Cogito ergo sum and alternative experiences of consciousness

Descarte's answer to the question "Do I really exist?" was simply put "I
think therefore I am."

He clearly went through what would nowadays be diagnosed as depression.
People who think about their existence at such a profound level are
usually depressed or depressed by the question. In fact there were tales
of Descarte having buckets of water thrown on him in the monastery when
he was younger. He liked to sleep in late and found rising from bed
difficult. He'd often lie awake under the covers in what's termed a
hypnogogic state where all the world senses are shut off and the mind is
free to exist as the totality of conscious experience. It's been
suggested that it was these states that lead him to ask the questions
that result in answers such as cogito ergo sum.

I remember discussing Descartes with a good friend of mine when I was at
university. He studied Descarte's work whereas I'd just picked up bits
about his life ands work from my own pursuits in learning. He didn't
know that Descarte invented the x-y type graph and that's why they were
called Cartesian coordinates. I didn't know that Descarte had a series
of truths of which cogito ergo sum wass but one. The first truth was,
surprisingly, god exists.

My own journey was somewhat different. I went through an experience
which is pathologised today by psychiatry. There were a variety of
experiences over the years but there was a short, intense period where
my internal conscious experience shifted drastically. The period would
be described as psychosis at the very least. It was intensely
distressing but I somehow managed to keep working at a part time job at
a mental health charity. I coped by withdrawing as much as possible to
hie externalising what I was going through, though outside the office
I'd self-harm and I was parasuicidal - suicidal but couldn't manage to
do it.

In that time my consciousness experienced many changes. Some days I'd
think people could read my thoughts and events were being controlled,
controlled by a force or power outside and above what is commonly known
about. I'd been through the experience before and had been hospitalised
because of it so I stayed away from mental healthcare services.

What was clear through my experience was our ideas of consciousness and
reality are....wrong. They're simplistic, inadequate and don't encompass
the possibility of ..something else.

In my stream of consciousness - the chatter of thoughts or voices in my
head, the committee in my head, the internal dualogue - there is an "I"
and this is what I am. This is my self. People are taught their "I" is
the entire chatter or the dualogue. Psychologists might say the other
consciousnesses are the sub and unconsciousess minds expressing
themselves directly rather than through metaphor in dreams and the like.
I think they miss the point.

What happened to me was a change in awareness as well as a change in
experience. It's very hard to separate the two facets of the change. I
became aware that my thoughts and my actions weren't under my full
control. There was another part controlling "I" which I didn't notice
before. What was clear was that my "i" was neither fully in control of
my body, voice, movements and mind. The internal chatter also became
clearly from another rather than from my own "i" and this was significant.

This is why I am "we" because my "I" has many contributors. I came to
question my very existence and I wanted to kill myself because of it
(one of many reasons) back when I was going through the acute
experience. I'm still not 100% sure but I think I do exist.

But so does this non-corporeal entity. I'm very careful not to use the
term god but it's synonymous. A higher intelligence, a non-physical
based thing that has influence on me, my life and everything around, a
power so in advance of human understanding that it it's power may as
well be divine. However it could be many things. It could simply be an
advanced alien intelligence. It could be lizard men with psychitc
powers. It could be humans from the future influencing the lives of
their ancestors. Or it could be a divine being that ,made and controls
the entire universe - and that's what god is. I don't know what it is
which is why I refer to it as a non-corporeal force or entity.

Anyway, the change in the state of awareness was the important thing.
Lots of people have an inner conversation or a voice in their head. Like
me they accepted these thoughts as their own. They never considered that
a conversation is usually formed by two consciousnesses or two "I"'s
discussing or commenting or whatever. There are some religious
understanding where this inner conversation (usually if it says the
right thing) is the voice of god. This perspective was explained to me
by one of the staff when I was in a children's home.

It really takes feeling your consciousness to start seeing that there is
more than one individual sentience in there. It can be quite frightening
for some people to think that the thoughts in their head aren't all
theirs. Some people think this is achieved by government control or
secret organisations. There are many perspectives.

What "I" know is Descarte was wrong. That I think is not proof that I
exist. Certainly not all my thoughts are mine. To me it is not a truth
that I exist. Not an absolute one, which was what he was seeking.

A good article on antipsychotics and their increasing use

Actually it's a bit of a ramble which is why I like it I think. There
are more psychiatrists speaking a similar message, that medication has
created an industry that isn't healthy.
http://www.huffingtonpost.com/dr-peter-breggin/making-a-market-in-antips_b_720861.html

"
Remember not so long ago when Prozac became the world's largest selling
medication of any kind, and then for years how Prozac, Paxil and Zoloft
took over many of the top 10 spots? Remember the explanations at the
time--that they were wonder drugs and that 15-50 percent or more of
Americans would need them some time in their lives? To many people this
seemed like a scientific breakthrough when in reality it was ... a
triumph of marketing. Some studies suggest that the antidepressants are
little or no more effective than a sugar pill and a lot more dangerous.
Recent research examined all antidepressant studies submitted in recent
years to FDA in regard to antidepressant efficacy and found that the
drug performed no better than placebo except in "severely depressed
patients," reaching "clinical significance" only "at the upper end of
the very severely depressed category." Even then, the difference between
the antidepressant and the placebo was "relatively small."

In addition to being largely ineffective, the antidepressants can be
very distressing to withdraw from, which keeps the market artificially
inflated by people who would desperately like to stop but find the
process too emotionally or physically painful. Often these individuals
fail to realize that they are undergoing withdrawal and instead
mistakenly conclude that they "need" the medication to control their
original psychiatric problems.

Now look what have become the new top selling drugs in the world:
antipsychotic drugs like Risperdal, Zyprexa, Abilify, Seroquel, Geodon
and Invega. Although the FDA has been expanding the approved use of some
of these drugs to some cases of autism, Tourettes and a variety of other
problems, their original purpose and their main use in psychiatry until
now has been largely confined to psychosis and acute mania. Psychosis
and acute mania afflict a very small portion of the the population. Yet
these drugs are now at the top of the list of most widely prescribed
medications worldwide. How did these incredibly toxic chemicals become
daily pharmacological mainstays for so many millions of children and
adults? It's time to face the truth that the prescription of psychiatric
drugs is driven by marketing trends--and now for the first time by
something even more dreadful and insidious than mere marketing.

To begin their market campaigns for the newer antipsychotic agents, the
drug companies created the myth that these products were not as
dangerous as the old antipsychotic drugs, which were becoming recognized
as highly toxic. Especially hard to ignore, it was demonstrated that the
old antipsychotics cause tardive dyskinesia, a disfiguring and sometimes
disabling array of abnormal movements in 5-8 percent per year cumulative
of otherwise healthy patients and more than 20 percent of older
patients. But even the unproven and ultimately false claim that the
newer drugs were safer could not make a huge market for them. Even if
these were wonder drugs, they were wonderful for a relatively tiny
percent of the population. The drug companies had to create a new
patient population market and that market became "bipolar disorder."

Once much rarer than schizophrenia, bipolar disorder would soon become
one of the most common diagnoses made in medicine and psychiatry.
Indeed, while ordinary folks used to talk about their biochemical
imbalances and depression, now they've upgraded to having bipolar disorder.

Lithium, once the magic bullet without side effects for bipolar
disorder--then called manic-depressive disorder--had turned out to be a
severe central nervous system toxin that over the years ruins mental
function while also producing thyroid disorders, kidney failure and a
host of other serious problems. The discrediting of lithium created a
new niche for antipsychotic drugs--to be used as "mood stabilizers" for
people with severe ups and downs. But it was a relatively smalll niche
to begin with.

Where would all the new bipolar patients come from? Many of them would
come from the fertile imagination of drug company sponsored
psychiatrists who found bipolar disorder in everything from toddlers
with temper tantrums to adults with bursts of energy followed by a
natural period of feeling fatigued. Leaders in child psychiatry like
Harvard's Joseph Biederman were literally paid under the table to push
antipsychotic medications for bipolar disorder in children. A recent
study showed that children labeled bipolar actually receive more adult
antipsychotic drugs than adults labeled bipolar . Another recent study
covering 2000-2002 showed that 18 percent of child visits to a
psychiatrist included antipsychotic treatment, and 92 percent of those
were for the newer so-called second generation drugs. It took a great
deal of marketing to convince physicians that these relatively untried
and highly toxic antipsychotic drugs are that safe and effective in
children.

