The hardest photos I've had to edit in a while

Canon 50D & Canon 50mm f1.8

One description of life

I'd heard life described as the briefly, deeply intense moment of
experience or emotion that rise above the sea of ennui. This description
of life is those memories reflected upon while awaiting death. Those
moments are good and bad times, but they are always interesting times.
The rest is ennui.

MAD

Music Aids Distress
or
Music Aids Destress

It's the name for a fundraising gig. It was for a gig for a local mental
health charity that never happened.

There was an even bigger idea. Mind Aid. In the spirit of Live Aid a
concert a Wembley Stadium for mental health. Concert organisers Mean
Fiddler are in the area and could be asked for assistance where charity
event organisers lack experience.

Shopping as an alternative to the gym

This may seem like a silly idea to someone with a car or living on a
decent income or who has to shop for a family. The reason I think of it
is because it's something that I do.

My local supermarket is about half an hour walk away so I walk up there
instead of taking the bus. I only use a basket so I take as much as I
can carry then I load up and when I'm not feeling lazy I walk half an
hour home with the bags.

It's exercise while not being exercise and I find it goes a lot easier
if I've got some music to listen to on the way. The walk back is hard.
Carrying a few kilos on each hand for half an hour is streneous
exercise. The walk up to the shops is like a warm up. It's important to
cool down properly once home and the eat or drink something with a lot
of protein. On a hot day milk can replenish lost water and provides
protein to rebuild those muscle fibres.

2 genetics and mental health studies show no association

Genome-wide association study of recurrent early-onset major depressive
disorder (abstract only) published in 2010
http://www.nature.com/mp/journal/vaop/ncurrent/full/mp2009124a.html
and
No Significant Association of 14 Candidate Genes With Schizophrenia in a
Large European Ancestry Sample: Implications for Psychiatric Genetics
http://ajp.psychiatryonline.org/cgi/reprint/165/4/497

both show no strong genetic factors, at least for common SNPs (single
nucleotide polymorphisms). Schizotaxia and other genetic 'risk' states
may, perhaps, exist over a number of nucleotide sites however i think
that even in that case the sort of method used in the second study
should identify some of the single sites. I really know very, very
little about genetics I'm afraid.

This slightly screws the rational that mental illnesses are part of the
human genetic makeup and an essential part that has been mispathologised.

The effort of psychiatric genetics research is to find this genetic
link. It's important to justify the idea of mental illness as a real
illness. It has little relevance that I can see to treatment unless
treatment is going to be stopping the mentally ill ever being born. It
may help create new medications but I'm not sure about that bit.
Psychiatrists are also interested in the cause of mental illness and
twin studies have shown that there is a significantly increased risk of
a person being schizophrenic if their monozygotic twin is also
schizophrenic.

I'm waiting for the data that shows there is some genetic component
because that supports my view that those that are described as mentally
ill or at risk of becoming mentally ill are just another subtype of homo
sapiens just as those without are are a subtype that, in a different
time or place or a parallel universe could be labelled as the mentally
ill and the same ostensive reasoning applied to their behaviour as an
illness.

The latter study is regarded as the highest quality study at the time
(http://ajp.psychiatryonline.org/cgi/content/full/ajp;165/4/420 - a
critique of the second study). Other studies have shown a genetic link
with common SNPs but none had the size of this study. The conclusion I'm
going to make is environmental factors are far larger than genetic factors.

Is mental health the only field that suffers from publication bias?

The anwser to that is "no" in my opinion. I think many sciences may
suffer from the problem of publication bias, i.e. where negative results
or results that don't support the underlying point of the research. This
happens for many reasons and is a trait I've noticed in a lot of people
and a failing of mine too. The reasons this happens in research and in
organisations is as complex and yet as simple as the human problem. The
simplicity is it has the same reasons as why people lie. And it is as
equally complex.

Mental health has the saving grace of acknowledging it's existence. The
funnel plot is a clever technique where data from lots of studies is
mapped on a graph with sample size on one axis and effect size (or
whatever variable is being measured) is the other. The shape of the plot
should look like a funnel shape and any biases caused by witholding of
data shows up as a blank area in the plot usually found near the wide
end of the funnel. It works on a principle which might relate to
regression to the mean. Studies with a small sample size have larger
errors and these will fall either side of the mean. Larger studies will
be closer to the mean. So the smaller sized studies should have positive
and negative results either side of the average (represented by the
middle of the funnel or the sample size axis). If there's no publication
bias then the spread would be symmetrical either side of the mean. The
smaller studies can have results far away from the mean while the larger
studies will vary less and this creates the funnel shape.

A recent funnel plot from a meta-analysis of around 1000 psycholgoical
therapies studies that was published earlier this year in the British
Journal of Psychiatry showed that the effect size for these studies was
reduced by about a third because of the publication bias. A metanalysis
by Kirsch in 2007 publishing in PloS Medicine that included unpublished
data showed SSRI antidepressants to be as effective as placebo for all
but severe depression. There are other examples in psychiatric research.

Psychotherapy research doesn't have the same motivations for publication
bias, i.e. they are not motivated directly by profit. Professional
pride, enthusiasm for a new treatment, subjective validation skewing
perception of results and other reasons can influence researchers to not
publish results. These qualities are found in many other fields. I
wonder how often funnel plots and other techniques used to identify
other forms of bias are used in other disciplines?

A large percentage of the completed suicides in women in the UK are by people with a diagnosis of schizophrenia

About 20% of a the direct victims of suicide in the UK are by people

with a diagnosis of schizophrenia. About 50% of the suicides are from
men and 35% from women (don't know what happened to the other 15% - it
can't be that hard to record gender after a suicide).(Mortensen and Juel
(1993) cited in http://pb.rcpsych.org/cgi/content/full/25/2/46). There
are several other sources that note the considerably higher risk of
completed suicide of women with a diagnosis of schizophrenia compared to
the national average for women. The ration for the whole population is
something like 75% of completed suicides are men.

It has been noted that the higher rate in the general population is
because men choose more violent or effective methods. I'm not 100% sure
this is true.

If the effectiveness of choice of method for suicide was a general
gender constant then it would show in schizophrenia suicides by gender
data. It does and it doesn't. There's clearly other factors in
successful suicide other than choice of method. I am not considering
data on suicide attempts.

I don't know enough about the suicides to make a conclusion.

How many people own good cameras just to say they have good cameras?

The UK needs a Mental Health Act (ramble)

At the moment it just has a mental illness or mental disorder act.
That's what the MHA 1983 is all about.

The dual continua model of mental health is little known yet the
movement that brought about this understanding has been going for over a
century. Disorder was the old understanding of mental health and mental
illness.

2009 saw the term "wellbeing" been bandied about. It means as many
different things to different people as the term positive mental health.
Perhaps what I really should say is "The UK needs a Wellbeing Act."

It'd be something like the Human Rights Act in that it would define the
rights of humans ideologically and (sadly) practically.

The US has bits in it's core legislation like "everyone has the right to
the pursuit of their own happiness as long as it doesn't interfere with
the pursuit of another person's happiness". I am unaware of any such
ideal in UK law. In practice I doubt it would make much difference but
that's the same of many laws.

I'm also not sure that the UK in 2010 doesn't have the same ideological
purity in the senior echelons of government that the forefathers of
modern America had after the end of the civil war.

War is one of mankind's (I'm afraid most of the time it's men who start
and end wars....) sickest activities however afterwards - at least WWII
and the American War of Independence - there is a time of positivity and
idealism (in my opinion). After WWII the NHS was created. War is one of
the most effective ways to make the populous realise what is valuable.
The world is thankfully free of the huge military wars of the 20th
century. Nuclear weapons (and other more advanced weapons of mass
destruction) and the policy of Mutually Assured Destruction have
engendered a world peace that may last longer than Pax Romana.

It takes idealism to write a piece of legislation that ensures the
rights that should guaranteed. The Human Rights Act isn't idealistic
enough but it was a significant step forward in progress. It
bootstrapped the countries that uphold into the future of a better
society and civilisation.

Wellbeing and the ideas that came with it at national policy level (e.g.
Lord Layard's stuff on economic theory and happiness) was a step
forward. The utilitarianism and idealism make strange bed fellows,
however there are many odd coalitions going on in the UK at the moment.
Could it be possible to see a Wellbeing Act that enshrines our right to
the pursuit of well being and happiness in the next decade? I hope so,
but in all fairness I think a Mental Ilness and Human Rights Act may be
more important in my opinion. I'm not sure.

