldn't give off those tells and therefore
wouldn't make someone paranoid who gets paranoid when dealing with an
automoton psychiatrist?

The more hokey reasoning is perhaps schizophrenia is related to other
aspects of human potential yet to be discovered? Perhaps they can tap
into the collective consciousness or perhaps they really do experience a
form of telepathy but it's chaotic? I'd give the analogy of what homo
erectus must have looked like to monkeys (don't called them monkeys
though or they'd get annoyed. Call them apes.) The first apes not to
walk on all fours would fall over and stumble. Their desire to walk up
right may seem mad. Ape psychiatrists would want to shackle them down
because they didn't understand evolution.

Nah. That's just crazy talk.

A useful link with some good text on schizophrenia theory in reasonably plain language

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=8805
<http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=8805>

There's other stuff on this site. I feel this page is well written.

There's a bonkers movement which I approve of

There's a movement rooted within the survivor movement to repeal the
medico-legal framework.

It's bonkers because I doubt judges will rule to repeal the Mental
Health Act, not without the public and political lobby behind it. The
politicians have made the Mental Health Act even more coercive and
immoral. The challenge is based on the right for people to exist phrased
as the integrity of people with psychosocial disabilities as seen in
Article...14 I think....of the CRPD.

The thing is change is always made by bonkers people who stand against
the present injustices and tyranny which other people accept. Gadhui,
Luther King, (Malcolm) X and anyone else who ever makes change in the
world has to be bonkers. They have to be depressed to see the world is
wrong. They have to...be schizophrenic or oppositionally defiant to have
the freedom of thinking or difference in thought from the consensus to
think differently. They need delusions of grandeur or megalomania to
think they can change the world.

The problem is many of the public and politicians are still rooted in
the old ways of thinking. It's the same for the judges and lawyers too.
Many human rights organisations also fall foul of doing little for
psychiatric rights. Many people see the mentally ill as different from
themselves and implicitly subhuman in this respect. Many cling to the
idea that it is a genuine illness. Many easily give into the harm which
can come from compassionate motives.

But it's these sort of challenges which stop lesser movements in their
tracks. No fight for freedom and equality has ever been an easy path nor
has it been a path not steeped in the inequities of lesser minded people
who would rather maintain the status quo and power structures than be
part of the movement towards humanity progressing into the amazingly
diverse race we're meant to be.

If I could quote someone smarter than I....well....Mel Gibson in the
film Braveheart playing the character of William Wallace,
"FREEEEEEEDDDOOOOOOMMMMMM!!"

Am I paranoid that some people don't believe what's happened to me in my life?

I find it so hard to judge these things. I can understand how some of my
life might seem a bit unbelievable but that's because I live my life
differently to other people.

Other people don't spend 2 years of there own time searching for answer
for the treatment for schizophrenia. Other people haven't been in a
children's home and a foster home for a few months then a couple of
years later ended up working for a project for the European Space
Agency. Other people didn't do a degree in Electronic Engineering but go
to no lectures and instead learn about other things while working in a
call centre, doing loads of photography and teaching internet and HTML
at the biggest students' union in Europe.

Other people have spent their lives living safe lives and relaxing when
they're not working. They wouldn't walk into an area on there own where
there had been riots the previous weekend dressed in a smart suit. I
guess those are the sort of changes that mental illness and living with
a death wish bring about in a person as well as a phenomenally high
level of education from an early age and a lot of abuse during my entire
life, as well as a few good times of course.

I wonder if it's because people can't believe a total loser who still
lives with his parents at the age of 33 and has a cat as his sole
companion could ever have lived a life once or had some amazing
employment opportunities.

Now all I do is work and drink alone. It doesn't matter. If I can pull
it all together perhaps I can save a few lives. This blog has a lot of
information about my ideas about schizophrenia and treatment. If I can
get my stupid, useless head together and sort it out perhaps I can
persuade psychiatrists and my local MP that they seriously need to
change what they're doing to the severely mentally ill otherwise history
will look upon this time and weep at what we're doing to the severely
mentally ill.

A simple answer to the limitation of suffering question

I would guess for a lot of people their limitation on the suffering of
another would be how much suffering they would have have happen to them?
Perhaps I'm wrong and people perceive some people must suffer more than
they would.

Or perhaps I'm wrong in a different sense? Perhaps the answer to the
question of how much suffering would allow to happen to any other
individual is the same as how much suffering you would allow to happen
to the one you loved?

There must be some altruistic people left who would answer the question
with this thought. There simply must. The limitation of suffering for
any other individual would be the limitation of suffering you would
allow to happen to the one you loved?

If anyone actually reads my notepad they may have seen me write about
love and suffering in the contact of being willing to take on another's
pain. This is perhaps a philosophical or religious way of looking at
love and stuff. It's the sort of answer which means if the person you
loved had no legs and wanted legs you would give your own. It is a mad
sense of love.

But as an answer to the idealistic question of the limitation of
suffering...I like it. I like it a lot.

A study which sort of does and doesn't contradict the danger of antipsychotics in dementia treatment

Let's be frank. Antipsychotics are strong chemicals which affect body and brain. They're rarely prescribed by primary care physicans until recently. usually it's only psychiatrists who prescribe them for long term use because they're harsh chemicals. They work on more than the dopamine pathway which is why they cause so many side effects compared to something like cannibidol.

But this study shows they're not that dangerous.
Risk of Death With Atypical Antipsychotic Drug Treatment for Dementia
Meta-analysis of Randomized Placebo-Controlled Trials
http://jama.ama-assn.org/content/294/15/1934.short

"
Conclusions  Atypical antipsychotic drugs may be associated with a small increased risk for death compared with placebo. This risk should be considered within the context of medical need for the drugs, efficacy evidence, medical comorbidity, and the efficacy and safety of alternatives. Individual patient analyses modeling survival and causes of death are needed.
"

So they're not that dangerous?

I can't be arsed to read the study so I'll just pick at the abstract. The study uses data from unpublished trials. I wonder if a funnel plot has been done to see what the publication bias is like?

The study sponsors....are perhaps pharmaceutical companies?


"
Fifteen trials (9 unpublished), generally 10 to 12 weeks in duration, including 16 contrasts of atypical antipsychotic drugs with placebo met criteria (aripiprazole [n = 3], olanzapine [n = 5], quetiapine [n = 3], risperidone [n = 5]).
"

The length of these trials in this particular review is significantly shorter than the period of time covered by the study which highlighted the the danger of antipsychotic treatment in dementia.

The ...naturalistic or observational study...which sparked off the controversy was not a controlled trial. It was an observation of real life data. The study showed life expectancy was halved from about 3 years to about 1.5,. The proviso on this result is those in the drugged-with-the-chemical-cosh group may have been closer to death which was why their symptoms were worse which was why they were prescribed antipsychotics. The Royal College of Psychiatry knew this when it came up with the 1,800 deaths per year figure.

But most importantly, the drug does not heal the neurological problem. Not really. It just makes people docile. The drug is chemical restraint or a chemical cosh and the application of this sort of behavioural modification to our elders is bad practice. People, carers and people working in care homes need to be able to accept that our elders when close to death can be difficult to deal with. This last idea was not in the conclusions of the authors of this paper because psychiatrists are a bunch of fucking cunts who are making society ill and turning the human race into a race of slave robots for the post-Industrial Age machine.