But even marketing bipolar disorder to the professions and the public
was insufficient to create a huge enough market to satisfy the drug
companies. Here's where the irony of ironies came into play. The newer
antidepressants--once the leading drugs in the world--frequently cause
mania. They do so in millions of patients, children and adults alike,
every year. These once most popular drugs in the world by causing mania
made and continue to make the market for the next wave of most popular
drugs--the antipsychotic drugs being used as mood stabilizers.

How common is antidepressant-induced mania? Very common. Several studies
have found that 6 to 8 percent of patients exposed to antidepressants
will develop a manic disorder. One research study, for example, found in
a retrospective study that Paxil produced mania in 8.6 percent of
patients exposed. Other studies find the rates as high as 17 percent And
if a person has already shown a manic tendency or has experienced a
manic-like episode, antidepressants will push one-quarter to one-third
into new manias (For a review, see P. Breggin, Brain-Disabling
Treatments in Psychiatry, 2008, pp. 157-165) . Yet misguided
psychiatrists commonly give antidepressants to patients diagnosed with
bipolar disorder. The result? Millions of people suffer from
medication-induced mania and other expressions of what I call
"medication madness."

When I took my psychiatric residency at Harvard in Boston and at SUNY in
Syracuse in the early 1960s, we never saw or diagnosed bipolar disorder
in children. In my four years of training, I saw one 19-year-old in a
manic state and a few adults. When a person was admitted in a manic
condition talking a mile a minute, imagining grand things about
themselves, making outrageous plans, bursting with anger and energy,
unable to sleep and otherwise euphoric, the condition was so unusual
that we would hold grand rounds, a medical show-and-tell, to discuss the
patient.

Now psychiatric wards are filled with patients having their second and
third or umpteenth manic episode and every psychiatrist's day is filled
with patients diagnosed bipolar. It's mostly about
antidepressant-induced mania. Every single child I have evaluated who
has suffered what looks like a manic episode has been taking stimulants
or antidepressants, both of which cause mania. At least 9 out of 10
adults I've seen in the last two decades who have suffered emotional
episodes that could be diagnosed as mania had them in direct response to
stimulants or antidepressants--mostly the newer antidepressants starting
with Prozac.

In the official diagnostic system, these are not cases of bipolar mania
but cases of medication induced mood disorder with manic features; but
they are almost always mistakenly called bipolar disorder in order to
avoid identifying the drug and the prescriber as the causative agents.

For those who want further details, I have reviewed all the studies
mentioned in this report in my medical book, "Brain-Disabling Treatments
in Psychiatry, Second Edition" (2008). In my popular book, "Medication
Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and
Crime" (2008), I have provided dozens of in-depth illustrations of lives
ruined by psychiatric drugs, especially the newer antidepressants.

Never before in the history of civilization has this occurred. Drugs are
marketed and become bestsellers when their most notable effect is to
cause a severe disorder that paves the way for the next generation of
bestsellers--and nobody's noticed. Was this done intentionally? Not
likely. Is this unfortunate situation being covered up and used to their
advantage by the drug companies and those who advocate their products?
Definitely.

Well, it's been noticed. It is time to stop ignoring the havoc created
by psychiatric drugs. The drug companies and organized medicine and
psychiatry must be stopped from benefiting from the creation of lifelong
patients suffering from chronic medication-induced madness.
"

An interesting criticism of the meta-analyses that show antidepressants have little clinical value above placebo

http://www.psychiatrictimes.com/news/content/article/10168/1520550

There are now 2 major papers that show antidepressants to be less
effective than expected to the point where the clinical value of
antidepressants over a sugar pill is questionable.

This is a critique of the Newsweek coverage. What's extraordinary is
major magazines cover psychiatric research papers. This really doesn't
happen much in the UK, not unless it's a crap paper about caffeine
causes psychosis.

The Kirsch meta-analysis is the significant one because it uses
unpublished data and that's where the big story is. The author
criticises the meta-analytic technique for only being as good as the data.

His criticism of the latest Fournier study is valid. I'm surprised the
authors of the paper selected subclinical doses for inclusion in their
review - I suspect they would have a response to this criticism. They'd
also have a reason why they chose to exclude placebo washout trials but
I can't think why.

He hasn't pushed aside the problem of publication bias and it's effect
on inflating the effect size from other meta-analyses of
antidepressants. Publication bias is significant and affects all areas
of mental health research. It's estimated in a paper published earlier
this year that publication bias accounts for about a third of the effect
size of psychological therapies research.

He makes a very important point though.

"
As research psychiatrist Dr. Sheldon Preskorn recently wrote me, "…
there is much more treatment [provided] by being on a placebo in a study
than most depressed patients get in routine clinical practice,
particularly in the primary care setting" (personal communication,
2/03/10). Indeed, Preskorn estimates that in a typical 8-week trial, a
subject in the placebo group may receive 10 to 12 hours of contact time
with knowledgeable and empathic healthcare practitioners. In effect, the
placebo control is a kind of substantive, supportive intervention."

His criticism that the placebo group do better because they're under
trial conditions makes sense initially however it's notable that this
effect is an important part of the placebo-controlled trial. In any
trial there should only be 1 variable the effect of the social contact
is shared between both trial groups. The research is to show the
effectiveness of antidepressants compared to the placebo effect. It's
not to compare to no treatment at all. (He's forgotten the studies that
show 85% of people recover from depression in one year).

There's another interesting thing on the following line. This is where I
wish people would cite their sources.
"
Furthermore, placebo group response rates in depression studies have
been mysteriously and substantially rising in recent decades—perhaps in
part because less severely depressed subjects are being recruited.
"

There's an easier to read critique of the Fournier meta-analysis
published in Newsweek.
http://www.newsweek.com/2010/01/29/a-doctor-disagrees.html

This is the Fournier meta analysis
http://jama.ama-assn.org/cgi/content/short/303/1/47
Antidepressant Drug Effects and Depression Severity - A Patient-Level
Meta-analysis
JAMA. 2010;303(1):47-53.

I rambled on another paper showing similar results that was published
later this year in the journal Psychotherapy and psychosomatics. It's
the third paper that's calling into question the value of SSRI-type
antidepressants in the treatment of depression.

The massive problem for psychiatrists is the effect sizes regardless of
these criticisms. In physical medicine effect sizes of 2 and 3 are
considered significant. In psychiatry an effect size of 1 is enough to
be considered significant. It's because psychiatry's armentarium isn't
very good.

A quote about street photography

'Give us a reason to remember the photograph.'
Hardcore Street Photography Flickr group

A great link on street photography

http://streetphotographynowproject.wordpress.com/the-book-2/read-the-introduction/

This is wonderfully written. Street photography was very close to my
heart. I miss it so much. Capturing unseen beauty was my passion. The
sight to see what other people didn't is something that developed with
time. I hope it's part of my path.

Tired of life

Someone mentioned their grandfather died recently. They explained that
he'd wanted to die for a long time and death was something he looked
forward to. I got the impression that he'd reached a certain age and had
had enough of life. The rest of it seemed pointless. He died of natural
causes but I guess had he wanted to live longer he could have.

I totally know how that old man felt. I don't have his years or feel the
physical tiredness he may feel. I feel the emptiness though. The
tiredness feels at a deeper level. If I had a pistol and ball I'd put it
to my temples right now. It's that sort of tiredness.

How do people 'treat' tiredness of life? I've tried a variety of drugs
including the strongest legal antidepressant. I found the most effective
drug for me was the right type of skunk but getting that reliably wasn't
possible, and tainted skunk caused a lot of damage to my life. The
hashish I'm smoking at the moment has a very potent antipsychotic
effect, i.e. it's good a calming me without making me sleep. I still
makes me feel tired though the tiredness isn't the same as the constant
psychache tiredness.