Rule 1 of living with psychosis (notes)

1. Survive and thrive
This is a useful idea. Surivival is all that's possible at times and
remembering to survive during those periods of hopelessness is vital.
Knowing when it's possible to thrive is possibly an art in itself. It's
always important to remember that thriving (an subjective thing) is
always possible. If the vision of mental healthcare in the UK is
realised in practice then the hope of the opportunity to thrive is
realistic for all people. For the moment it is a hope that is still
available to anyone who's willing to keep fighting for it. It is easier
to give up than face that struggle, but the facing the struggle is more
important - at least to me. The struggle - in whatever form - may be the
best treatment for suicide in my opinion and personal experience.
Accepting the shitness of everything and still facing the world just
like anyone else does when all you want to do is kill yourself is, in my
opinion, one of the most amazing things a human being can do.

The zeroth law - the one that preceeds everything (and an idea taken for
Asimov's later books in the robots series) - is don't kill yourself.
I totally understand if you do it though. It's no crime to exit and it's
certainly a rational choice. If other people knew the pain they would
understand. See Rule 1 though.

0.1 law
Make sure you leave a note. It's your last communication, your last
opportunity to speak to the world and it's an opportunity to make sure
that whatever brought you to take your life doesn't happen to anyone
else ever again so be honest and open when you write that note. If
you've got the time take the time to make sure the note is everything
you want it to be.

0.2 law - the patronising or pointless law
Talk to someone even though you've made the decision to end your life.

0.3 law - the other pointless law
Go through all the alternatives

Imagine if there was a punishment for emotions

A person with bipolar disorder could be consider to be unable to control
their emotional swings. They could be considered to have two large an
emotional range, or that that they are unable to handle that emotional
range. If a parallel universe they could be punished by having their
emotions or their full range of emotions taken away. Imagine if there
was a way to take that away.

It would be a terrible thing to strip a person of their emotions. For
some people it would be the sort of punishment that would be worse than
death. Imagine a passionate person with their passion removed or a
spontaneous fun lover reduced to a robotic peon. Imagine this parallel
world where this was possible and the fear that the people would live under.

If a person is mad in the woods but no one sees them are they still mad?

This is a play on the "if a tree falls in the woods and no one hears it
does it make a sound?" or some sort of philosophical question I'm too
lazy to try and answer at this present time.

Why I believe there may be an alternative to hospitalisation and medication for psychosis

I can always look back to the days when I thought my life was controlled
by an unseen, noncorporeal entity or force and it's useful to remember.
I can't remember the pain itself but I have the impression of the agony
that no one could understand. I was in pain and I was being controlled
by this force. I had a feeling of totally powerless as even my volition
itself was controlled. My thoughts, my actions, my behvaiours, my
everything inside and outside my skin was controllable by this force or
entity. I couldn't talk to anyone about it while I went through it for
fear of what medical services would do to me, and there were times where
they were part of the delusion and the terror.

If you know that place then you'll understand why anyone would want to
die. This part of psychosis is torture. Peace was all I wanted.

I managed to make it to my job during this period though had a high
number of sick days and was working far below my capability. I fought
the disturbing thoughts and forces to get to work. I'd have to fight an
internal battle with a mix of realities and a psyche that was
continually being hammered by influences and thoughts and impressions.
There were times when my colleagues were part of the delusion and where
I thought they were causing it. My computer would 'talk' to me (certain
words or parts of words would be highlighted as I read them to give
meaning outside the information given or the sense of the words would
feel like they were all about me when they weren't). Unusual events had
high significance. It got to the point where I couldn't understand what
people were saying because the communication or influence of the other
consciousness overpowered my capability to grip on to the old reality
that I had to use to function. All I could do was withdraw at that time
to minimise damage from spurious or aggressive behaviour. There was also
a feeling like I wasn't in control of my behaviour but I suffered the
consequences, like "I" was a passenger without control of my mind, body
or actions at times.

I still feel the power of this force but I am powerless. It does not
make me suffer like in those days. We are at a strange peace and have
been for a long time. During that period of intense unshared perceptions
and a shifted state of consciousness all I wanted was to die. The
overwhelming suffering and intense ...rending asunder of ego and reality
and trust and everything that I'd know was true...is a pain I still
don't have the ability to communicate.

The worst part was that I couldn't bring myself to kill myself. I tried
in different ways. I used it as a way to fight for control over this
other consciousness or force. It took everything from me. More than
other people lose when they go through a life crisis. "I" was me.

I think if I'd seen mental health services I'd have been sectioned,
drugged up and given a diagnosis of schizophrenia. Instead I went to
work and survived the intense distress in my spare time.

A thought on a step before ECT

This sounds really dumb or makes a lot of senses.

ECT is an electrically-induced seizure as far as I am aware. It is an
insane treatment in an insane world.

There's a placebo effect seen in ECT trails. Why not, before using real
ECT, enter each patient into a trial and give them placebo ECT under
trial conditions (to replicate the environment that produced the placebo
ECT effect in some people).

This zany idea could work. But...there's the nocebo effect - the
negative placebo effect. I'm not sure if the same side effects seen in
ECT were seen in the placebo group who responded to treatment.

Fwd: What has happened for physical disabilities that hasn't happened for mental ones, yet

A person who can not walk is seriously disabled in a society designed
for people who can.

Wheelchairs and ramps and lifts. These were the solutions. Public
buildings and workplaces need ramps and lifts because buildings are
built for everyone. Inventors even make all-terrain wheelchairs so
stairs are no longer a problem.

A person who can not walk is not as seriously disabled because society
made a choice to make its physical structures for everyone. Abled and
disabled people can live and work side by side.

A person who is disabled by society for being mentally ill must use the
Disability Discrimination Act to create those ramps and lifts. Society
is yet to put in place the ramps and lifts in public organisations and
workplaces. Even with the DDA society has not yet reached the point
where mentally abled and disabled people can live side by side.

What will the future bring? What will a society and work environment
designed for all of humanity be like?

The journey

Sometimes there are parts of life's journey that must be done alone.
It's hard but it's part of life. It is also dangerous because isolation
can bring a person closer to the edge. I think that is all part of the
process and the journey, and in my life it's worth the risk.

The journey has gotten cold and rainy. I have endured this before.
Others couldn't, wouldn't and shouldn't. Not alone. Experience has
taught me there is always a light even in the blackest night. And I can
stumble through the darkness alone.

An inspirational poem by Rudyard Kipling

A friend showed me this poem a few years ago and for some reason I
wanted to read it recently.

http://www.kipling.org.uk/poems_if.htm

It's called "If".

IF you can keep your head when all about you
Are losing theirs and blaming it on you,
If you can trust yourself when all men doubt you,
But make allowance for their doubting too;
If you can wait and not be tired by waiting,
Or being lied about, don't deal in lies,
Or being hated, don't give way to hating,
And yet don't look too good, nor talk too wise:
If you can dream - and not make dreams your master;
If you can think - and not make thoughts your aim;
If you can meet with Triumph and Disaster
And treat those two impostors just the same;
If you can bear to hear the truth you've spoken
Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to, broken,
And stoop and build 'em up with worn-out tools:

If you can make one heap of all your winnings
And risk it on one turn of pitch-and-toss,
And lose, and start again at your beginnings
And never breathe a word about your loss;
If you can force your heart and nerve and sinew
To serve your turn long after they are gone,
And so hold on when there is nothing in you
Except the Will which says to them: 'Hold on!'

If you can talk with crowds and keep your virtue,
' Or walk with Kings - nor lose the common touch,
if neither foes nor loving friends can hurt you,
If all men count with you, but none too much;
If you can fill the unforgiving minute
With sixty seconds' worth of distance run,
Yours is the Earth and everything that's in it,
And - which is more - you'll be a Man, my son!

Just

This was the word in my head when I looked at this image.

Canon EOS 50D and Canon 50mm f1.8
ISO320 f4 6s

"Population-based studies have attempted to estimate the prevalence of hallucinatory experiences in adults and have found the lifetime prevalence to be 8-15%"

From the introduction of
http://bjp.rcpsych.org/cgi/content/full/180/2/174
Occurrence of hallucinatory experiences in a community sample and ethnic
variations
The British Journal of Psychiatry (2002) 180: 174-178
Johns, L. et al.

It references these two papers
Sidgewick, H., Johnson, A., Myers, F.W.H., et al (1894) Report of the
census of hallucinations. Proceedings of the Society for Psychical
Research, 26, 259-394.

Tien, A. Y. (1991) Distributions of hallucinations in the population.
Social Psychiatry and Psychiatric Epidemiology, 26, 287-292.

would Jung have gotten a diagnosis of psychosis risk syndrome?

From what this article says he would.
http://www.psychologytoday.com/blog/side-effects/201005/carl-jungs-frightening-demons

I wonder upon reading that information how people would consider that
Jung might have schizophrenia?

Human and nature

This is a sad image.

I deliberately underprinted it to give the darkness I saw in the plastic
bag in the pond.

