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?

Go on. You can finish this one of yourself

This is probably the worst thing to say to a woman in bed. I've only said it once.
Oh god she deserved it though. I remember just getting so bored of her  poor sexual skills. I'm not great in bed myself. Just not enough practice. But I make an effort and I always want a woman to climax. She on the other hand was...well....lazy. Never made the effort. I think she thought sex was just fucking or something. Her idea of foreplay was what a man did.

I admit a degree of anger but more frustration. I suppose it's just a lack of my communication skills.

But I wonder what she told other people? I wonder if she told any of her female friends about what I'd said. I never told her she was crap in bed so she'd have thought "Go on. Finish yourself of" was said out of male
 laziness or something.

There's a time when a girl I loved who was a friend of hers looked at me awry when I made a joke along the lines of "Go on. You can finish this one off yourself" referring to a joke I couldn't be bothered finishing. Now she may have looked at me funny because she was amused by an off the cuff comment that made innuendo out of a normal phrase that could be mentioned in the office, or perhaps my ex-loved one had told this person what I'd said.

There's this thing called Theory of the Mind. It's interpretation of people's intentions often based on little gestures. Apparently schizophrenics have poor ToM. I stay away from attempting to interpret these little tells because they're not explicit. I'd like to ask the person I joked with but whose reaction to the joke I couldn't interpret but I don't trust her and she doesn't value me.

It's a shame because I'd like to know. Really just for a blog piece about a "How good are you in bed?" mobile phone application of the future. It's relevant because gossip becomes formalised using this sort
 of application. Imagine people could rate their partners and other people could access these. After all, we can rate companies and products. Why not public ratings of people once the technology matures?

A quote that's hard to live by

‎"Never, never be afraid to do what's right, especially if the well-being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way."
- Martin Luther King Jr


I'm trying to piece together what happened last night. I got drunk when I shouldn't have. I ended up going food shopping after getting really drunk. There was a guy who started a fight. The staff had called the police. I tried to calm him down and calm down the staff as well. He was angry and upset about something. I hadn't seen what happened but was told he punched one of the staff who thought he was stealing stuff which it turns out he wasn't. The accusation had set him off.


It turned out his wife had left him that week. I'm not sure if it was true or not. The police arrived and I hung around just in case they were going to arrest him or take him to a psychiatric ward. I have no idea why. I was really drunk and hungry too.


In the end they let him go. It surprised me but I hope the officers understood that the guy was just having a day night. I'd spoken to one of the officers briefly before they escorted the guy into a room in the store to speak to him. They may already have been mental health aware.


I walked him back to his house or what he told me was his house. He brought me in the back way which was odd. He broke a window at the back to get in. At that point I went to leave because I thought we were breaking into a place. He then took me round the front. The front door had already been broken through. He kicked the front door in. At that point I should have thought this is really fucked up but I wasn't really thinking. This is very stupid of me. I've never broken into a house apart from my own.


I wonder if he was going through a divorce and it was his old house or something?


Anyway, he poured a  glass of good wine for me and we shared a spliff. He needed to clam down and the weed I'm smoking is high in cannabinoids (the antipsychotic comoponenet of cannabis). The emotional onslaught he had that evening mixed with the alcohol and cannabis knocked him out pretty quickly. I hope he slept well and felt a bit better in the morning.


I trusted him when he told me it was his house and that he'd lost his wife or they'd gotten divorced. I should have used my better judgement and never gotten involved in the first place but I perceived someone who was going through something shit and it was externalising in unacceptable ways. I wasn't trying to live to that quote. Just trying to help someone out like I was helped out last Friday night by a random stranger who chatted to me about life.  He treated me like a human being and that's more than I can say for some of the mental health professionals I've met in my time.


I suppose I can take comfort in the fact that I'm not gutless. The value it has for my soul can cost a high price through society's punishments.

A quote on the acceptance of madness as normal as a means to understanding life

When we remember that we are all mad, the mysteries disappear and life stands explained.- Mark Twain


Mark Twain says some great stuff. He also says it better than me.

Personal attributional style and mental health measures using self report

Attributional style in this context means how a person measures something. Three people may experience the same experience of the vagries of the human condition. They all fill in the the same self-report questionnaire  Person A fills it in how the person who designed the scale meant it to be filled in. Person B may be more sensitive or less resilient or exaggerates so their scores are much higher or more extreme. Person C may be less in tune with their pysche, more resilient or more conservative in their self-report.