The Daily Mail: The paper that's racist so you don't have to be

I love to hate the Daily Mail. It's actually not that bad a paper but it
does promote prejudices.

Thanks to Time to Change they are bashing the mentally ill less. This
will be a significant step towards changing the stigma in the long term.
They will shift their attention to other prejudices.

I'm waiting for the headline that says "asylum seekers cause global
warming" because that's the sort of thing the Daily Mail would love.
I've just seen a recent headline that's aggravated me though. "Cocaine
Chloe kicked off the X-Factor." Why does that piss me off? Well if she'd
had any other mental illness some politically correct organisation would
have got in there and said they shouldn't be branding people with labels
which they would have done had the headline read "Psycho Subo" instead.

The same methods of immoral moral judgements pushed upon society through
the media that reinforced the stigma of other mental illnesses still
happens to drug users.

The roughest life

Service users have a pretty tough life. But there's a little noted type
of service user who has the worst life: the service avoider.

This was my definition for a few years till I got stupid last year and
tried to access services. I thought I was the only one but there are
many people who actively avoid mental healthcare services. There are at
least 100,000 people who refuse secondary mental healthcare. This group
is little studied though they may suffer the worst of what mental
illness has to put a person through.

The hardest times were going through psychosis alone. I'd come off
incapacity benefit and managed to hold down a part time job. I took a
brief course of sodium venlaflaxine when I started the job and moved
house because the accommodation I was in was temporary housing. I wonder
if these were the factors that triggered the psychosis. I was smoking
tiny amounts of skunk at the time so it wasn't that (dose is very
important and doctors don't understand this applies to cannabis too).

Had I sought help from the NHS two things would have happened. They
would have wanted me on medication and they would have probably
sectioned me for psychosis and risk of harm to self. The risk was very
real. These are the scars I carry for life.
http://imaginendless.blogspot.com/2010/06/hardest-photos-ive-had-to-edit-in-while.html

for a short period of my life last year I didn't want to die and thought
it would make sense to use NHS mental healthcare. Thankfully that moment
of weakness has passed.

social exclusion and madness

The social exclusion I'm talking about is exclusion from circles of
friends and cliques. It happens for many reasons and because of many
different prejudices. One of these is madness.

The mad when they're in a mad state are a pain in the arse. That's the
simple thing.

When I'm in a 'well' (socially acceptable state) I'm popular because I'm
fun and people want to hang out with me but when I go into an 'unwell' state
. When I'm not people would rather not see me. They have too little
spare time to give to my aggressive or sad behaviours. They want to easy
to get on with, fun loving, cheery person.

I admit I do it myself. I prefer to spend time with cheery people.
They're easier. They may not be real experiences because most cheeriness
is a façade that's necessary for congenial human interaction. It also
reinforces the need to be cheery, because those people are more
acceptable. It's the same for attractive people. The rest have to use
makeup.

It's inauthentic and a lie to be cheery just to fit in. In the same way
it's inauthentic to be against stigma but try to hide the symptoms of
madness to fit in and get on in life. Both of these reinforce the
prejudices of mental illness. Both promote the lie that people are happy
and sane. Both hide the fact from being expressed, the fact most of us
are truly miserable and fairly crazy.

There will come a day when this sort of social exclusion because of
malformed norms of human behaviour will cease. Sadly I won't be around
to experience it. My life will be marred by those times when my
behaviour is judged to be unacceptable, tiresome or simply boring. And
lots of the friends I make when I'm in my 'well' times don't want to
accept the person I am in those 'unwell' times.

My state of being has one big advantage. I truly know how my real
friends are. Those who've never had their friendships tested will never,
ever have that privilege. They live a false life with false friends.

Anyway by Mother Theresa

This is beautiful. It was shared to me by my cousin who works as a
pharmaceutical rep...

"
People are often unreasonable, illogical and self centered;
Forgive them anyway.

If you are kind, people may accuse you of selfish, ulterior motives;
Be kind anyway.

If you are successful, you will win some false friends and some true
enemies;
Succeed anyway.

If you are honest and frank, people may cheat you;
Be honest and frank anyway.

What you spend years building, someone could destroy overnight;
Build anyway.

If you find serenity and happiness, they may be jealous;
Be happy anyway.

The good you do today, people will often forget tomorrow;
Do good anyway.

Give the world the best you have, and it may never be enough;
Give the world the best you've got anyway.

You see, in the final analysis, it is between you and your God;
It was never between you and them anyway.

"

A short update

It's been 3 days now and I can't sit down to write a CV. WTF? Fucking
useless cunt.

Why don't some people like some psychiatric medication? (a ramble)

This is a good question that's been poorly answered.

From my experience it's because it takes away too much. It takes away
what is a pleasurable experience as well as what is causing distress at
the time.

It is in describing the internal mind that language becomes weakest and
metaphor best. The inside of people's minds is different. Some people
have a monochrome existence. Others see colour. Others still see bright
and vivid colours. These different colours of experience might be
analogous to being high, i.e. people with monochromatic minds might use
drugs to see colour.

Antipsychotics take away that colour, that richness of internal
experience. Mood stabilisers take away the emotional range from people
who have lived with the highs, the lows and the inbetweens for most of
their life until they're diagnosed as something abnormal.
Antidepressants take away the necessary quality of sadness, enforcing a
poverty on some people they take gladly whereas others might to maintain
the emotional richness of sadness.

It's these effects that make people turn away from medication. It's the
boredom of life that they induce, a boredom as complex to convey as
happiness is, that makes them a poor choice for anyone. Those who make
the choice to accept the effects and the side effects (and the chemical
cosh quality may be an effect and a side effect) make the choice
willingly to sacrifice their richness of life for the hope of normality
and acceptance in a world that doesn't accept certain behaviours
associated with madness, the wealthiest of emotional experiences.

That last thought stems from something I've been thinking about today:
would people in religious settings be more likely to score higher on
psychopathological
measures (i.e. cognitive symptoms of schizophrenia rather than the well
being-type scales). The reason is because I was considering people who
had schizophrenia in the past and many of the saints and sage archetype.
A distant uncle is a swami and I wonder if he would get a diagnosis of
mental illness (without the suffering and poorer outcomes). An unusual
experience of consciousness may stem from the same biological cause and
the same genetic predisposition however different contents make for
different outcomes. Biomedical psychiatric thinking would mandate
antipsychotic medication to rectify the neurological problem, except
he's not suffering distress, occupational or social dysfunction.

This thought process returns to a conversation about the relabelling of
schizophrenia. It's this idea of recontentualisation. It's totally
abstract. If he supposed brain disease happens in a developing world
country the outcomes are better, at least in the 1970s. My guess is it's
the content it's treated in and the social systems that are in place.
There's another factor. Put simply: people in developed world nations
have little time for each other and each others failings.

So I was thinking about monasteries and nunneries. Well, alternative
places where the severely mentally ill might exist at least but without
the poor social outcomes. I think of John Nash and the support he got
from Princeton, but he was an exceptional individual. In modern society
that sort of privelidge is sadly not available to the masses. In
religious settings some mandesses are still raised up as a form of
exceptional experience instead of a delusion caused by a malfunctiioning
brain, and the latter is the distasteful opinion of the biomedical
model. The biomedical model of psychiatry came about early on in the
little observed change of people's conditions being judged by science
rather than religion.

Bah. Bored. Rambling. Not too coherent. Off to drink.

A note on how the UK seems to be missing out on progressive research

I'm just leafing through the Wiki page on ketamine. Someone mentioned to
me it wasn't used as a horse tranquiliser however the Wiki page says
it's often used in veteniary settings. It's apparently only a class C
drug in the UK.