Canon EOS 50D and Canon 50mm f1.8

Hung like a chihuahua or men's secret shame

I've been considering this a bit but haven't reached a conclusion. My own experience of having a small knob is one of anxiety that induces lack of pscyhosexual maturity. Basically I was really, really really inadequate because of my small penis. It was an embarrassment or a shame I just couldn't get over and still to this day I feel inadequate because of it. That's probably why I have such big lenses on my cameras.... Of course there's nothing wrong with a small penis....except the look on a woman's face. A small penis can make a man feel small. It's hard to get over given the whole...well....it was probably Freud who went on about stuff like this. I'm probably lucky I overcompensate with big lenses. But it's always been hard to get over the inner stuff about how inadequate it feels as a man to have a small penis. Men hide this pain without exception. It is a shame that is far beyond the masculine paradigm. It is unpseakable. My evidence is that I'm probably one of the handful of people who can be open about what that sort of man pain feels like. I have the advantage of lived experience too. And so I learned to compensate. I believe the metaphor expressed by the vernacular is "it ain't the size of your boat it's the motion of your ocean" or something like that. Essentially, and much thanks to prolific research in porn, I tried to learn how to make a woman climax. I'd heard from an influential person in my life many years ago when I worked in call centre that a way to a woman's heart was the simple explanation that I could make them climax. I haven't read the study on that and I'm not sure about the lived experience. It's hard to be so resilient to the negative feelings about my inadequacy. It's not helped by the "tells" or the signs that people find hard to hold back that tell the truth of their emotional response. This is a silent shame. This is not recognised in a society where a man going, "small tits love. I'd rather eat an omelette", would be vilified but that look from a woman can be just as withering. It is so much worse because it is a hidden shame not talked about at all and rarely recognised. Porn has an effect on this just as marketing does. Porn itself...well...have you ever seen Monsters of Cock. Men with small penises who watch porn often see professional porn stars who have huge penises. It's like the problem of size zero models. They also get adverts for penis enlargement and Viagra to solve the problem of inadequacy that's created by the porn industry, just like anorexia and the fashion advertising industry. The diversity of the portrayal of women in porn is actually pretty damn big. Anything can be catered for. I've even have the pleasure of watching psychiatric porn which featured one of the world's top porn stars. I'm glad the antistigma message is getting out to lots of lonely boys. Anyway, I'm hung like a Chihuahua ....and I'm not proud. I think there are many, many other men who would also not usually talk about it. Films like 40-year old virgin have helped a bit but never raised the idea of penis size anxiety.

Self-hate and progress

I'm a failure in mental health campaigning. It doesn't matter. I can
keep fighting. I can keep fighting for something I believed in and I will.

Mental health as a definition has changed and evolved. It will continue
to change and evolve. I hope the input of the Bhutanese will be part of
that change.

It can mean social control. It can mean political control. It can mean
forcing norms of behaviour on people. It can be a sort of pre-crime
system where the innocent are made out as guilty.

The important change is the change to understand mental illness as
distress rather than disorder. It is to understand that it is human
beings that are being judged, and that human beings are fallible and
complex.

Sadly or thankfully I rarely take this mentality on board myself.
Internally I am highly self-stigmatic and I need to be because without
it I would be more of a failure.

In the last 6 months I have totally failed in what and who I am.

I can accept my failure rationally or I can take the self-criticism on
board. I can do better. I will do better. It may take some self-hate to
do it.

If someone else lived my life they might, perhaps, be ecstatically
happy. That's probably another bad thing about me.

Some might say that's because my standards are different. Others might
say that my values and measures are different. Still others would say I
have complex depression that they'd like to unpick.

The high standards drive me like they drive my siblings. We are unhappy
because of it but it doesn't matter to us. I have a cousin my age. She's
Oxford educated. When she graduated she turned down a £75,000 graduate
job to be a doctor. She has a posh flat in a nice area. She has a
private pilot's license which, I assume, she uses to get away from the
world the same way I do through my....'flying'. Ask her if she's happy
and she'll tell most people that she is. She has the burden of the
hedonic treadmill to cope with as well as the burden of the high
expectations (98% - what the hell happened to the other 2%). It's why
I'm lucky to have been through crisis so severe as to be called a
psychiatric crisis. It's why I'm luck to be mentally ill.

Anyway, I have lost my way in my path over the last six months. I have
been weak and a pitiful husk of the man I was. It wasn't much before but
it was more than I am now.

I sold out and in too many ways. No longer will my failure stand. I'll
fix this. Failure is a human thing just as self-criticism is.

Should I answer yes or no to the question of disability?

I think on the current social model yes but in truth the question, if it
were to be legally accurate in my opinion, is that society is
maladapted. It is the same for all disabled people. They are made
disabled by society.

On other paradigms it may not be so easy. The DDA which is the current
law goes on about impairments. I'm sure I've got tons of those. So what.
I've got other things that make me useful. I may not be where I should
be in life and part of that is through mental health crisis and mental
healthcare and me. Some of the things that have made me have poorer
outcomes than my peers are my decisions after crisis. Many of the people
I know haven't had a psychiatric crisis and many have much more
opportunities in life however my education and upbringing compensate for
those to a degree.

It is my wholehearted believe that I and no one else is disabled. 100%
of humanity, even the unwanted people, are humanity.

Failure of the people to understand this is another reason why mental
illness is a necessary construct however if I am to be truthful it
doesn't exist. In my opinion.

Just a small bit about my life

A couple of weeks ago I had one of my bad nights.

There are bits from that evening I don't want to remember or recount.

At some point that night I lost my mind. My memory is blurred. I
remember taking a bunch of flowers from the site where someone had been
killed there a week or two before. I am ashamed and I don't know why I
did it. I don't know what possessed me. I've never done that before. I
was incredibly drunk and in a bad state too. It's not excuse from taking
flowers from a dead person. Hate me if you want.

Somehow I managed to get a night bus but got the wrong one going the
wrong way.

I remember falling asleep at some on the road outside someone's house
near a car park near a Sainsburys somewhere south of the Thames. After a
long series of events I ended up walking home. I walked past Westminster
and Trafalgar Square, through Holborn and through the back streets of
Angel and Islington till I got to Finsbury Park where this misadventure
had started. I walked around the area for a bit before I decided to skip
on a train home.

I'd spilled stout on a white top the night before. It look a bit like
dried blood. In all that journey through London with what looked like
dried blood on my top - visible to anyone who walked past me - only 1
person asked me if I was ok. I was very lucky as well that someone
dropped a bottle of water near one of the offices of St Mungo's. I
needed the water and I needed the reminder of the suffering of the
homeless drunks and vagrants.

I don't know why I took that dead person's flowers.

How desperate are people to assign a label?

I'm not sure if this is about sexuality or mental health.

In mental health professionals and the public would give different
diagnoses. In sexuality I would have the same problem.

If the question if of love then, in the main, I love women. In the not
so main I can love men too. My definition of "love" is complex as complex as anyone's.

Sex? I'm autosexual with 100% heterosexual (biologically) material.

The "(biological)" is about an alternative view of gender, a psychological one.

At some point I may get over my prejudices and kiss or have sex with a guy. At the moment I have enough problems to get over with heterosexual sex.

A lot of people assume I'm gay because of how I am. I'm comfortable around gay men and women. I've got no problem with flirting with members of either sex. I'm not too worried about people thinking I'm a bit girly.

So it's understable why someone might be confused.

There's a concept in medicine called hermenuetics. It's one I'm coming across. It's about how people make a correct diagnosis.

If it's got four legs, hooves and a tail is it a horse? 66% of four legged animals with hooves and tails are horses in my experience.

Software for reducing the suicide rate

There is a piece advanced software that was investigated by a friend of

mine when I worked at a local council. The purpose was to help solve one
of the problem's of the Victoria Climbe case. There were reports of the
suffering of this child but they went to different agencies and I think
in different boroughs as well. If the information had come into a
central source the she would have been helped. Information systems in
local government are appaulling and the idea of connecting them up is a
decade away.

The software they selected was called Autonomy if I remember right. It's
an exceptionally interesting and powerful piece of software. If people
knew about this commercially available software they'd be pretty
paranoid about privacy. Autonomy had many purposes but it was being
investigated for it's ability to connect with all sorts of data then get
the information out to the people who needed it. It could connect with
all sorts of electronic information systems including email. It could
also understand voice information so could understand conversations and
voicemail messages. It could even translate from 30 different languages.
Any form of data could be understood by this system then anything
relevant could be sent to appropriate groups of people.

The software could have helped in the Victoria Climbe case through this
hypothetical series of events. A neighbour hears a child being beaten so
leaves a message on the phone of the local children's services system.
The kid's teacher notices the child has been withdrawn and emails a
colleague. A doctor makes notes on an electronic system that there are
unusual scars on the child but the cause is unknown. Individually these
three events wouldn't flag up on the children's social care system and
the child wouldn't be put on the Special Protection Register. With
Autonomy in place these events would be picked up and would trigger an
email contain the 3 events to the local SPR administrator, a manager and
a senior social worker or whatever. The software would work within the
constraints of the poor information systems and ensure the child was
safe. It was the hope that it would have saved Victoria Climbe's life
and many others.