This attributional style may be a personality trait however it may also change day to day, moment to moment. This is the 'noise' of personality traits that makes identifying a person's type challenging from a single assessment of personality type.

It may be possible to train self-reporters so the variance in their attributional style disappears. It may also be possible to design a pre-questionnaire or something similar to assess their temporal attibutional style before the assessment. 

I'm not sure if this is taken into account in the CORE-OM measures. I'm aware of seeing in it practice. I've filled out forms in an attempt to get access to psychological therapies however I didn't score my disorder highly because I'm resilient to a lot of it and I've been in far worse states (states which would shatter anyone's psyche). I may have been filling in GAD or PHQ or some other measure. Not too sure if it was the CORE one.

A private psychiatrist I saw for a few years offered a useful measure. Well, one that I felt worked at the time anyway. He asked how I felt but the extremes of the scale were the best I've ever felt and the worst I've ever felt. The time I spent with him meant that he could assess my attributional style as well and he could question my answers. 

He could also develop a consensus understanding of the measure between himself and the patient. This is probably the most important thing with any measure.There's no point taking about measures when one person's taking in feet and the other in metres.

The most famous song mentioning suicide

Suicide is Painless (M.A.S.H Theme)

http://www.youtube.com/watch?v=4gO7uemm6Yo

I'd hoped that Shenidamn had something to say about this song. Is it positive, negative or objective. Does it feel right?

It was a theme to one of the most popular war comedies of all time.

I'd be really interested to know what the 1 in 6 who have experience of thinking about suicidie at some point in their life thought of this song

Thoughts on the pursuit of happiness

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

An emoticon for the mask

:'-)

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.

Several reports on justice and the mentally ill in the UK

Court experiences of adults with mental health conditions or learning disabilities
http://www.library.nhs.uk/mentalHealth/ViewResource.aspx?resID=381576&tabID=290


This is a series of policy and research report that's a major piece of work.

LSD, Special K and Ecstasy for better mental health!

Image by Hugger Industries via Flickr

This story was published a few hours ago in Time magazine.

Is Ketamine a Quick Fix for Hard-to-Treat Depression? by John Cloud

I think the study authors would be a little more conservative in their reporting of the results however the people who end up in these experimental drug trials in the US are people with severe conditions where other treatments haven't worked and the prognosis is likely to be poor.

It follows another article written in Time magazine a fortnight ago.

Cloud, J. 2010, Ecstasy Shows Promise in Relieving PTSD

I also reported on LSD being used to treat mental ill health in an earlier blog post.

As Simon and Garkfunkel sung,

"Oh the times they are a changing."

Eureka? A solution to the problem of language in mental health

There is an ultimate division that will never be healed if any language is used to differentiate different human beings as long as mental health exists.

There are the mentally ill and there are the normal but a movement has pushed for the term mentally ill to become euphimised to mental health problem, difficulty, experience and other less bad terms. This will continue till there is no more mental health stigma.

What if the movement tried an alternative, just for a bit of fun. Why not rename normal? In an earlier blog post I changed the word to "automoton" referring to a mindless machine with properties akin to a robot rather than a human.

This levels the playing field. When presented with a choice between "mentally ill" and "mindless automoton" many wouldn't know which to choose because they have equally (and meaningless in my eyes) negative connotations.

It's sort of turning the problem on it's head and applying a little lateral thinking...sadly the latter is rarely seen in automotons but with help and therapy and medication (delta-9-THC or C2H5OH may be effective) many automotons can be assisted to become normal....I mean mentally ill.

There is a pleasant feeling of smugness associated with this thought. I think the meal I just ate helped and a little smoke with the dust from an old skunk baggie.

2 articles I like on Breakdowns and Upbringing and Psychosis

Understanding Madness as Life Management Breakdown by Brian Davey

http://www.bgmi.us/web/bdavey/Breakdowns.htm

I like this so much I'd like to cut and paste the whole (short) article here. It's one of about interpretations of breakdowns.

The second one is from the Lecture to World Congress of Social Psychiatry, Hamburg, June 1994 by the same author.

Upbringing and Psychosis

http://www.bgmi.us/web/bdavey/Psychosis.htm

Here's one snip I like. The author puts his personal experience in brackets. I like the rest of both of these articles and I think many people who are going through a hard time might have something to learn from either of these pieces.