Anyway, here's the text
"
> There is ongoing research in France, the Netherlands, Russia,
> Australia and the US into the drug's usefulness in pain therapy,
> depression suppression, and for the treatment of alcoholism
> </wiki/Alcoholism>^[25] <#cite_note-24> and heroin
> </wiki/Heroin> addiction </wiki/Substance_use_disorder>.
"

The paper on progressive treatment paradigms for first episode psychosis
by John Bola last year had studies from a few countries but once again
the UK was notably absent.

Psychiatry is still a very basic science

This thought comes from thinking about exogenous and endogenous
depression. These concepts aren't embound in either diagnostic criteria
but I can't think why. Perhaps the medicalisation meant that all that
was required for doctors was knowledge of the outcome or the symptoms
rather than the cause, and all cause was treated by medication as
psychiatry became less of a pseudo-science.

But then I think of adjustment disorders. These are often misdiagnosed
by GPs as depression. I don't know enough about this area to understand
how a doctor would differentiate between reactive depression and
adjustment disorders. My internet connection's a bit ropey at the moment
so a google search for "adjustment disorder differential diagnosis" will
have to wait.

The mental health system that's represented by psychiatric and medical
practice is driven by treatment of symptoms rather than cause. Cause is
best explained in a simple sense by the biopsychosocial model of mental
health however this understanding of cause has little value in practice
because there is very little depth of understanding in a scientific
sense. There is no system I'm aware of that can identify the causes of
mental ill health with any degree of precision. The -social part of the
biopsychosocial model is least understood by doctors and researched
into, i.e. questions are rarely asked about society and its influence on
mental health. It's in this last area where mental health is shown to be
a pseudoscience nad more complex than anyone could imagine.

The results showing presentation of symptoms changed when Westernised
ideas of anoerixa were published in the Hong Kong media, the effect the
introduction of television (and perhaps the influence of the research
itself) showing an increase in eating disorders and body image related
anxieties in a Fijian youngsters and the studies that show people with a
diagnosis of schizophrenia do better in developing world countries are
illustrative of just how many effects interplay on mental health from
society and culture.

It is my perception that eventually there will be a period table of
elements or a genome established for the mind. I think it was mendelev
who came up with the idea of the periodic table (I can't google it to
check). It described the individual, irreductible (in chemistry terms)
elements that combine to make the diverse solids, liquids and gases that
may up the entire universe. There are millions and perhaps billions of
combinations of elements that make up the universe (or 99.99999% -
there's blacvk holes, neutron stars, dark matter, Bose-Einstein
condenstate, plasma and other things too).

Those millions of combinations of elements took centuries to cataloguse
without any understanding that they were made of a small number of
irreductible elements. When psychiatry has the capability to understand
the elements it will become a true science. For now it languishes in the
doldrums of pseudoscience, evermore studying the mad man's mind from the
outside.

The problem of mental illness

It's nearly 33 years of living this life.

In that time I've travelled the far reaches of the human mind. I still
do and will do.

My psychopathology varies though. There are times when I'm normal.
There are times when I can hide the insanity. There are times when I
can't fight the irrationality.

Inside I'm chaos but on the outside I'm like a swan on the water. Most
days at least. There are times when I'm like a swan on land.

Those small moments where I'm on land can scar my life forever. This is
the problem of mental illness.

There are periods where I heal those scars and repair. Those are the
good times. I'm lucky I have the capability and capacity. Other people
can learn to have the capability to survive and gain the courage to keep
on going no matter what..

An alternative approach to ADHD in children

From
http://www.bbc.co.uk/news/uk-scotland-11383097

The Scottish equivalent of NICE are developing training for parents to
better manage their children. It's a great solution for the supposed
mental illness ADHD.

What if...

....history had been different and the Mongol culture had taken over the
world. Their war-like culture valued aggression, arrogance and the power
of an individual's will. They achieved world peace by total domination
but they also developed a mental illness system.

They noticed that people with Parkinson's disease lacked the sort of
qualities they wanted in normal individuals. They realised that people
who were different to the norm in this parallel universe were ill in
some way and have a brain problem. They realised cocaine could induce
the correct dopamine response in these malformed individuals.

Their mental illness system pathologised a totally different subset of
the human race. The meek. However they treated physical illnesses the
same way.

What the fuck? Depression's happening earlier? (a ramble)

I just read this statement in a recent article about the use of
antidepressants in children.
http://www.guardian.co.uk/society/2010/sep/18/children-depression-antidepressants

"
"We're getting clear evidence that the onset of depression is happening
earlier and earlier," says Marjorie Wallace
<http://en.wikipedia.org/wiki/Marjorie_Wallace_%28SANE%29>, chief
executive of the mental health
<http://www.guardian.co.uk/society/mental-health> charity Sane
<http://www.sane.org.uk/>. "In previous generations, people would be
overwhelmed by depression in their 20s. Now the peak age for onset is
13-15: the numbers of teenagers calling us for help suggest the rates of
depression in the under-14s have doubled in the last four years, and in
the 15-24 age group it has increased by one-third."

"

What her definition of clear evidence and what mine is may be totally
different. I'm not going to dismiss her point that children depression
may be happening earlier in the UK? The earlier post on what depression
actually means is important to answer the question, i.e. is it
biological depression happening earlier or is it something else,
something that society or culture is doing to children to make them
unhappy earlier? Or are doctors being forced to diagnose children? Or
are they overdiagnosing them?

Looking at prescription data or call volume by age band may show a
change in behaviour, for example more children being willing to contact
emotional support services or doctors being more ready to prescribe
antidepressants to children. Prescription dta would offer a very large
sample size compared to the call volumes the SANE helpline receives.

Elsewhere in the article it notes 113,000 prescriptions were given out
to under-16s. That's a lot. Prozac was only recently licensed. There's a
lot of off-label use of medication in children, i.e. use without or
against guidelines or clinical approval.
I'd guess the figures for 2008, 2009 and 2010 would show a steep and
inreasing trend.

I'm looking at the BNF for children. There is detail on 13 approved
antipsychotics, 2 formulations of lithium and 5 other antimania drugs, 8
antidepressants and 4 ADHD drugs. No listing of St John's Wort though....

Anyway, it then goes on to pharmcological treatments for obesity in
children. The treatment of obesity is one of those interesting things
about medicine. It no longer treats diseases. Obesity is not a disease
but it is a risk factor associated with other illnesses, just like
smoking. Doctors didn't believe it was a disease so wouldn't diagnose
it. Treatments were produced though including gastic bypasses and lipase
inhibitors toreduce the absorption of fat. Upon creation of a treatment
the idea of illness became more valid and doctors would be more likely
to diagnose it.

The same is true but through a different mechanism for parents. They can
become more likely to diagnose a mental illness through learning and
change in perception passed through the media and social networks. Few
parents worry about whether childhood depression is really an illness or
just an unwanted facet of the human experience (the removal of which
could be detrimental to the child). When they see a media report
describing something that's similar to how their child behaves many
parents may take their child to a doctor and tell them they think
they're ill. Teachers may also tell parents they think their child is
mentally ill when in fact they're bored or going through a horrible
childhood process that no one should go through but is part of their
personal and individual development.

So what I'm saying is potentially childhood depression isn't increasing
but the diagnosis by doctors, parents and teachers (and other people
involved in care) is increasing. This is the spreading and widening of
the definition of mental disorder that the chair of the DSM-IV task
force is campaigning against in America.

The biggest problem is people, in general, don't understand depression.
For example studies show that depression is often cyclical in a person's
life and the cycle has become quicker since the introduction of
antidepressant treatments.

Hmm....actually, the biggest problem is the use of medication when there
could be the option for preventative stuff like trying to keep a check
on a child's well being and equipping them to deal with emotional
suffering then offering therapeutic interventions when necessary. These
could take many forms, from mentoring or coaching to psychological
therapies or an adventure holiday at PGL. It could take meeting J K Rowling.

This takes a shift in thinking though. This takes the shift to call it
childhood misery instead of childhood depression. Demedicalising it
changes how it's treated. For a start it means doctors don't necessarily
have the answer - and there's pretty good evidence to support that
statement. It means drugs are not the first choice.

The change in thinking would also need to be associated with a large
increase in funding for childhood mental health and social care.
Medication is cheap and convenient, and it produces changes reliably.