Automony could be used for suicide prevention and perhaps even homicide
prevention. This application would be far harder because of the
considerably larger dataset and the need for access to what would
ordinarily be considered confidential data, for example personal email,
phone and other communication. A lot more people experience suicidal
thoughts too - 1 in 6 in a lifetime according to the UK's Adult
Psychiatric Morbidity Survey 2009 - but computational power is
relatively cheap now with distributed processing systems like what are
used by Google or cloud computing from Arjuna.

Autonomy is a commerically available bit of software primarily purchased
by media and information organisations with large budgets. I think the
software costs £150,000. I was told it was too expensive for children's
services at the time. It's pretty damn cheap if it can save 1 life a year.

I would guess that there is more advanced software today in the commerical sector. Military technology would also be a generation or two ahead of what's available commercially. The number of people who have died from terrorist attacks is significantly lower than the number of people who have died over the last few years from suicide.

Of course this is totally screwed by people's rights to privacy and human rights and stuff like that. I suspect that, just like terrorism, those would be ignored.

http://www.autonomy.com/
http://www.arjuna.com/
http://www.ic.nhs.uk/pubs/psychiatricmorbidity07

Delusional and psychosis and paranoia suicide

This is another type of suicide. I think it can fit in the category of
planned or spontaneous suicide though at a guess it happens more often
spontaneously.

I would guess that the neurobiology of a delusional suicide, in general,
would be different to that of suicide from depression.

What am I talking about? Well imagine you discovered that you were under
the control of another force or being, that your thoughts weren't your
own, that people could read your mind, take your thoughts, that the
world was influenced by an unknown force or entity. These thoughts,
feelings, beliefs or impressions weren't something you'd worked out or
read about: it was just what your senses and reality told you.

Initial onset of that experience of life or consciousness is probably
also described by the terms first episode psychosis or the startling
phase of psychosis/hearing voices. It is my opinion that this experience
is the most extreme form of suffering on the mental health distress
contiunuum. It is not surprising that people want to kill themselves
upon experiencing this in the psychiatric system and being told that
their brain is malfunctioning. It is also at the extreme of the mental
health disorder continum and the self-stigma of that is another hell to
compound the other distress.

The intense early onset period can last different lengths of time with
different people. From personal experience the suicide risk during this
early onset period is exceptionally high. It can also difficult to
engage with the person about their delusion because trust in people and
relationships breaks down just as trust in reality disintegrates. I
would guess this is why hospitalisation or use of the chemical cosh is
necessary however experimental and progressive treatment programmes for
first episode psychosis in countries outside the UK have shown there is
a hope to treat without standard doses of medication and incarceration.

There is then the problem of suicide from a long life of psychiatric
treatment for and the experience of psychosis or schizophrenia (with or
without treatment). This can come in many forms. This may be more akin
to depression-type suicide.

Notes on where I am with the clozapine thing

After two trials of antipsychotics clozapine can be tried. It is a broad spectrum antipsychotic working on a range of neurotransmitter sites. It's intended and theorised action is on D-receptors. I would guess that a broad spectrum medication would also affect other areas of the body and brain. There is the problem of agranulocytosis and the risk of his has been reduced by haemotological monitoring. If levels of granulocytes and other immune system cells drops too low the clozapine is stopped and they shouldn't be put on it again. It is highly valued by the psychiatric profession because it treats when nothing else will and has the most potent effect of the suicide rate. Its use is also widening.

When the manufacturers introduced it they didn't know about the damage it could do to the body's immune system and there were a few fatalities. They voluntarily withdrew it however because of its capability to treat schizophrenia it was reintroduced. Even with the blood level monitoring there have been deaths attributed to clozapine-induced agranulocytosis and the secondary infections. I can't remember if the blood level monitoring covers clozapine-induced neuropenia (a milder version of agranulocytosis from what I understand) however this is still a condition that reduces the body's immuno-response so any infection has more chance of harming the body. There is a hypothetical possibility that granulocyte levels can drop precipitously between the periodical blood level checks and this is a risk factor.

Clozapine doesn't reduce the suicide rate through the same neurobiological pathways as have been studied for depression. I haven't found suitable qualtitive research into the experience of taking clozapine. I can make an educated guess that it is through the induction of apathy, avolition or a sort of stoned haze. In the research into experiences by the manufacturers it was mentioned that it does have an effect of dulling psychosis.

Agranulocytosis is not the only condition caused by clozapine. There is a long list. There is evidence that many people may be dying much earlier than they should though on average the reduction in completed suicides means it will continue to be used.

Based on the current psychiatric understanding of severe mental illness (which is changing to be a more socially-orientated model) there is no alternative to clozapine. There is no alternative to antipsychotic medication.

Research into alternatives happens in the fringes of mental health. The research into alternatives isn't generally accepted in mainstream psychiatry. New journals like Psychosis are publishing studies on alternative approaches. However the studies used by NICE and are part of their evidence reviews are mainstream psychiatry.

There are few if any alternatives to hospitalisation and/or antipsychotic medication for psychosis and schizophrenia in the UK though early intervention services that were part of the New Horizons strategy may be a step forward in this area.

High doses of quetapine may, perhaps, be an alternative before clozapine use because it is the same type of chemical however my neurochemistry knowledge is virtually non-existant.

I know there's an alternative to pharmcotherapy or at least a way to get people off clozapine and onto a safer antipsychotic. My belief is that there is a solution such that the maximum number of people can be taken off clozapine and the least number of people put on it.

-- treating the suicide rate is important and also very difficult. More research into that.
-- there are other factors in the action of antipsychotics beyond the chemical cosh element however there are also non-pharmocological ways to achieve some of the gains of antipsychotics, for example by brain training to try and overcome the cognitive deficits and keep the brain sharp
-- I need the figures on mortality
-- there's little chance but I want to try clozapine
-- I need to find a high quality qualitiative study - perhaps someone's done one in America?
-- I need to understand more about what people really go through because that's where the solution will come from
-- I need a good, long list of things that work for some people with schizophrenia and psychosis
-- I need to keep thinking outside the box because this is a really difficult problem to solve
-- if it is the action as chemical cosh which is why clozapine is effective then...I'm not sure what to do.

Quotes as therapy

http://www.brainyquote.com/

Start there. Let yourself choose which topic area from the left hand
column or author type from the middle. Let your heart choose, not your
brain.

I find quotes inspirational. I find they can bring a smile, a tear or a
deep thought. They can even trigger life change. The right quote at the
right time can make a difference. It has to my life.

They are also a condensed and highly communicable form of intelligence.

"I love quotations because it is a joy to find thoughts one might have,
beautifully expressed with much authority by someone recognized wiser
than oneself."
Marlene Dietrich

Depression or intense misery?

or intense unhappiness? Or soul pain? Or psychache?

The Cumbrian who needed help

I've just heard about the tragedy in Cumbria.
http://www.telegraph.co.uk/news/uknews/crime/7799167/Cumbria-gunman-profile-of-Derrick-Bird.html

A man who went on a killing spree is being described as a mass murderer.
He had no pre-existing diagnosis and probably won't have got one unless
the mental health practitioner was very ,very, very good.

It seems no one has compassion for him, at least reading the news
reports from shortly after the incident.

What ever happened to him that night, whatever he'd been going through
must have been an internal hell. Some people externalise that hell.
Others kill themselves.

Like suicide there are always victims of murder. My heart bleeds for
them too.

I don't know enough about the story yet but I'm sure many people would
consider that he'd be alright if he had gotten it off his chest somehow,
whatever it was that was troubling him so.

I know that feeling of snapping. I've been there. It's lucky that the
worst thing I do is try to kill myself.

Two articles about the diagnosis of schizophrenia is racist

http://www.theroot.com/views/schizophrenia-political-weapon?page=0,0

http://www.psychologytoday.com/blog/side-effects/201005/how-schizophrenia-became-black-disease-interview-jonathan-metzl

It's yet another example of the use of mental illness as a device of
social control.

I'm sure other people have observed how the psychiatric system has been
used as a form of political control. Bentall notes that people would be
given a diagnosis of schizophrenia for being capitalist or anti-party
line in Russia. I wonder if the Soviet psychiatric were better than the
gulags where Alexandar Solsernichen wrote his book. I think socialists
may have gotten a similar diagnosis in the West. There are stories of
people being put in asylums by the French for being Libertines.

There is an interplay between social and cultural norms and mental
illness. The overdiagnosis rates (of schizophrenia in black men) in the
UK are even higher than the overdiagnosis rates in the US.

But there's a tragedy here. A real human tragedy. The asylum or social
prison the author in the article wrote about would have been a terrible
place. I'm not sure a prison in those days would be worse than an asylum.