"

(One of my greatest frustrations eventually lay in trying to communicate my developing theory of madness - since this was mostly ignored by local medical psychiatrists. One of them said 'We don't have to listen to him, he's only a patient'. Others listened but it has made little difference to their practice. I knew I was on to something important and was desperate for the breakthrough when I hoped they would realise the value of what I was saying. The fact that they ignored what I had to say aroused powerful feelings that became too frustrating. The anger spilled over into all my relationships and periods in which I would withdraw from everyone. In isolation nearly all thinking is fantasy as there is no feedback to reality-check in conditions of intense aroused emotion. Later I saw I was rather 'father/teacher fixated' as I was appealing to local psychiatrists to support my attack on their work. I wanted them to accept me even as I attacked them - acting out repressed feelings as rebellious son/pupil. This was a reproduction of, and a failure to go beyond, chronically unsatisfactory childhood relationships. It was Professor Romme, who did see the value of my work, who advised me, very wisely, to address my ideas to those who would listen, not to those who would not).

"

Sadly I disagree with Prof Romme about presenting work to those who won't listen but then I'm a miserable loser who's pretty unhappy because of his own misadventures and Prof Romme...well...he's a professor. His work has been instrumental in getting other people to listen to the voices of patients, people who otherwise wouldn't bother to even look a severely mentally ill person in the eye nor consider their experiences to have any meaning.

World Hearing Voices Day

Did you know something about Louise Pembroke?

Louise is so famous that if you type her name into Google it comes up with an autosuggestion for "Louise Pembroke self harm." I know her as a contributor to the legendary Openmind magazine.

I'm reading through an interesting article on hearing voices and the hearing voices network published in the New York Times a few years ago. She's mentioned in there as the person who prompted the start of World Hearing Voices Day which will be on the 14th of September this year.

Hurrah!

A solution to the renaming of schizophrenia: Latinise it

I've been handwriting a bit of an essay about the use of language. Resorting back to handwritten notes is something that's been forced by the smashing of my laptop but it's a useful return to a pleasure forgotten.

There's a conclusion. Perhaps the old psychiatrists got it right. Latinise the language.

Schizophrenia has been relabelled "integration disorder" (or Togo Shitcho Sho) in Japan for salient reasons however it carries a meaning that people who don't read psychiatric research will take as the sole definition of schizophrenia.

So way back in 1896 when Emil Kraepelin named the schizophrenias in his classification system he chose the latin "dementia praecox". The terms means little to anyone. They'd have to Google it at the very least to find out what it meant. Wiki would tell them it meant premature dementia which isn't quite true but they'd hopefully read the rest of the page.

I understand the reasons why there's a modern movement to rename Bleuler's term schizogruppen that was used in a paper in 1908 and Gruppe der Schizophrenien in a book in 1911 for how he conceptualised the schizophrenias. The concept has little to do with the public interpretations of split or shattered mind but relates to the division of faculties of the mind (rather than the mind itself).

None of the terms relate to the diagnostic criteria itself.

From

http://en.wikipedia.org/wiki/Schizophrenia#Standardized_criteria (referencing the modern American manual).

"

Characteristic symptoms: Two or more of the following, each present for much of the time during a one-month period (or less, if symptoms remitted with treatment).

- Delusions

- Hallucinations

- Disorganized speech, which is a manifestation of formal thought disorder

- Grossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or catatonic behavior

- Negative symptoms: Blunted affect (lack or decline in emotional response), alogia (lack or decline in speech), or avolition (lack or decline in motivation)

If the delusions are judged to be bizarre, or hallucinations consist of hearing one voice participating in a running commentary of the patient's actions or of hearing two or more voices conversing with each other, only that symptom is required above. The speech disorganization criterion is only met if it is severe enough to substantially impair communication.

- Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset.

- Duration: Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less, if symptoms remitted with treatment).

"

So according to an online Latin translation site the Japanese term could be

"integration incompositus" which means nothing to the lay person.

To the academic there's a more interesting debate that seems to have been ignored in the relabelling debate. There's a response from a medical student on the student British Medical Journal site that goes on about a point I agree with:

"

Unfortunately, changing the name of the condition (or even abolishing the concept) will not affect the root cause of the stigma—the public's ignorance and fear of people with mental illness. Renaming may even have the unintended effect that the person, rather than the illness, is blamed for the symptoms.

"

It's a bit of a ramble. I guess someone like Professor Mary Boyle makes the point more lucidly in Schizophrenia: A scientific delusion? I'm embarassed to say I haven't read it but there's a Google Book preview if you follow the link.

What is the right thing to say?

I am desperate to know the right to thing to say to these words.

"i wonder why no matter what i do, i don't get any better."