I just don't believe in drugging children. There are other options.

My childhood was marred by many a bleak patch. Long, deep and intense
depressions. I survived it with a typical male epistomology of mental
health, and I shed many a tear alone. I know that abyss well. I learned
to survive on my own and without friendship. It's a mistake I keep
making to this day.

It's making me sad to think of the sadness in my childhood and this
ramble is hard to thinking about. I was trying to look at my childhood
experience and see what stuff worked for me, what made me happy and
brought me out of the inky black. I was thinking solutions could be
derieved from that sort of process: people reflecting on how they do
through bad shit when they were young so that young people today could
have that instead of be given drugs for their misery.

But it's made me feel quite sad and alone. So I'm going to stop writing
now and have a spliff.

Anorexia in Hong Kong and bipolar in the UK

Elsewhere on this blog I commented on the effect where a media story
changed the local presentation of a disorder.
Anorexia in Hong Kong use to present differently from the Westernised
ICD-10 definition of symptoms but local psychiatrists understood it was
the same disorder. After the media story which was informed by internet
research and use of the reference definition of anorexia people began
presenting with Westernised symptoms.

There's been a bipolar story line running in East Enders, a popular UK
soap opera watched by a wide cross-section
of the population. The storyline will affect how the nation think of
bipolar disorder. It may also change how people with bipolar present,
i.e. people may more often be seen to present with bipolar in a similar
way to the character in East Enders. In fact there's a huge varied of
experiences of bipolar but this is changing, something that Dr Joanna
Moncrieff noted in her Madness Radio session.

The makers of East Enders aren't aware of this effect that the media
representation of mental illness can change the presentation of mental
illness. It's explained in a book that's already out in the US and will
soon be out in the UK. There are other cultural and media-related
effects that are little explored by the people who work in the media,
risks they're unaware of or chose to be unaware of.

The problem with determining cause and effect

I've been thinking that perhaps the exclusion faced by children with
early onset schizophrenia is part of the reason why their brains develop
differently. Research shows that children with a diagnosis of
schizophrenia have a 5% reduction in brain volume while growing up but
those without have a reduction of 1% in the same time period. The
psychiatric and biomedical interpretation of the reduction in brain
matter is proof of a brain disease component however I wonder if it's
the effect rather than the cause or if there are casual features of
symptoms.

I doubt the exclusion alone is enough to precipitate the relatively
large increase in brain volume changes. I think there's something
important about the internal experience. People learn to use their
senses. These include sense to perceive the social environment and this
processing may achieved using a certain area or network of neural
circuitry. It may be what is lacking in people with autism and with
schizophrenia.

In schizophrenia and other psychotic disorders the internal experience
becomes prominent. The sense of information from a different
source....how can I put this.... The increased use of what some people
call intuition or gut feelings is a different way of processing reality
from using 'standard' processes of interpretation of reality, events and
people. If this increased use and experience of the internal reality
persists the brain may change over time (and this is possible in
adults). The change from a pervasive 'standard' processing of reality to
a spiritual or quasi-intuitive way of processing reality may be another
cause of the brain matter changes.

It may also be an effect of the brain changes. This is the problem with
determining cause and effect.

A random paper I'd like to spend more time reading but don't understand much of it

While looking for something else I came across this paper. I'll get
round to reading it at some point.

Pronouns and procedural meaning: The relevance of spaghetti code and
paranoid delusion
David Cram and Paul Hedley
Oxford University Working Papers in Linguistics, Philology and Phonetics
(2005), vol. 10, pages 187-210.
http://mostlyharmless.org.uk/linguistics/documents/cramhedley-web.pdf
It'
Spaghetti code is a programming term for poorly written software code
that jumps around using GOTO statements. The author consider this
analogous to the use of pronouns to structure sentences.

The authors begin to break down the cognitive linguisitic process in
people experiencing paranoiddelusions using whatlooks like guess work
though it may be logical reasoning and inference rather than what a lay
person might consider guesswork.

Depression: mental illness or not?

This is about concepts and language.

There are several definitions of depression. It is the medicalisation of
misery however there's an important quality of what an illness - there's
a biological component. Personality disorders apparently have no
biological component which is why some people don't consider them mental
illnesses.

The idea of the (true) illness is important when considering what
depression is. In practice the diagnosis may cover condition other than
a biologically /caused/ syndrome. Reactive depression or an adjustment
disorder (which is often not diagnosed and a diagnosis of depression
given instead) are states of misery that may not hold to the classic
view of an illness. Endogenous depression is a biological depression and
in that sense a true mental illness.

However both reactive and endogenous depression are diagnosed as
depression. The US diagnostic criteria and I'm pretty sure the one used
in the rest of the world doesn't make the distinction. The distinctions
are made on things like severity and course. I think earlier versions of
the diagnostic criteria have attempted to make the distinction however
I'm unaware of why the distinction was removed or not ever included in
the definition of depression.

In the US there's a large research program attempting to find biomarkers
which should be able to reliably identify endogenous depression. Their
much better funded medical system uses a lot more testing than here in
the UK. It's only in mental healthcare that they've been forced to rely
on guess work whereas UK doctors have been using it for years.
Eventually they may be able to establish who has a biological problem
and who doesn't. This may result in better response rates for
antidepressants - something noted by the researchers on the STAR*D trial
in a recent review of antidepressant trials with unpublished data
presented (which again showed the lack of efficacy).

Clearly non-biological depression wouldn't respond to biological
treatments. Or would it? This will be the interesting experiment once
the biomarkers have been established. Will people with endogenous
depression respond to talking therapies and will those with reactive
depression still find drugs work? I can guess yes to both of those.

Importantly, to the true definition of mental illness it's not the
medicalisation of misery. However the 'true' definition has changed
radically in well over a century. Mental illness should perhaps now be
called mental health problems but not on some whim of the politically
correct movement. The concept is rooted in the problematicness of the
emotions and behaviours of the individuals who are unable to mask or
cope. This is the cause of the social disability. In fact mental illness
could now simply be called social disability, so someone would ask the
question "What disability has society given you?"

Precise concepts aside, clinical depression is know by everyone as a
mental illness. According to that modern definition personality
disorders are also mental illnesses as is substance misuse (though this
has been recognised for far longer as a mental illness).

This wouldn't be true of the phrase "mental illness" when it was first
conceived. This is a problem because of the privilege of medicalisation.
It is assumed that if it is an illness it can only be treated by doctors
and approved medical treatments, it is healthcare and it is pure. The
last bit - the goodness and purity of medicalising misery - is the most
dangerous. It blinds people to seeing beyond. It bamboozles ethical
considerations.

The idea of mental illness allows doctors to 'treat' unmarried mothers.
In the UK in the mid-20th century the medico-legal framework classified
these individuals as mentally ill. I very much doubt the National
Association for Mental Health or Together or any of the other mental
health charities at the time said a word about unmarried mothers being
mentally ill but their modern counterparts, with the benefit of
hindsight and the change in cultural norms, would break down the doors
of parliament to get that particular mental illness unpathologised. At
least I hope they would.

Their antecedents wouldn't have said a word because it was doctors who
told them it was an illness, a genuine biological one that must be
treated and anyone who considered anything different would either be a
challenging patient or someone with lack of insight into their condition.

Another paper on schizophrenia and communication

Another random open access find. I've been looking for another
explanation of the word "ostensive" (in the psychiatric
sense) other than the explanation I read in a BJPsych paper on the
difference between a mental illness and a personality disorder.

Understanding Minds and Understanding Communicated Meanings in
Schizophrenia
http://philrsss.anu.edu.au/~mdavies/papers/pragmatics.pdf
<http://philrsss.anu.edu.au/%7Emdavies/papers/pragmatics.pdf>

I can't remember if the distinction is solely on a biological basis,
i.e. all 'true' mental illnesses have biological cause- this is known as
Kraepelinian ostensivity. There's another aspect apart from the
biological cause and I can't remember if it's aetiology (which wouldn't
make sense) or prognosis (which would).