There's a relevance to the modern day. Treatment with antipsychotic
medication for anything isn't a pleasant experience. They take away too
much. It's not just the reduced life expectancy. It's the reduced human
quality of life lived. They are shackles and straightjackets for the
mind. People who choose to take them to relieve the distress of unusual
states of mind or consciousness willingly and knowingly accept the cost.
To do that because a person is 'socially ugly' or undesirable
politically is immoral however in practice we live in a racist society
with racist mental health professional (in practice, though not in
intention).

Last words on the etymology of schizophrenia.

From
http://www.psychologytoday.com/blog/side-effects/201005/how-schizophrenia-became-black-disease-interview-jonathan-metzl?page=2

"
And in 1911, Swiss psychiatrist Paul Eugen Bleuler argued that the
underlying mechanism in praecox was a "loosening of associations," a
process in which patients existed in the real world and at the same time
turned away from reality ("autism") into the world of fantasy, wishes,
fears, and symbols.

As an early proponent of Freudianism, Bleuler placed psychosis on a
spectrum with neurosis as a developmental disorder with childhood
origins. He maintained that the term dementia praecox should be replaced
by a name that combined the Greek words for split (schizo) and mind
(phrene). "I call dementia praecox 'schizophrenia,' " he wrote, "because
the 'splitting' of the different psychic functions is one of its most
important characteristics."
"

A quote about schizophrenia and humanity

“There is a schizophrenia, as the psychologists or the psychiatrists would call it, going on within all of us. And there are times that all of us know somehow that there is a Mr. Hyde and a Dr. Jekyll in us….There’s a tension at the heart of human nature. And whenever we set out to dream our dreams and to build our temples, we must be honest enough to recognize it….”

—Dr. Martin Luther King Jr

From
http://www.theroot.com/views/schizophrenia-political-weapon?page=0,0

Morality, harm reduction and legalisation

There are two things that should be legalised: drugs and prostitution.

Legalisation of drugs brings them under the complete control of the
state. Quality control ensures users are safe. Information can be
provided. There could even be a license which can be revoked. Research
can be conducted which has benefits for physical and mental health.
Designer drugs could be created which are safe and people can be taught
how to take drugs safely.

There are more dead drug users because it is illegal. There is more harm
because it is illegal. It is a highly profitable industry and the people
want drugs. They have wanted drugs since the first person worked out
that if they ate enough rotten apples they felt better for a while.

The story of Belle du Jour is an example of how it could be but for most
prostitutes I imagine it's a terrible life. Some prostitutes are slaves.
They have been brought to the UK with the promise of money which they
probably send back to their family (in Thailand prostitution is
culturally acceptable and the girls are respected for going out and
earning a living). Their passports may be taken away. They may not be
able to leave the premises. They may be forced into doing things they
don't want to do. They run the risk of sexually transmitted disease.
They also run the risk of being murdered. The risks and the harm can be
significantly reduced by legalisation.

Essentially take drugs and prostitution out of the unregulated hands of
crime and make it safer for everyone.

How much childhood trauma does everyone go through?

Childhood trauma is seen in a high percentage of people who have the
experience.

But doesn't everyone go through crap in their childhood? Doesn't
everyone get beaten or verbally abused at some point? Don't all parents
at some point get drunk and take out their aggression on their child in
one way or another?

Thoughts on mass murderers

Mass murders are probably the most vilified people in society.

I don't know much about the evidence base but I would guess that a lot
of them would have had a bad childhood. They are a product of their
environment and upbringing.

I think the crime of mass murder is the worst thing a person can do. I
also think a mass murderer deserves compassion however in practice I
wouldn't know how I would react if the reality ever hit me. I've never
been affected by murder. Could I forgive the murderer of my child by
understanding that they are a product of life just as I am a product of
life?

I'll make no attempt to see the positive in murder.

The public, in general, have no compassion for mass murderer even if
they have a mental health condition.

Buckminster Fuller, suicide and spirituality

For anyone who's not up with what's going on in material science one of
the most exciting developments in the 20th century was carbon 60 or
Bucky Balls.

There was a chemist called Buckminster and he came up with the
theoretical possibility of a round carbon molecule which was
eponymously entitled. I can't remember if he made it or not.

This was a leap for molecular chemsity and the technology is bringing about significant advances in other areas, for
example through the development of carbon nanotubes. The application of Buckminster's advance will be seen in area from computing to cars over this century.

In his younger years he contemplated suicide. There's a story (I read in
a book about buddhism but can't remember the title and which I'm afraid
I'm butchering in the retelling) about him walking to the edge of a lake
ready to kill himself.

Anyone who's been to that place - the edge of the lake, the moment
before you swallow the pills, the edge of the cliff - knows how special
that time is and how intensely significant the moments before a planned suicide are.

He stepped away from the edge of the lake but the experience changed
him. He decided to give his life to his science.

He also came up with a concept I rather like. He considered the universe
his employer. I just love that thought.

Whatever happened to him at the lake changed his life. He clearly found
a spiritual answer to suicide and he found a similar way to survive life. The concept of the universe as our employer is quasi-religious.

I wonder if he found it as hard as I have to keep the faith.

What would you do if you died yesterday?

I remember something I wrote a while back during a suicidal period.

There's a positive motivational phrase "live every day like it's your last" but perhaps it could be written "live every day as if you died yesterday."

It puts more onus on the value of the days you have left.

Many people forget what life is and what it means, or what it can mean.

I think this thought also helps with suicidal feelings. If the answer is "I wouldn't care" or "nothing" then I'm terribly sorry. I don't know what life has done to make you unable to answer that question. It's never too late to seek the answer for yourself and there's probably no better question to have an answer for. It's one that's worth searching for if you haven't got it yet.

Rules of psychosis

This is something I'm thinking of after reading the paper about Schenidan.

I've got 3 at the moment and they're caveated by something
important: I'm a hypocrite. Anyone who knows me will understand what I mean.

Rule 1
Never go through it alone. It may be hard but you just do it.

Rule 2
Never let anyone else go through it alone. It may be hard but you just
do it.

Rule 3
Never kill youirself no matter how mad the world becomes and never, ever, ever thinking of harming anyone else. It may all be a delusion and it may be real but no one needs to die over it.

The most expensive photograph ever

The image is called 99 Cent II Diptychon and was taken by Andreas Gurksy.

It doesn't look like anything special does it.

Image taken from
http://www.artnet.com/Artists/LotDetailPage.aspx?lot_id=0275C0FAFAC63235FA492B86E31AD105

Another rule for psychosis

No matter what, no matter how mad it all becomes, never, ever kill yourself.

Hot beverages, performance in the workplace and solutions from research

I'm just thiniing about an imaginary study. Tea and coffee consumption
compared with performance in an organisation. A number of organisations
could have their use of hot beverages measured and the results averaged.
Some funky statistical analysis can be done and in the hypothetical
study it was shown the performance was higher where more tea or coffee
was drunk.

Another hypothetical study comes along and redoes the trial but adds the
option of hot chocolate as another cohort. The results in this study
show that hot chocolate is just as effective at improving performance.

How to interpret the results though? Should there be more hot beverages
provided at desks, for example should the tea lady be reintroduced?

I think the obvious interpretation is that it wasn't the drinks. The
factors are socialisation and the positives for a community feel to a
workplace. There's the "5 minute meeting" or "water cooler meeting"
where people share information or bounce ideas off each other. It's the
simple act of taking a break from the screen or whatever else a person
is doing to go make a beverage that improves performance (there's a
study somewhere that may have been replicated by Monty Python that shows
that on average people can hold concentrate well for about 40-50 mins).
(Of course workplaces with high levels of social cohesion and good team
interaction would do rounds of hot beverages and this would increase the
number of hot beverages consumed which may affect the results)

Were this true the solution wouldn't be to reintroduce the tea lady.
That would not gain the benefits because the mechanism of how hot
beverages make. Further studies would need to be done to establish the
precise mechanisms in the association between hot beverages and
performance. Only then can an effective solution be developed that works
on average.

Of course the research couldn't stop there. Organisation size, sector,
organisational type, hierachicalness, etc would all need to researched.

Hmm. This is a crap post.

Suicide, what I know about the neurobiology of and the action of clozapine

Somewhere in an article by John Mann entitled "The neurobiology of
suicide" he mentions stuff about the sereotnin receptors being
'abnormal' or different. The neurobiological solution would be to change
the neurotransmitter levels artifically to compensate and this would be
done using an SSRI.

Clozapine has a totally different action I think. It may work on the
serotonin pathways as well but it's primary action is as a broad
spectrum thing that works on dopamine. I'll probably have to look for a
paper on the neurobiology of suicide in schizophrenia however I suspect
that, based on the biomedical model, all information about suicide would
point to quasi-depressive symptoms (or misery or unhappiness or
pscyhache or soul pain) or, perhaps, to reckless suicides.