I ended up giving the individual a lengthy response that they'd probably already heard with little or no empathy. The lack of empathy is part of my state at the moment. I'm very sad inside. But even if my heart wasn't stone cold I still wouldn't know what to say.

This is a friend of mine and I'd like to have been able to apply Schneidman's techniques to apply what I knew of their life history to see where they were and what was up. They won't talk to me nor will they answer my questions.

I want to be able to give them five words that will salve their psychache. Instead they got one of my length essays that cover every possibility which I know was the last thing they wanted but I just didn't know what to do.

I explained a little about my life and how I went through hell and came back, but they know that I went through hell again and haven't returned yet.

I have fought and fought to keep my head above water and now I'm drowning. It is at this time that it is hardest to help another.

Do I say, "It gets better and worse" or "this is life little youngster." "You know not hell yet" is perhaps a closer truth but none are what a suffering person wants to hear.

My relationships in helping people depend on my honesty and I can't tell this person honestly that "It gets better so chill" but the bleakness of truth at the wrong time can break a person.

"seek wisdom from the veterans" is true, perhaps. "Listen to your loved one" is true, perhaps. Yet this individual is smart enough to know that. It's why I didn't say, "buck up and keep trying."

But I think that's all I have left for me. That's all I can say to myself I mean. I'd not say it to someone else when they needed help but I think that's come from my upbringing. It's how I treat myself. Like shit.

When will lack of financial capability become a mental illness

I noted that gamling appeared in one of the UK's big mental health surveys and there was talk of it's inclusion into DSM.

That's a form of recklessness or addiction perhaps that's only a mental illness when it goes wrong. Those who can take the risks and win aren't mentally ill just as those who manage psychosis or paranoia without hospitalisation aren't diagnosed with schizophrenia or other psychotics disorders such as bipolar (sorry ladies and gents and fans of Steven Fry. Bipolar's a psychotic illness).

Learning disabilities is the modern term for idiocy and the other old terms for people who lacked a degree of general intelligence (according to the consensus measures). Financial capability has been a observed to be a problem for some people with or without mental illnesses, for example the people who take out door step loans with daily interest in the tens of percent.

The modern finanical world is a set of tricks designed to make a person spend more. Those with high finanical capability, for example the sort of person who knows more than the sales person, might be able to sail through the multitude of offers designed to squeeze more out of a person's pocket.

Pay as you go mobile phone contracts are one of these areas where people are tricked by bargains. They're given offers that sound amazing to anyone who can't do the maths, for example buy £10 of credit and get £20 free sounds like an amazing bargain however they up the call charges to 30p a minute while their standard or previous tariff was £10 for £10 of calls at 10p/min. The old tariff would roll over the credit to the next month whereas the new tariff would only roll over any of the initial £10 (which is used up 3 times quicker) while the £20 'free' wouldn't roll over.

Of course in this example the best thing would be a contract-free deal rather than pay as you go however people who have bad credit ratings or are financially excluded through bankrupcy don't have that option.

There are other examples. I remember working with someone who had enough money to buy a car outright and planned to. She was persuaded by the salesman to buy it on credit, even though she had the money and was ready to spend it as a lump sum. She was persuaded that it's better to have the lump sump in her bank and pay over time though it was really a ruse to increase the salesperson's monthly bonus. I can't remember if they'd attempted to sell Payment Protection Insurance.

Financial capability is important because money is important and people who work selling financial products may knowingly or unknowingly mis-sell them (unknowingly because many are just handed call scripts from their managers). Clearly the reckless spending associated with hypermania is something that's recognised as part of the illness. People in clinically manic states are often ripe pickings for the nefarious and those that are simply mental health unaware.

I'm considering this more analogous to intellectual disabilities. The lack of financial capability is a problem created by a complex system and not a real thing. I think every person, even the bankers themselves, must get frustrated at some point with the illogical of financial systems and credit packages. Certainly from the stories I've heard from my friends who've worked in investment banks it seems a certain amount of exploitation of a lack of financial capability is not the exception but the rule in their industry. Examples are hard but it'd be like me swapping a phone for a bag of crisps which might have a prize of £10,000.

I imagine in a decade or two there might be research papers that start with, "In the story of Jack and the beanstalk there's a clear example of a man with a financial capability illness. 3 magic beans for a cow is like spending £173million just on improving access to CBT. But they did it ten or twenty years ago."

Notes mental illness and disability

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

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

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

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

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

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

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

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

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

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

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

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

Music speaks more than a thousand words.

Cry if you want to sung live by Holly Cole.

Onion Girl is another beautiful song.

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