I find seeing two versions of a definition interesting. It presents a
fuller picture. I find some ways people express definitions easier to
understand than others so seeing two or three helps me understand better.

There are somethings you should never stop doing

They're the things that define who you are.

The good thing about pessimism

I'm usually right. I didn't get the interview.

I'm glad I never gave up the things I cared about. A day spent drinking
on an empty stomach wasn't part of the plan for what I was going to do
but the lucky thing is I know how to use plans. They're useful unless
you've got something better to do and today it's drinking myself into
oblivion!

Of course normally that plan-as-a-backup strategy would be something I'd
suggest for someone who's on holiday.

Thoughts on debt from personal experience

I'm probably about £30,000 in debt now and have a few thousands of
unpaid student loans as well.

The majority of the debt I accrued several years ago in a short period.
What had happened was I'd quit my job for various reasons. I hit the
self-medication good and proper. I then got asked to consult on a new
magazine and got involved in the startup.

I took the loans out to fund the magazine and my lifestyle. I wasn't
worried about paying them back. I'd experienced severe depression for a
long time as part of my bipolarness - the sort of thing antidepressants
for treatment resistant depression can't treat.

I consciously decided that if the magazine didn't take off then I'd kill
myself. I think this is illegal - to take out a debt without being ready
to pay it. If the magazine had been a success I'd have paid it off of
course.

When the money ran out and the credit letters started coming in I tried
to kill myself. Twice in a week, both times taking high doses of an
antipsychotic I'd been prescribed. I'd found out that 10,000mg had
killed one person. I only managed 5000mg in my first attempt and I don't
know why I didn't take the 10,000mg. I can't remember how many I took on
the second attempt that got me into hospital and thrown out by my family.

A long standing debt - a £10,000 graduate loan - I took out many, many
years ago when I was manic and it was just before I was first
hospitalised and diagnosed with bipolar with paranoid features (the
paranoid features bit I only recently found out when I came across my
section form recently). I didn't need the money but I was hypo- and
hypermanic. It was the first time I'd experienced full blown mania and
psychosis.

Some people might consider there's an argument for those to be written
off however when I started to pay my debts a few years ago I made a
decision to pay them all back. This was based on two things. The first
is the belief that the mentally ill are equal to automotons. We are all
the human race. If I want to be equal then I have to live on the same
terms, and for me that meant taking all the responsibility for my
actions in the past. Every penny had to be paid back. The other reason
is it would repair my credit score and, with enforced manual
decisioning, I could prove myself creditworthy. If ever I chose to sort
my life out and get on with construct measures of success I'd still be
able to get a mortgage at a good rate and access to whatever parts of
society are accessible only with a good credit history in the future.

There is a part of me that says that any debt taking out when a person
is unwell or suicidal should be written off. That's probably what I'd
say when I'm drunk. But I don't think that could happen, not least of
all because everyone would say they were suicidal or had been going
through a period of mental instability. I say to myself I took those
debts on and I spent the money. It's a sacrifice but I can pay them off
with time.

The problem is the sacrifice though. My debts have severely impeded my
life. I had to reduce everything in my life from a much higher level of
choice and consumption to a bare minimum. I had to make the choice to
cut a lot out of my life but kept the things that were important to me.
Drink, drugs, photography, food, socialisation and a few basic
essentials like clothing.

The issue is how to change the system. The mentally ill have to repay
their debts like anyone else otherwise the lenders will ask for a mental
health history and make credit judgements based on that. They work on
statistical modelling and if they see they're getting less profit from
the mentally ill they'll offer higher rates of credit and smaller
amounts, and ultimately seek to exclude them from credit and
credit-based services. The banks will seek a way to divide the mentally
ill from automotons as a way to protect their profits but in doingso
will create another divide in society, one that disadvantages the
mentally ill.

Basic mental health training may help. I wonder if had that Barclays
manager would haver refused me the loan had he know what hypermania
looked like. It's awareness of individual's temporary states rather than
a pre-existing condition that may make the banking system a bit safer
for everyone. Stopping a person who's ever been suicidal from taking out
a loan would be the sort of conclusion that I'd hope wouldn't be thought
of or ever implemented. There's no point in creating a new area for the
stigma of diagnosis to contribute to poorer access to what anyone else
has fair access to.

Debt is like any drug though and many people get hooked. It's easy to
take out loans and the stigma of personal debt has changed radically
since the 1970s. Banks hook students in with loans and interest free
overdrafts like crack dealers offering the top quality stuff to get the
users hooked. Debt gives that freedom to be in our consumer society and
it's a feeling that's better than crack for many people. The addiction
to a lifestyle funded by debt can end up with the same or worse outcomes
than a drug addiction when it goes wrong.

At least it's a drug for people who are like how I used to be before my
debt-related suicide attempt, lost in social status and the trappings of
the construct of human value and wealth.

Being used to irrationality

I am crazy in the sense of being irrational. I make choices no one else
would make without reason or logic. It's a totally mad life for anyone
else but for me it's just life.

Here's an example. I've had an email telling me I haven't or have got an
interview for a job. I've planned for failure, i.e. I've planned around
not getting the interview. I avoided reading it yesterday and I still
can't look at it now. I'm anxious but I'm also comfortable in my
irrational reaction to the anxiety, irrational in the sense that I've
planned for the negative outcome so it should be easier when it comes to
confirming reality and in the stupid logic of pessimism I've got
something to gain if I'm wrong. It's not quite true of course. There's
going to be negatives if I get the interview. I'm just not thinking
about those.

I wish

I wish I could get the help I needed. I wish I didn't get arsed around
and treated like a dick by services. I wish the world could accept my
difference and not call it illness, but still be willing to help me as
if it were an illness.

I wish people understood.

Science in direct marketing

There's an earlier post on hypothesis testing.
http://imaginendless.blogspot.com/2010/08/hypothesis-testing.html

The example I'll use is what was used for me when I worked at a direct
marketing business.

Lets say you want to send out a mail shot and are giving a choice of
blue or yellow envelopes. Most people would likely chose to use the
yellow envelope because they might think people will be more likely to
open brightly colour envelopes.

Evidence-based, or direct, marketing doesn't think that way. Both blue
and yellow envelopes are sent out with the same letter to the same
target group as an experiment. Only one thing is changed - the colour of
the envelope - in the experiment. The result can then be used in the
next mail shot.

Direct marketing companies take this science to a new level. The
subtlest differences are tested.

It's important to consider the options though. There are many choices of
envelope and it may be surprising what people are most likely to open.
It's important to stay as open-minded as possible when choosing the
variables.

An amusing blunder at a an bank shows what I mean. In the 1980s a bank
with a large number of high value clients (millionaires) tried using
mail merge to customise each letter from the information on their client
database. In this era there wasn't the convenience of Microsoft Office's
mail merge wizard. It was a bespoke application written from scratch.

In the "Dear.." field the programmers used the test name "Rich bastard".
You can see where this is going. By accident the programmers forgot to
take it out of the code and no one checked so the letter went out to
their richest clients calling them Rich Bastard.

This letter got an exceptionally high response rate. The responses
turned into sales too. The investment opportunity that was offered was a
good one and this may have been a factor. It was the 1980s though. Harry
Enfield was ribbing the rich with his Loads of money character. The
letter may have been seen as creative marketing and it definitely worked.

Creativity is important in science. The willingness to try something
very different in an experiment can lead to new avenues. This applies to
the science of direct marketing too.

The definition of schizophrenia is atheist

Here's the definition from the Mayo Clinic.
"
Schizophrenia is a group of severe brain disorders in which people
interpret reality abnormally. Schizophrenia may result in some
combination of hallucinations, delusions and disordered thinking and
behaviour. The ability of people with schizophrenia to function normally
and to care for themselves tends to deteriorate over time.

"

The Hearing Voices movement have a totally different perception rooted
in the previous understandings of unusual states of consciousness. The
delusions aren't delusions. It's not an illness but a gift.