Also, I think there are two types of suicide (and there may be a
continuum between them or they may be discrete entities): planned
suicide and reckless suicide. In fact there are more

Argh! My stupidness, lack of knowledge and inability to put my words
down properly is frustrating. What I'm trying to answer or say or
whatever is this: is the action of clozapine not to make patients
'happier' or less depressed to treat the risk of suicide but to reduce
the risk of reckless suicide or perhaps just to induce apathy or
passivity and thereby 'treat'? It has anti-aggression properties and
this sounds great except that what it really means is that it's like a
chemical straightjacket for the mind.

I really, really want to try clozapine. I need to understand this from
the inside. I'm going to keep hunting through the research looking for
good qualitiatve data (and probably getting side tracked in whatever
study comes across my purview) but at the moment my efforts are leading
to less rather than more clarity on how clozapine works and how an
alternative can be found. I also need to understand exactly what it
feels like and no amount of words will ever teach more than personal
experience.

Exclusion at school

Just like the Great Confinement, the Special Edicational Needs system
removes those with complex learning needs from mainstream schools for
good reasons but the impact is that children never see the SEN kids.
They're unintentionally removed from mainstream society like what
happened to the mad when the asylum system was created.

I'm tired. The general gist of this is that exclusion creates more
problems down the road. If society is to be integrated then it has to
happen at every level. If people can't see and hang out with SEN or mad
or freakish or ugly people then those people will always be excluded.

The difference between the psychiatric and the politically correct movement's understanding of the meaning of mental illness and me just rambling on as I usually do

I've read a fair amount of material that would be read by psychiatrists,
psychologists and their ilk. I've also worked at a politically correct
mental health organisation, the kind of place where it's not amusing not
put up a poster saying "You don't have to be mad to work here but it helps."

The mentally ill aren't called mental ill at the place I used to work.
They're not even called people with mental health problems. There's a
special language there that goes a step beyond. It's excellent language
to use when interacting with the public and people who stigmatise mental
illness. It's also excellent language to use to sell an idea.

Psychiatrists and doctors may have a more profound understanding of
mental illness. A person is a schizophrenic or a manic depressive. It is
actually what a person is in the same way as a person can be described
by gender or by race. Those descriptions apply to the individual. The
descriptions are also as equally useless in that they tell little to
nothing about what the person is actually like.

One form of intepretation is very....amenable and sensitive to how a
person may feel to be described as mentally ill. However it is without
the understanding of what mentally illness actually means. I haven't
quite managed to sum up what it actually means but the psychiatric view
is very different to the politically correct, public and media-friendly
view.

Meaning and concepts are vitally important. Mental health is an
exceptionally complicated concept and deeply difficult to define in a
useful way. The public-friendly view of mental health and healthcare is
that it is compassionate and this is broadly true I think and the
psychiatric system is getting better and better. I think psychiatrists
are also aware of what else it is. It is a line drawn between what is
normal and what is not, and this is not a constant. It may also
unwittingly be a form of social control to make people normal and make
people fit in because society is maladapted to the full spectrum of
humanity, perhaps as a result of the Industrial Revolution which
required the creation of mindless automatons capable of repeatedly and
consistently doing the same thing day in and day out and the need for
people to be 'normal' so large collectives could work together.

The language a person wants to hear upon inital diagnosis is not "mad",
"mentally diseased", "mentally disordered" or even "mentally ill" and
this is true for many people who haven't gotten past their own self
stigma of mental illness, preferring instead to think of it as a
different concept that makes changing them into a 'normal' person much
easier. If the psychiatric system wasn't there to make people fit in and
be 'normal' then those people would be excluded and outcast. They would
be homeless, penniless and jobless because of the maladaption of society.

To record and research the effects of difference on life outcomes then
to offer support and 'treatment' to modify the person into something
that won't have those outcomes is compassionate. It is necessary. It is
a necessary evil in my opinion and the lesser of the evils would be to
remember that people can change and learn to accept each other and our
differences.

Will global warming make people mentally ill?

People have a shorter fuse when it's hot and humid and they're not used to it.

In a recent UK mental health policy consultation there was a whole bit about the potential effects of climate change on the nation's mental health. I have to admit I had a bit of a giggle but upon reflection now I wonder if it's something worth considering.

A quick google later
http://www.google.co.uk/search?sourceid=chrome&ie=UTF-8&q=temperature+psychiatric

and a there's a study that shows admissions to psychiatric wards go up.
http://www.annals-general-psychiatry.com/content/7/S1/S201

The results are somewhat bizarre.
"
Temperature was strongly positively correlated with the number of overall psychiatric admissions (r=0.475, p<0.01), admissions for schizophrenia and other psychoses (r=0.360, p<0.01) and with male gender of admitted psychiatric inpatients (r=0.416, p<0.01). A positive correlation was noted between temperature and the number of involuntary admissions (r=0.302, p<0.05), whereas the correlation between temperature and the number of inpatients admitted because of mood disorders was of marginal statistical significance (r=0.260, p=0.05). Rainfall was negatively correlated with overall psychiatric admissions (r=−0.306, p<0.05). Further negative correlations of rainfall were also found with the number of patients admitted for organic brain syndrome (r=−0.373, p<0.01) and involuntary admissions (r=−0.425, p<0.01).
"

Interestingly it's psychoses that see the effect whereas mood disorders don't. The results for rainfall and admissions is explained by the authors as related to increased difficulty or inconvenience in accessing healthcare in the rain being the reason for the reduce number of admissions.

So, the recent BP oil spill is going to cause psychiatric hospitalisation....

Schizotaxia and how madness is part of humanity

I'm reading
The Silent Side of the Spectrum: Schizotypy and the Schizotaxic Self
http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/sbq008v1

and I came across this passage
"
''genetically determined integrative defect, predisposing to
schizophrenia''and the term schizotypy for a subtly
deviant psychobehavioral organization, reflective of
interactions of the schizotaxic vulnerability with environmental
factors.
"

Schizotaxia is a concept that's 30-40 years old. My understanding is
that it's a genetic vulnerability which, given the right circumstances,
can turn into a varied of disorders like schizophrenia or
non-pathological states of being like schizotypy.

Schizotaxia is one of the reasons I feel that one day people will argue
that schizophrenia is not a mental illness per se. It is a term that
describes the hypothetical idea of a gene that makes a person vulnerable
to a certain behaviour and the authors of the paper consider schizotaxia
pathological. It doesn't have to be that way. There's another paper in
the same issue of Schizophrenia Bulletin which I'm unable to access
however the topic is the relationship between schizotypy and creativity.
There's an often noted link between the two however I am unsure of the
evidence.

The idea of a genetic pre-state, to me, means that this is part of who
we are as human beings. Since the damn of homo sapiens there has been
this gene which predisposes people to the schizophrenia spectrum (from
schizotypy to schizophrenia).

My fear is that one day with genetic screening of embryos parents will
want to remove any chance of their child becoming a schizophrenic, just
as they will attempt to get rid of all hereditary physical diseases.
Perhaps it may even come in the form of a future government measure to
prevent mental illness by removing the schizotaxia gene from the gene
pool. After all, the consensus of mental health, science and mainstream
society is that schizophrenia is a terrible illness and anything at all
should be done to prevent schizophrenics from existing.

It's really, really, really bloody important to use the hated noun
somethings. "A person with schizophrenia" is not correct. Here's why.

In the 1970s pro-homosexuality campaigners used the genetics research to
show that homosexuals were a normal part of the human race. There may be
a similar sort of gene that can predispose a person to become a
homosexual. The logic applies to schizotaxia and whatever other genetic
predispositions for mental illness that will be discovered in the next
century.

The opportunty to understand an undividuals b behaviour and make up as
part of a genentic vulnerability is great in a theorectical abstract.
It's when people start to consider what to do with it that the problrms
will happen.

I fear that society doesn't want schizophrenics just as it doesn't
really want blind or physically disabled people. Not really.

Life is easier without socially ugly people. Parenting is considerably
easier if the child is....compliant and obedient. Life is easier if
adults are all the same and fit in. Those and other excuses could be
used in the future to remove the schizotaxic, just as osciety will
attempt to remove the blind and, had progress not happened in the 20th
century, society would attempt to remove the homosexuals through genetic
means as well (in my opinion).

Really interesting stuff about psychiatry and spirtual emergence

http://www.spiritualcompetency.com/jhpseart.html

From Spiritual Emergency to Spiritual Problem: The Transpersonal Roots
of the New DSM-IV Category
by David Lukoff, PhD
Journal of Humanistic Psychology, 38(2), 21-50, 1998.

