This is some fucking interesting shit man

http://www.plosgenetics.org/article/info%3Adoi%2F10.1371%2Fjournal.pgen.0010042
Genetic correlations with professional dancers. I

t's interesting for so many reasons even while I'm drunk. Of course my critical mind is nipping away at the ...oooooh ..we have a result based on 20% of people have gene X (to do with musicians with perfect pitch)..that says sod all. It shows  a vague correlation but there may be more significant factors...oooooo....look at the tiny sample size...ooooo......look at how the experiment is so limited - just professional dancers and athletes, why not religious folk, drug users and ravers.

But I'm just like. wow. This is some fucking interesting shit.

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.

A rambling discourse that started on the meaning of misery and ended on what should mental health treat?

There are many types of pain, suffering and times when an individual says "I am unwell". These are complex and individual experiences. They are not the same for everyone and they do not look the same. Psychiatry and the medical model has developed to say they do look the same and essentially that's what's important.

Depression is the simple example where people experience a range of internal experiences, externalisations and other influences that could by understood as being "depressed". This is poorly recognised in the current definition. It has been observed that men are more likely to externalise their unhappiness in different ways. This may be partially covered by the a diagnosis of atypical depression though the very language shows that it is unusual or not typical when in fact it is simply poorly recognised. This would be even worse in clinical practice where primary care physicans may not be aware of what atypical depression looks like.

A high quality study in the US looked at the experience of people using the DSM-III (or DSM-IIIR) clusters and how often people fitted one or more symptom. The first criteria was a feeling of low or mental unwellness as reported by the individual. There was a surprisingly high number of people who reported this with a slightly higher prevalence in women. As the 8 symptoms that made up the cluster of symptoms (that are clinically signficant when 4 or more are present for a period of time (?2 weeks)) were gradually included the percentages decreased overall and faster in men. This very clearly showed how the cluster approach was 'feminsed' towards acting in symptoms and it also shows that in its question to be scientific it was missing large swathes of people who had the base criteria: a subjective feeling of unwellness.

The diagnostic criteria for depression is a good shot for a poor science. It doesn't cover the heterogeneity of the experience and the human condition, i.e. it thinks that depression is the same for everyone. The cluster system values the individual's report that they are unwell for a period of time but the research criteria ignores some who don't fit the pattern and this may be a large section of the depressed population.

In reality of course it may be quite different. I would expect that the implementation of the diagnostic criteria and the treatment protocols would vary between physicans. Another American study looked at the factor of bias in diagnosis amongst psychiatrists. Surprisingly the bias was not on gender of psychiatrist or patient, ethnicity or age but where the psychiatrists had trained. This is another of many examples of the problem where people will receive different diagnoses from different doctors, something that is much less so but still present in physical medicine.

There is likely a large difference between primary care diagnosis and psychiatrist diagnosis, though again this is likely (but less so) for physical illness. Psychiatric training for primary care physicians was the theme of World Mental Health Day 2009 and the point is a salient one. Better trained GPs who see the majority of people with mental health problems are underequiped to recognise the complexities of emotional and behavioural disorders. However psychiatrists are also poorly equipped by a diagnostic criteria that demands adherence to the cluster of symptoms approach rather than the report of the individual.

The problem of the unusual depression that is experienced without mood effects, e.g. withdrawal without mood fluctuation or usual externalisations, would mean individuals would not report their potential unwellness. This particular idea of depression though is a tricky one where the individual themselves doesn't feel the low of depression which is the most significant cultural definition of depression but exhibits either changes in behaviour, withdrawal or excess giving. It is a question whether this is a form of depression or a socially acceptable way to be depressed from an inner experience point of view. The individual may be unconsciously feeling the roots of where other people feel low feelings. Their externalisations could be based on excessive guilt or clinically low levels of self-esteem. Their behaviour may cause morbidity, changed life course and may reduce their 'flourishingness' (to make a noun of a recent rewording and perhaps reconceptualisation of what is mental health by the Department of Health) and this may be identifable as a prognosis below the average and below their expected life course.

And yet is that something that should be to treated?

I think that's a post for another day.

People have a right to be mentally ill

Its a strange concept: the right to be ill. Its worth remembering that mental illness isn't actually an illness and but its a way of considering it. The same concept can be euphimised as mental health problems or mental distress, though the latter is an incorrect description of mental illness.

An individual has the right to go through depression, mania, anxiety, psychosis, personality disorders and every other manner of mental illness. That is a right but there is a counter argument based on the reality of that anarchic, liberal thinking which I espouse.

The mental health system is based on many things, one of which is dealing with the stigmatised. The stigmatising behaviours or the extremes of normal traits are not well accepted by the public so people became seen in healthcare settings. Mental crisis is also a real thing even though it is a result of society's maladaption to the complete human experience, i.e. a society in the future will be setup such that crisis happens in the community with no social harm and no risk to another person's life (I see suicide as something can be a rational choice but can also be an irrational one and the latter prevented, whereas murder and manslaughter should be prevented).

The maladaption of society is real but it is as changeable as the mental health and legal systems. Again I use the example of the demedicalisation of homosexuality. Or the huge change that is seen over the latter twentieth century in the application of a quasiscientific framework with the operational definitions of cluster of systems. Sadly the early twenty first century is seeming a psychiatric insanity in the development of premordibity operational definitions as part of the American psychiatric system.