There are other interpretations. My personal one is it's a state of
human existence that is rejected by the current construct of what is a
normal human being. There is an unusual and sometimes painful change
process where a person goes from a 'normal' experience of consciousness
to a different one. This is quite a significant change and there's no
support for it embedded in the culture. People get dragged into
psychiatric wards, drugged and told they have a dysfunctional brain.
They are not made aware that that whole brain illness thing my be the
highest form of bullshit (bullshit backed by the best science and
totally believed in by the scientists and doctors). I don't know if it's
a religious experience or not but I know it's not just a brain defect
(in fact in may be a brain advancement, like the first monkey to stand
up taller).

What fascinates me is the religious organisations have not entered
debate. Perhaps they're totally bought by the medicalisation of mental
illness and have lost the organisational memory that they used to be the
mental healthcare system. They've totally bought into the Age of
Reason's (or the secular enlightenment) replacement for what the faiths
provided to society, from treatments for mental illness (e.g. confession
- a form of psychological therapy) to diagnosis of psychosis.

There's a quote by a famous psychiatrist from the 1970's which says it
better than I. I goes something along the lines of: if psychiatry had
been around in the time of Jesus he'd have gone back to being a carpenter.

Injustice for all

A story that doesn't seem to be hitting the headlines is the possible dissolution of the civil legal aid system.

The cdhange sto UK legal aid have threatened legal aid firms. Many have already already gone bust. These firms provided the highest quality access to justice for the most disadvantaged people. The solicitors in these firms could be earning a lot more working in the commercial sector but instead they work to ensure the most important thing: everyone has equal rights and equal access to justice.

What's sad is many organisations can't see the implications of the cut backs to legal aid and the threat to the civil legal aid system. Benefits appeals are covered by civil legal aid. Many poor and disabled people access justice to ensure they get their right to the benefits they're entitled to through community solicitors. Asylum seekers also get legal advice to help them appeal their claims. Those in debt get support through the civil legal aid syatem and they get the best support from the solicitors that people with more money can employ to resolve their debt problems.

The is a cost cutting exercise but the cuts mean the worse access to high quality legal help for the worst off. This is like cutting NHS healthcare and farming the work out to unskilled call centre operators. Manypeople won't get the full legal support they're entitled to. These cuts will affect the mental ill and the physically disabled because they're the people currently using the services provided by social justice firms.

What's so painful is seeing the poor media coverage. I wanted to find an article to link to that explained what's going on with the legal system to a lay person but I can't find anything upon a cursory search. There are important theoretical legal reasons why the civil legal aid system must remain well funded and these are what the lawyers seem to be talking about but these mean nothing to the public.

My own experience is getting help from a legal aid firm for my debts after a suicide attempt and subsequent hospitalisation. I was in no fit state to deal with any of it and my ardent desire was that I would have died in the failed attempt. Thankfully with the help of a dear friend I got to see a solicitor who helped me out with my debt problems and made it not seem like the end of the world.. I think they help many people in dire straits.

Does stuff like this just happen in mental health medication or does it happen with all the other medicines?

http://www.pharmalot.com/2010/09/forest-labs-pays-313m-for-illegal-marketing/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed:+Pharmalot+(Pharmalot)#comments

$300+ million fines for a pharmaceutical company promoting off label use of medication.

Interferon is a very expensive medication that's very dangerous. It's very effective at treating lots of things and its use is increasing.  But I never hear of this sort of story about those sorts of medication. It's just mental health stuff. Perhaps this is just my bias but perhaps not.

What's the real need at the moment for people with severe mental illnesses?

Is it really psychological therapies? That's the band wagon that everyone's on. Cognitive Behavioural Therapy shows the best performance in political outcomes which is great for therapy as a means of behavioural modification. It's also good for improving mood which is great for mental health as a thing about distress rather than disorder. Many patients prefer non-pharmacological options so more therapy is great for patient choice.

Of course people with severe mental illnesses will still die quicker. Long term psychological therapies don't have much funding. Doctors still believe in medication - the older generation at least - so will try to prescribe drugs rather than talking or social interventions; and they're right too based on the psychopathological view of schizophrenia rather than the compassionate one. They'll also give people with mental illnesses fewer operations and lower quality physical care. The quality of life of people with severe mental illness is still poor and the medication makes it worse for many. It contributes to their reduced life expectancy but, well, that's something the Scientologists were right about so it's best not mentioned.

The UK not only has one of the highest standardised mortaliity ratios for people with a diagnosis of schizophrenia, it is also has one of the lowest employment rates in Europe for people with a diagnosis of schizophrenia. People with a diagnosis of depression get stigmatised but anyone admitting to schizophrenia....well...they're fucked basically.

But psychological therapies are the new bandwagon just as medication was half a century ago. The evidence that the UK still has very poor outcomes for people with a diagnosis of schizophrenia (I'm unaware of the evidence for other diagnoses) compared to other equivalent nations is about as interesting to most people as the possible immorality of mental health when it's used as a behavioural modification and social prejudice enforcement system dressed as healthcare. After all, it's just another fucking dead schizophrenic.

3 good quotes

--
"Even the rich are hungry for love, for being cared for, for being wanted, for having someone to call their own."
Mother Teresa

"All tyranny needs to gain a foothold is for people of good conscience to remain silent."
Thomas Jefferson


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

3 good quotes

--
"Even the rich are hungry for love, for being cared for, for being wanted, for having someone to call their own."
Mother Teresa

"All tyranny needs to gain a foothold is for people of good conscience to remain silent."
Thomas Jefferson


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

A quote that's hard to live by

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


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


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


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


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


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


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


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


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

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

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


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

A schizophrenia joke

I just saw this on Facebook.

Roses are Red, Violets are Blue, I'm a schizophrenic..and so am I




It's the incorrect meaning of schizophrenia of course but Dissociative Identity Disorder doesn't have the same ring to it.

Register of All-Party Groups for campaigns

http://www.publications.parliament.uk/pa/cm/cmallparty/memi01.htm

The mental health one can be found here
http://www.publications.parliament.uk/pa/cm/cmallparty/register/memi242.htm

Fuck me. I didn't realise this.
"
Mind, Rethink and Royal College of Psychiatrists provide the secretariat for the group. They meet costs for production of publications, hosting the group's website and funding receptions for the group.
"

Personal attributional style and mental health measures using self report

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

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

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

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

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

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

The book where the original 1 in 4 figure comes from

Mental illness in the community: the pathway to psychiatric care By David P. Goldberg, Peter Huxley
http://books.google.co.uk/books?hl=en&lr=&id=yU0OAAAAQAAJ&oi=fnd&pg=PR7&dq=undiagnosed+rate+incidence+mental+disorder&ots=9-mcNMuHgA&sig=xW8t5NkRDylS_GDS8vb6jGuJOPc#v=onepage&q&f=false


It's somewhere in here they estimate a 250 in 1000 incidence figure from a 180 in 1000 prevalence figure. I think the sample period was a month for the prevalence figure.

However definitions of mental illness are important. I haven't read the book thoroughly to see which measure was used to calculate the prevalence figure. The calculation that goes between the prevalence and incidence was noted to be incorrect in the authors second book published in the nineties.

Biomarkers for depression

Biological measures are the next big development in mental health
science. They're being pioneered in America and the STAR*D trial is
something to do with this though I'm afraid I still don't know enough
about this significant study.

The hope is these markers will really bring a scientific approach to
diagnosing depression. There's the huge problem of undiagnoses mental
illnesses - people who have mental illness but survive without
treatment. To many doctors and psychiatrists this is a bad thing. It's
an untreated biomedical illness.

From my understanding of clinical depression it doesn't always have to
be associated with low mood. There are types of depression identified as
depression without low mood but I forget the name. The diagnostic
cluster has low mood as one of the 8 or 9 symptoms but low mood is not
an essential component of clinical depression because any other 5 can
cluster together for a clinical diagnosis. The diagnostic criteria was
developed through statistical methods to identify what was depression
and the cluster system defines depression.