Abstract

Religious or Spiritual Problem is a new diagnostic category (Code
V62.89) in the Diagnostic and Statistical Manual-Fourth Edition (APA,
1994). While the acceptance of this new category was based on a proposal
documenting the extensive literature on the frequent occurrence of
religious and spiritual issues in clinical practice, the impetus for the
proposal came from transpersonal clinicians whose initial focus was on
spiritual emergencies--forms of distress associated with spiritual
practices and experiences. The proposal grew out of the work of the
Spiritual Emergence Network to increase the competence of mental health
professionals in sensitivity to such spiritual issues. This article
describes the rationale for this new category, the history of the
proposal, transpersonal perspectives on spiritual emergency, types of
religious and spiritual problems (with case illustrations), differential
diagnostic issues, psychotherapeutic approaches, and the likely increase
in number of persons seeking therapy for spiritual problems. It also
presents the preliminary findings from a database of religious and
spiritual problems.

Paper from which 2 deaths in 4.5 years figure is taken

http://bjp.rcpsych.org/cgi/content/abstract/169/4/483
Neutropenia and agranulocytosis in patients receiving clozapine in the
UK and Ireland
K Atkin, F Kendall, D Gould, H Freeman, J Liberman and D O'Sullivan
The British Journal of Psychiatry 169: 483-488 (1996)

2 deaths in 4.5 years from clozapine-induced agranulocytosis

http://www.bmj.com/cgi/content/full/313/7067/1262/a

"
Over the past five years this rigorous monitoring has successfully minimised mortality due to agranulocytosis. Analysis of 6316 patients taking clozapine showed a cumulative incidence of agranulocytosis of 0.8% over four and a half years, with just two deaths.
"

2 deaths in 4.5 years directly from agranulocytosis even with the compulsory hematological monitoring. This doesn't take into account reduced life expectancy.

People thought neuroleptics could cause suicide when they were first introduced but now they think they help with suicide

I've found something interesting in a paper published in 1990. Nowadays
neuroleptics are thought to improve the suicide rate, especially drugs
like clozapine, but back when neuroleptics were first introduced it was
thought they may increase the number of suicides because of they cause
depression.

What's changed? The medications have gotten more targeted in the bits of
the brain they work on.

My (little) experience of drugs like Olanzapine makes me think atypical
antipsychotics aren't much better however I've heard very good reports
about aripiprazole from 2 people who've taken it. Mental health
practice, by which I mean the experience a person has of medical care,
has also changed significantly. The 20th latter century saw empowerment,
advocacy, involvement, choice and all manner of changes that returned
power and humanity to individuals with severe mental illnesses. It may
also have seen more compassion and sensitivity from clinicians. It is my
guess that this progress towards humanisation would make people that
little bit happier and that little bit less likely to kill themselves.

A population study looking at the suicide rate and medication today will
show that antipsychotics can significantly reduce the suicide rate.
There was one published last year that got into the media and it showed
just how effective clozapine was - it was enough for the authors and the
press to call for clozapine to become a first line treatment. That
particular study was flawed because while it looked at medication it
couldn't control for the effect of accessing services. The people in the
study that didn't receive antipsychotic medication of any kind would
probably not be in contact with mental health services.

That means that people should maintain contact with mental health
services but many suicidal people clearly don't. I don't know why that
is. There must e some research somewhere on that. Identifying the
different reasons why people don't stay in contact with services may
provide useful information for clinical practice, the result of which
may be an increase in the number of people with severe mental illnesses
who maintain contact with services. It is my hope that that sort advance
in the of patient-service relationship in real terms could mean fewer
people commit suicide.

http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/16/4/571?view=long&pmid=2077636
<http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/16/4/571?view=long&pmid=2077636>

Schizophrenics kill themselves too: A review of risk factors for suicide.

"
Two common beliefs about suicide
among schizophrenic persons have
not been borne out by mortality
studies. With the introduction of
neuroleptics in the 1950's came the
fear that the combination of neuroleptics
and hospital liberalization policies
might result in an increase in
depression and suicide among schizophrenic
patients (Saugstad and
Cdegard 1979). However, early reports
(Beisser and Blanchette 1961;
Hussar 1962) of an increase in suicide
among schizophrenic patients
treated with neuroleptics have not
persisted over time. In fact, only one
study (Warnes 1968) has found a significant
difference between suicide
and control groups with regard to
neuroleptics, reporting that significantly
more control subjects were on
higher doses of phenothiazines.
Other studies (Cohen et al. 1964;
Roy 1982a, 1982b, 1986a, 1986b;
Hogan and Awad 1983; Wilkinson
and Bacon 1984) found no significant
difference in neuroleptic treatment
between suicide and control groups.
In reviewing the literature, Johns and
colleagues (1986) reported that they
found little support for the notion
that neuroleptics precipitated suicide
by the mechanism of depression induction.
"

Notes on diagnosis and suicide and self stigma

When I was first diagnosed and hospitalised it was a horrific
experience. Initially I'd been hospitalised for making threats of
suicide. I wasn't suicidal per se. I was living in apersecutory delusion
that came about through trying to interpret the change in consciousness
I was going through or may have been part of the change.

I received a relatively high level of support following my
hospitalisation. I was seen frequently by a private psychiatrist -
sometimes more than once a week. My friends were supportive and
understanding at the time, or tried to be. My family tried to get me the
very best treatment. This is a privilege few have.

A major problem was self stigma and to this day I'm not sure I've gotten
over that problem. I hated becoming one of the mad. I was cool crazy,
not actually crazy. The stereotype of the mad, deranged fool was all I
could see and I could see no good or value in that. The deeply ingrained
stigma turns to self stigma upon diagnosis.

I could sense the immense loss of social standing that came with madness
and I thought my career was over. Who would want a mad person? The
mental picture or stereotype of a dribbling, incoherent,
incomphrensible, babbling, mental human being was not something I had
much sympathy for.

I've been debating about the renaming of the term schizophrenia and I
thought it was a dumb idea. As I've thought about it this morning I can
understand why someone might think it's a good idea.

When I was given a diagnosis of bipolar and almost 8 years ago I didn't
know of any positive stereotypes. I knew nothing of the mental illness
except that it was a mental illness, and not a 'nice' (=acceptable) one
like depression.

About 4 years ago I went to a local writers group in North London. I
ended up chatting with some people in the pub afterwards. Somehow the
conversation got round to mental illness and I revealed that I'd had a
diagnosis of bipolar. Someone said to me, "you're so lucky." Clearly my
life had changed a lot in the interim because I'd never have been at a
writing group had I not gone through crisis. I also wouldn't have been
able to hear that response in other social settings. Most importantly I
think, I wouldn't have heard that response without the Stephen Fry
program the Secret Life of a Manic Depressive.

A diagnosis of madness or severe mental illness is associated with a
high suicide rate and the epidemiological data shows the risk is highest
in the period after initial diagnosis. With time an individual becomes
comfortable with the concepts and able to believe in themselves again
though the journey to find oneself again after a diagnosis is long and
very, very painful one.

I haven't heard anyone say it yet but I'm sure someone already has: part
of the cause of the high suicide rate is the diagnosis itself (and
associated self-stigma).

If your life and hopes were taken away because of the self-stigma and
prognosis of mental illness, if your identity and self-esteem were
shattered through thinking that you were now mad, if you were told that
your mind was diseased and abnormal and if your dreams for your future
were rended asunder wouldn't anyone want to kill themselves?

It's my opinion that if the effects (and others) of a diagnosis of
severe (and maybe common) mental illness listed in the above sentence
that can lead to suicide could be ameliorated in any way whatosever this
could reduce the risk of suicide after initial diagnosis.

From the research and from personal experience the suicide risk for
those who have lived with mental illness for a long time may need a
different sort of approach. Living with severe mental illness for ages
is very different.

There's a useful snip from a paper I'm reading.
http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/16/4/571?view=long&pmid=2077636
<http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/16/4/571?view=long&pmid=2077636>
Schizophrenics kill themselves too: A review of risk factors for suicide.

"
Although the majority
of the studies point to a concentration
of suicides among schizophrenic
patients in the first 10 years
of the disorder (Johns et al. 1986),
there is also evidence that an
increased mortality risk exists across
the life span. M. Bleuler (1978) observed
that the timing of suicide
among his probands was distributed
throughout the course of the illness.
Based on his clinical experience,
Bleuler rejected the "fallacy" of what
he called the "outmoded assumption"
that older schizophrenic patients are
too burned out to experience suicide precipitating
suffering (p. 306).
"

Study recalculates lifetime risk of suicide in schizophrenia as 5.6%

"The Lifetime Risk of Suicide in Schizophrenia"
http://archpsyc.ama-assn.org/cgi/content/full/62/3/247

Its an epidemiological study and meta-analysis. I don't quite understand
that maths. I think what the authors are saying is that the conventional
estimate assumes a constant risk of suicide throughout an individual's
life and this isn't true.

Another stat on the suicide rate in schizophrenia

From
http://www.rethink.org/how_we_can_help/news_and_media/briefing_notes/briefing_2.html

The suicide rate for patients with schizophrenia is 20-50 times greater than the suicide rate of the general population

Masking mental illness and a strange thing about depression

I've been masking mental illness for years. I used to mask with
medication and I managed to mask with self-medication for a while.

