Tuesday, 23 August 2011

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.

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We It comes in part from an appreciation that no one can truly sign their own work. Everything is many influences coming together to the one moment where a work exists. The other is a begrudging acceptance that my work was never my own. There is another consciousness or non-corporeal entity that helps and harms me in everything I do. I am not I because of this force or entity. I am "we"