Calling someone mentally ill is an insult

I put my images up on Facebook and someone made some vile comments on the photos I took of people protesting outside Westminster. It made me very angry.

I did something dirty. I offered them my compassion and suggested they were mentally ill and needed clozapine. I made other veiled insults.

I didn't think about what I was doing. It was pure rage and instinct or whatever. I don't do stuff like that. I'm straight and direct. Something took over as the crimson blurred my vision.


It's important though. Calling someone a diabetic wouldn't have been an insult though there are perhaps other physical illness that may be used as an insult.


Perhaps if I'd said they had a mental health problem that might have been better if I didn't want to insult them or I thought that they were distressed which was why they were projecting their anger on these protestors. That dirty part of my psyche, the part that's usually hidden from civilised society, made sure I lashed out with the worst thing I could say to a person: I think you need clozapine.


From the case studies of clozapine patients in America it is an insult.

The medical profession are researching alternatives to clozapine

http://jop.sagepub.com/content/21/6/657.abstract
Review: Combination therapy with non-clozapine atypical antipsychotic medication: a review of current evidence
Jenifer Chan et al.
2007


There's a DARE record as well though it seems they've been less critical of this paper than others. I can only read the abstract of the paper.


<sarcasm>
I'm so glad to see this is a research priority. It's great to see the NHS are pushing forward these sorts of papers. It's even bettter to see the amount of funding, the high quality researchers involved and the huge number of psychiatrists and experienced research professionals involved in the effort for medicine to stop killing people with antipsychotics. It makes me thing that doctors really care about their patients and the NHS really focuses on important research, rather than a million and one trials of treatments for smoking cessation which are left for years before reviewers get round to adding to the DARE database.


The NHS clearly has the deaths it causes through the use of clozapine and other antipsychotics high on the agenda.
</sarcasm>


Now that I've disengaged from using the lowest form of wit let me remember my project management training. A lot of modern project management theory came from NASA because they had the unenviable task of getting to the moon. The Apollo programme is was one of the most ambitious of mankind's endeavours (and it was mankind because women would have been smart enough to know that it was just men compensating for the size of their phalluses and they wouldn't have bothered).


I got some of my training around the time of my first major breakdown so my memory of it isn't fantastic. There are variables. Time. Quality. Resources. If you want something done well then you need lots of resources or lots of time. If you have little resources then it'll take a long time or it'll be crap quality. You get the picture.


Every day that someone doesn't do something about the clozapine deaths is another person killed by psychiatry's solution to treatment resistant schizophrenia. Clearly that's not a priority. The authors of this paper published in 2007 may be the best researchers in the world however it seems the psychopharmacy isn't their specialist area. The main author works at an eating disorders clinic. Her other papers are not on psychiatric medication.


I do not point this out to slate their research. I point this out to slate the medical profession and the NHS's attitude to the development of an alternative to clozapine even if it's still pharmcotherapy.


This paper was in the latest NHS Evidence email that came out today though it was published 3 years ago. Even the NHS Evidence team can't be arsed with clozapine research. It gets stuck at the bottom of the pile. Smokers like me who knowingly self-inflict a reduced life expectancy (and who pay for their treatment on the NHS through all the tax revenue) are more important than the lives of those people that psychiatrists knowingly reduce their life expectancy. There's regular evidence about smoking cessation treatments in the NHS evidence email.


In project management if time is of the essence and quality is important then what's needed is resources. This isn't just money. It's organisations such as the Royal College of Psychiatry getting their heads out of their arses and making research into alternatives to clozapine a priority. It's getting research psychiatry on the case rather than a couple of inexperienced researchers.


At least that's what I understand from my project management training. Back in the day some totally irrationally and potentially mentally ill President of America said that they'd put a man on the moon, gave NASA an unlimited budget and told them to get on with it. To John F Kennedy it was important to reach the moon.