There's another mask I use. The psychological mask. It's what we all use
to disguise our internal madness.

I might have showered twice this week and stayed in the same clothes for
three days in a row but when I go out people see a reasonably clean
person with the mask of arrogance and exuberance. It takes a lot of
alcohol to break that mask down or a very perceptive person. I've lsot a
lot of weight from not eating but I've tried what I can and it seems at
the moment drinking stimulates my appetite and supplements my calorie
intake. There's a high degree of isolation - self-imposed and otherwise
caused. Other factors have caused that but it is actually a blessing and
I'm sure a lot of people are glad that I'm withdrawing.

That immediately sounds like depression, perhaps. Perhaps it's just
laziness or convenience. Perhaps it's just who I really am or it's how I
feel externalising in my behaviour. It may even be punishment from the
thing that other people call god for all my wrongs and sins and evil.

The thing is, were it anyone else I'd suggest that they start getting
out more and taking St John's Wort or omega-3 fish oils. Instead after
two days off alcohol I'm going to go out and drink myself into oblivion
to kick start my process to returning to a fully functioning state.

I can recognise the depression even though there's limited amounts of
low mood. There's lots of negative thinking but that's normal for me. I
can even smile at that thought. I know the things that I need to do like
eat more, wash more, exercise, get fresh air and sunshine, keep the mind
and body active as well as the pharmacological pick me ups. I can even
skip past the bullshit of NHS doctors and get some medication from
Mexico without prescription though that's far from an ideal situation.

Instead I blog, drink, think and snap away.

The financial system causes morbidity and mortality

I worked in the credit industry very briefly before I had a breakdown. I
was a credit strategy analyst.

The credit industry doesn't make it's money from people who are good
with their money (the investment people make money off them). The sort
of people who pay off their credit balance on time and in full - the
people with the highest financial capability - make for the least profits.

The best customers were the ones with lower financial capability. People
who used credit they couldn't afford would accrue interest and charges,
and that's where they made the real money. Essentially the worse a
person's credit record was (to a point) the more they wanted them as a
customer because there was more opportunity to get more money out of them.

This would, of course, lead to high levels of exploitation. Financial
capability will probably become some new psychiatric measure if it isn't
one already. The measure will be used for people with a pre-existing
diagnosis however it could also become part of a distinct mental illness
one day.

Today there are many, many examples of people with low levels of
financial capability being exploited by the credit industry. It's not
just door step lenders.

The best customer is the one who goes into bad debt but still pays. The
tactics they use to ensure they pay are to cause distress. Research
shows this may lead to mental illness. Personal experience shows crisis
debt leads to suicide.

It is inescapable logic (that evidence might prove wrong) that the
financial crisis would lead to illness and death. Smokers pay a "sin
tax" because their choice means they may use NHS services more. A few
years ago it was estimated that smokers cost the NHS £2 billion a year
and they paid £7 billion a year in tax.

When Goldman Sachs went public each of the partners got a bonus of at
least £5 million. They've got a few partners too. I've heard of people
working in the exotic derivative market earning even larger annual bonuses.

The government allotted something in the region of £10-20 million for
extra provision of psychological therapies to help with the fallout of
the banking crisis.

What the fuck?

Why are there no census measures of mental health?

At the moment a random sample is considered the best way to be
representative. That's not quite true. It's the cheapest way. Stratified
samples, matched studies and the like are all much better but more
expensive ways to get closer to a truly representative sample and
experiment.

A census is the most representative 'sample'. This is done once a decade
in the UK. There are no measures of mental health, well being or
happiness included as far as I am aware.

The data would be the start of making a very useful dataset. The
Bhutanese do a 5 day census which is considerably closer to a full
research project to determine the government's success on the measure of
Gross Domestic Happiness. They do that every year as well. Why? They
measure what matters I guess.

The problem with people who don't fill in surveys

Someone must have written a paper on this. Can't be arsed to look for
it. It'd probably make my point more authoritative.

Surveys in academia can get very high response rates compared to
commerical surveys. 60% and even 70% responses rates are expected for
high quality studies.

The results from a survey of 70% of the population can't be assumed to
represent the result for the whole population. What I'm guessing and
what has been guessed before in papers I've read is that there will be a
higher degree of negative results within the non-responders.

For qualitative and quantitative researchers who want high quality
results this is a serious problem.

What will utopia look like?

Will it be full of happy, perfect people? Or will it be full of people:
beautiful and ugly; normal and mad; black and white and all colours;
able and ....well, just able?

The current trend is to make society full of happy, perfect people. The
rest get excluded.

There are many forms of exclusion and the trend will continue to find
more and more ways to exclude the undesirable from society.

It is assumed that society is working for the good of everyone yet with
each step forward there is more inequality and more exclusion for those
with less or those discriminated against in other areas.

Bayesian theory of the mind and psychosis

My experience and reading a paper on drugs and the mind is why I think
there's an option for considering psychosis with respect to the Bayesian
theory of the mind. During my experiences of a different state of
consciousness there was nothing to prepare me. It's like being the first
person to set out to find an undiscovered country. The journey is more
difficult because its unknown.

...hmmm....that's not a great way to describe it. It's like how I
explained in the earlier blog post about how I attempted to interpret
the shift in consciousness. There was nothing that prepared me for it
and all my sense were shifted. There was no pre-information to allow the
change in inputs to be contextualised. My wide reading, knowledge and
imagination meant I wandered wildly across the different interpetations
looking for a truth.

What if people could be 'treated' by being ready for psychosis. Since 1
in 10 people go through it at some point on their life (Bentall, R.
Can't remember the paper though) there may be a hope that if people have
a way to interpret it they may be able to handle it.

In some African cultures the experience of psychosis is revered as it is
in other micro-cultures around the world (I don't know a single large
culture that still reveres psychosis). It is interpreted as the voices
of the person's ancestors speaking to them. This is part of the culture
and it is something that can be spoken about openly when the experience
happens.

Just an idea.

A little bit on my relationship with a non-corporeal entity

My experience of a non-corporeal entity in my life, an other in my
consciousness and communication and information outside the ordinary
senses chance my religion. Since the age of 11 I'd been an atheist but I
was born into a traditional Asian family with strong cultural ties and
who lived a life with lots of religion in. I'd grown more steady in my
faith in the non-existence of god however I continued to read religious
texts because I enjoyed the stories and found more wisdom and ways to
help understand life than I got from science.

When I was thrown out of home during my GCSEs I ended up in a children's
home somewhere in Harlesdan. One night one of the people there chatted
to me to see how I was doing. He talked to me about god and he was
clearly a religious man. I explained my position: god didn't exist. He
explained that I could talk to god. It's the voice in my head. I didn't
understand what that meant.

I went through some unusual experiences before and after I was first
hospitalised. I heard the voice of god through a drum and bass tune.
Apparently I was on a mission, back then, and I flirted with the idea of
the existence of god during my delusion but I came out of it fairly quickly.

It was coming up to my last hospitalisation when I was coming off lots
of medication and starting to re-enter social life again (rather than
being alone in a room playing Sudoku) that I started to feel the
presence of another. I didn't call it "god" nor did I make the link till
a while later. I just started to become aware of another force or
entity, something that didn't fit with scientific causality, that was
influencing events and actions.

As the psychosis or 'delusion' escalated the profoundness of the belief
in this entity or other power (?higher power?) became intense and
overpowered years of rational book-learning-based belief. I didn't
ascribe the force or entity to any religious intepretation. In fact
there were times I experienced the feeling of control as coming from
people around me. I went through the usual suspects - secret government
or organisations, alien or non-human manipulation. These are how sane
minds attempt to rationalise and understand the experience when there
senses tell them something different to pre-psychosis days. This may be
described in other language as "startling phase".

I changed my religion to an antitheist: a person who knows that god
exists and knows why people, for thousands of years, have thought that
god or spirits or whatever existed, and hates it. It extended to a whole
"cult of one" system of beliefs for a while.

In all fairness the entity is both good and bad. If it is truly what
people call god then it is responsible for all the good that happens and
all the bad. Religions can often ascribe the good to god and the bad to
something else, but that is not true.

This doesn't make me very popular. The theists hate me because I hate
god. The atheists hate me because I used to be an atheist but believe in
god. The agnostics hate me because I tell them they have no faith. C'est
la vie.

My entity is still with me. We have had a prolonged time of peace but I
feel it's influence. Now I wonder if it is all just a delusion and all
just some biochemical abnormality. I remember what my senses told me and
I have an indelible reminder of the pain of the transition. If it is
just my unconsciousness that I was fighting then I am a fool, but the
experience was so real that it makes me doubt if there is any difference
between the unconscious and the god that people speak of, i.e. is the
unconscious the voice of god or is the voice of god the unconsciousness
speaking.