It is with this change to diagnosing pre-illness states that this point about the right of the individual to refuse treatment, espeically psychopharmaceuticals, if they are definied as pre-mentally ill by the new system. Premorbid psychosis does not guarantee a person will experience full-blown psychosis or schizophrenia, but standardised treatment would likely be the chemical cosh which cause changes in a person's experience of life and have harmful physical side effects that will reduce their life expectancy.

Psychosis itself is highly misunderstood because it is understood by people who have never experienced it. The psychaitric dogma of pathologising this experience and offering treatments designed by people who have not had the experience (up until recently) are two of the reason the outcomes are so poor. It is well recognised that many cultures around the world have alternative explanations for this experience and stigmatise it considerably less than in the UK.

The new Community Treatment Order in the 2007 amendments of the mental health act meant medication could be forced on people who wanted to live free of the chemical cosh and was overused a considerable amount because of psychiatrists infringing on a person's right to free experience. Some of those people may be taking an antipsychotic called clozapine, one that is well established to induce life threatening conditions and dramatically shorter life expectancy. If I remember right one of the arguments for its introduction was to reduce the number of 'revolving doors' patients who were repeatedly hospitalised but became a tool to force medication (as is often what happens during hosptialisation anyway, even with a section 2 where there is no legal power to force treatment (if I remember right) though in practice nurses and doctors may not inform patients of that right or they will be exceptionally coercive in persuading a person that they must take medication).

The right of a person to be considered mentally ill and refuse treatment is a complex debate and I've only provided one side of the argument. I think its a strong one though and I'll make my final point.

Life may be more complex that what is understood by simplistic psychiatiry. These illnesses may not be illnesses. They may be a reaction to something that is wrong in society, and medicating them away is like dismissing criticism: its blinding oneself to a feedback channel. They may also be part of an individual's journey through life and that these experiences have purpose beyond Kraeplinean ideas of where these experiences come from. They may be part of change for the better, but if they are stopped by psychiatric treatment or mistreated by misunderstanding psychologists then the individual's journey suffers and their development may be stunted. And its all done for their best interests, of course....

"The soul would have no rainbow if the eyes had no tears."

Native American wisdom printed in Our Voice/Notre aux voix (Canadian consumer magazine).

That's an alternative view from an alternative mental health system. The spiritual wisdom handed down through the oral tradition of evolution of knowledge beats psychiatry's understanding of mental illness, in my opinion.

We have a right to be mad.

A rant on the motto of the Royal College of Psychiatry

The Royal College of Psychiatry's motto is something like Let wisdom guide. I chuckled hard when I heard that. There's as much wisdom there as there's snow in the Sahara.

Psychiatry creates the divide between normal and illness and calls it a science. It uses sophisticated tools of evidence to justify social stigma and it does it so well that its fooled itself. I always refer to the example of homosexuality because its such a good example. It was stigmatised and so became psychopathologised. Yet how often does the wise psychiatrist question the other diagnoses and ask whether they're really illnesses or just normal.

Psychiatry is a profession that uses clusters of external symptoms to map experiences which are often internal. There is no concept of the lived experience psychiatrist (more on this later) which is an idea I have that would be the future of good psychiatry. Its very simple: people with lived experience go through psychiatric training - only they will possess the full knowledge of the experience and the knowledge of the textbooks. Depression would be treated by people who know what depression is. Treatment of psychosis, mania and all the other dimensions and domains currently medicalised by people who lack the real knowledge of these experiences would be revolutionised to become effective and ethical.

Their great lack of wisdom is most seen in the use of medication. The prophylactic use of psychiatric medication, i.e. the lifetime of taking medication for the mind after one crisis or episode, is foolish. Trust me, I'm a fool so I should know. A person can become unnecessarily drugged as an unintended punishment for a single hospitalisation and repeated hospitalisations can mean this regime is enforced through the medico-legal framework because of the introduction of Community Treatment Orders in the amended Mental Health Act (and in other legislation outside the UK).

Its not meant to be a punishment but the removal of certain emotions, range of emotions or expression of emotions is punishment. These are the very things that make us human and make the human experience liveable. To mess with them is dangerous and should be done with a care, and very differently to the current sledgehammer approach favoured by psychiatry's foolish wisdom.

Perhaps its greatest error is to disregard the pre- and extrapsychiatry mental health systems. Its an ignorant assumption that the only people capable of understanding mental health are psychiatrists. The converse is likely to be true. Spiritual, religious, cultural and other forms of extrapsychiatric mental healthcare have existed for generations. As far back as Roman times mood stabilisers were used for madness but these were very low doses of lithium found in certain spring waters. There are many examples of mind healers outside psychiatry and psychiatry is becoming influenced by them in the 21st century, for example Mindfulness Cognitive Behavioural Therapy is in part Buddhism.

And the last two 'wise' idiocies come together in another absurdity: the medicines for the mind prescribed by doctors and psychiatrists are usually given by people who have never tried nor would try them. There are some anecdotal stories of consultant psychiatrists making trainees try psychopharmaceuticals but this is very rare. There are more stories of doctors and other mental health professionals being averse to taking medication because of the stigma of mental illness and medication of mental illness in their profession. Last year a local doctor in Enfield was struck off for self-prescribing antidepressants; he could have got another doctor to write the prescription but that would be admission of illness, or weakness.

I think perhaps the motto is aspirational rather than a description of the RCPsych and the collective consensus of thought they represent. I really hope that it will describe them one day but they really should have an accurate motto.

"We're way out of our depth but we've got loads of science to justify our foolishness. Just try not to remind us of the mistakes of the past because those were wise mistakes."

or

"The legal drug dealers."

Or perhaps you can think of something more snappy?

Add them below in the comments box