Around that time was the real boom period of psychopharmacy. Psychiatry moved away from psychoanalytic methods of care which required time and patience. Instead they found the convenience of pills like an 18 year old clubber at their first rave. This convenience factor, the biomedical model of schizophrenia and psychiatrist attitudes to anything that isn't of their establishment means they'd rather keep on researching new ways to use clozapine rather than ways to stop using clozapine.


How many dead schizophrenics does it take? Wasn't the Thalidomide disaster enough?

Image via Wikipedia

Going back way back into prehistoric psychiatry there were great men like Pinel who removed the shackles from the men in the Bicêtre Insane Asylum. 200 years on he would piss in the face of psychiatry for it's continued use of the new chemical shackles.

Is it possible that a psychiatrist from over 50 years ago could do better than NICE recommendations for schizophrenia

Don't ask how I ended up reading about insulin-induced comas. I'd heard of them before because they're an example of the power of the randomised control trial which eventually proved how they should have never been used. Anyone reading that Wiki page could work that out though.

However, there's a useful snip from that page (this piece is a slight piss take btw).

"

When they were not in a coma, insulin coma patients were kept together in a group and given special treatment and attention; one handbook for psychiatric nurses, written by British psychiatrist Eric Cunningham Dax, instructs nurses to take their insulin patients out walking and occupy them with games and competitions, flower-picking and map-reading, etc.

"

The very least NICE could have done in their guidelines for the treatment of schizophrenia is a have a little recommendation like that.

The worst, most disabiling and dehabiliting mental illness had recommendations of CBTp (16 sessions of CBT for psychosis), arts therapy and family interventions in the psychological therapies and psychosocial interventions bit of the updated 2009 guidelines. But Sweet Fuck All (SFA) else. (sorry....inappropriate humour again...thank goodness...read on and you'll understand why I'm so thankful for this morning's inappropriate humour).

SFA is an accurate acronym. I can't remember their depression guidance and only briefly flicked through it but I'm fairly sure it would be unfair of me to use that acronym on those because, if I remember right, there were considerably more options. (my sarcastic mind wants to write, but then depression is so much worse than schizophrenia but really it's just more difficult to treat and society doesn't treat schizotypy whereas it does mild depression.)

I'm sure NICE might say that their recommendations were made on the highest evidence but I'm afraid the evidence is that talking with me is about as good as talking with a qualified CBTp therapist (which frankly is probably the most disturbing thing you've ever read). They also had no reason to disrecommend any of the other treatments, for example supportive psychotherapy or social skills training. They may also have recommended against counselling of all bloody things noting that if the client asked for it they could have it but my memory really is poor so it may not have been that well-established psychological therapy that was recommended against in favour of CBTp.

In the end SFA was all they recommended. I suspect that they wouldn't have recommended art therapies without a kick in the arse from one of the involvement 'tokens'.

I have the privilege of being a critic. I can sit from outside the process and read the end result, zoom in with my detail lens and pick out any little mistake without understanding the bigger picture. Sadly in the treatment of schizophrenia, guess work, non-therapeutic controls or...ugh.....perish the thought.....talking to me would be as good as talking to an experienced, trained CBTp therapist.

What the wikipedia clozapine page might look like in half a century

Or less if i can figure out an alternative.

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

This was a nationally approved treatment for schizophrenia.

People used to be injected with massive doses of insulin to induce comas and seizures. This would happen many times in a week to the patients and while they were in a coma ECT would sometimes also be used.

It is always the absence of an alternative that allows these inhumane treatments to be justified using whatever passes for evidence-based medicine at the time.

At the present time it seems the convenience and inexpensiveness of clozapine is also a significant factor to it's continued use, as well as its suppose effectiveness based upon the cardinal sins of schizophrenia as described by psychiatry.

If patient experience or as a proxy measure patient compliance with treatment was a measure of success then clozapine would be banned right now. Mental healthcare is so far from that sort of measure.