Biomarkers may only apply to low mood aspects of depression. Resilience
is a factor that isn't measured and may overcome the biological
component that would disable some people. There's also non-biological
depression. Many of the psychological theories of treatment are
non-biological.

So while the development of biomarkers may identify those who can
benefit from biological treatments there's still the need to identify
those who would benefit from psychological treatment and the specific
therapy that would work first time round. The issue of an individual's
reslience to emotiona pain and low mood is also necessary to take into
account when asessing what treatment to offer as well as cultural norms
and personal beliefs. The last of those is is least considered in
psychiatric research.

What to do when my jug is empty?

I use the metaphor of the jug of giving. When my jug is empty I can't
drink and it's hard for others to drink. Some people don't have this
problem because they don't give from their jug. For those that know the
feeling of feeling empty and still trying to give there's a point where
it gets hard.

LAst Friday a stranger gave me the advice to refill my jug. But I'm not
sure I know how for myself. I think I can sometimes offer the solutions
to that for other people though.

The Parity Act in the US and travel insurance in the UK

This is an interesting piece of legisliation. The American health care
system is insurer back which is why it may be necessary. It's brings
parity between mental health problems, including substance misuse
disorders, and physical health.

In a sense there's no need for a legal bill to achieve the same in the
UK because there's no problem of insurer-backed provision. There are
huge inequalities in provision of care for mental and physical illness.
The costs of Herceptin - a cancer drug that offers a few years of extra
life - are in the millions for the treatment of a few hundred people
whereas the thousands of people of clozapine, a drug that significantly
reduces life expectancy, have fewer options and aren't offered
expensive, long term psychological therapies. Admittedly the evidence
for Hereceptin's effectiveness is considerably better however much of
the psychiatric research looks at psychopathology (illness spectrum of
mental health) rather than than the unhappiness (distress spectrum of
mental health).

There is a need for the sort of legislation that ensures equal treatment
in consumption of certain services such as travel insurance. This
effectively works like the American healthcare system however mental
health problems are often excluded or have significantly lower levels of
cover and this is rarely made explicit by providers.

A cracking blog post exposing the problems of using measures to describe hospital quality

Straight Statistics is an interest organisation and I really like
their blog.
http://www.straightstatistics.org/article/hospital-mortality-%E2%80%93-genie-out-bottle

Essentially the results from different ways of working with numbers and
applying them to the qualities of a hospital come out with widely
different results. There's no system that's agreed to be robust and
provides a statistically accurate and reliable picture but they're used
anyway. The site has been involved in criticising the national measures
and from the author's conclusion it seems the Department of Health have
moved swiftly into action and....renamed them.

The application of scientific techniques in early sciences is usually
pretty poor. Measures have always been important but they're getting
more and more common. More people expect to see numbers and graphs, then
use them to make decisions or campaign for change. But these techniques
have a long way to go before they become anything akin to the accuracy
and predictable usefulness of these methods in advanced sciences where
these techniques have been used for millennia..

Sadly people still treat numbers and measures of soft quantities with
the same trust as they put in a car speedometer. Currently measures
outside the physical sciences often and at best can be used to
guesstimate stopped, going forward, going forward really fast and going
backwards. They haven't developed the accuracy to really use numbers
like 0, 15, 50 and -15 miles an hour. They also don't predict yet either
though they're somewhat better than sacrificing a chicken to the gods
and looking at its entrails.

Brain grey matter changes in psychosis

Fundamental to the biomedical model of mental illness is biological
cause. The most well studied is schizophrenia and there is some
frightening evidence that there it may have a significant part of the
illness coming from changes in the brain. Wherher these changes are
illness or just a change is a complex debate but for another post.

In an earlier post I made the point that changes in the brain don't mean
illness, otherwise taxi driving would be a mental illness according to
the research.
http://imaginendless.blogspot.com/2010/05/driving-taxi-is-brain-disease.html

At a guess and from experience of schizotypy and schizoaffective
disorder before then I think there are important aspects of the internal
experience that are missed by the psychiatric research. This is based on
my personal experience rather than anything based in stuff I've read.

There is the inside world and the outside world, the world of the mind
and the world of the real world or external reality. As a geenralisation
I'd probably say people who experience psychosis or have alternate
experiences of consciousness tend to be more inside world people.
Automotons, or those who don't experience mental health problems may be
more outside world people.

The terms inside and outside world can cover many experiences. I use it
in this sense to differentiate how people understand the world. This
mainly applies to social reality rather than physical reality but I
haven't full gone through the thought process on this concept yet to see
what it does and doesn't include.

How does a person judge an event in the world and intepret it. There's
the Bayesian theory of the mind. There are other theories too. I
percieve two modes: listening to intuition and this is analogous to
listening to the voices of the hearing voices experience or trusting the
other consciousness and thoughts in my experience. The other is to
interpret reality as a person would, using the tools developed through
learning through society.

A person winks at you. What does it mean? An outside world person may
consider the many possibilities. It could be the wind. It could be a
sign of attraction. It could be a secret sign. It could be a wink at a
joke you don't understand. It could be something else. It takes more
brain effort and uses more of the brain, and in doing so keeps the brain
working like 'normal' people who aren't in touch with their internal
experience. People who listen to their intuition or their unshared
perceptions or voices or whatever may use their higher brain functions
less. This could be a factor in the changes in brain volumes seen in
studies.

Not everyone listens to their other consciousness or voice though some
paradigms of treatment for psychosis tell them they should. A person who
experiences a 'paranoid' experience of consciousness may not be able to
safely listen to their other consciousness. In the classic story of
command hallucinations, the story of Abraham in the Old Testament, the
voice of god tells Abraham to kill his son. The Bible story has a happy
ending but I expect in modern life the story may happen and be retold
differently. A noteworthy result is people who are paranoid tend to be
more intelligent. This may be because of having to use the external
world processings bits of the brain and the internal world processing
ones which are both experienced at the same 'volume' (or intensity).
They're constantly having to choose and do more processing to interpret
reality so their intelligence increases. Constantly having to do this
may mean their brains change differently to how other people's brains
change. Just like with taxi driving this may show in brain volume changes.

It's worth noting that I don't take the psychiatric view that the
exprience is a brain dysfunction but I have no clarity on what it is. It
may, perhaps, be a spiritual or paranormal experience and there are case
studies that show this could be possible. See the paper noted in the
blog post below. It's the case of a woman who self-diagnosed through her
voices. In terms of society's judgement of hearing voices and psychosis
this single case is the opposite of the case of Abraham in that this
woman's experience was benign and there was no risk of homicide. There
are other cases detailed in Accepting Voices by Marius Romme and Sandra
Escher.
http://www.mind.org.uk/shop/books/self-management_self-help/274_accepting_voices

Anyway, this factor of the internal experience being the source of the
change in brain volume may be significant. The debate about changes and
differences in brain matter and volume as non-pathological is a bloody
hard one.

A startling case of hearing voices diagnosing cancer

A difficult case: Diagnosis made by hallucinatory voices
http://www.bmj.com/content/315/7123/1685.extract
Ikechukwu Obialo Azuonye
BMJ 1997; 315 : 1685 (Published 20 December 1997)

"
A previously healthy woman began to hear hallucinatory voices telling
her to have a brain scan for a tumour. The prediction was true; she was
operated on and had an uneventful recovery.
"

Yeah. That's pretty cool huh?

It's n noteworthy the author, a consultant psychiatrist, is black. Many
people from other cultures wouldn't have attempted to get this case
study published in the British Medical Journal.

Bibliography of hearing voices research on Guardian website

http://www.guardian.co.uk/society/2001/nov/30/mentalhealth

Where's the wanker?

On a recent job application bit I was filling out that "what sort of
'token' are you?" bit - the equal opportunities section.

I got to the sexuality bit and my sexuality wasn't there. I'm an
autosexual. I'm a wanker. I masturbate more than I have sex.

We're not an underrepresented group I guess. There are a lot of
successful wankers. But the category isn't noted. The great sexuality
battle was about hetereonormativity. Autosexuality is a different kettle
of fish all together. There is the autosexual's choice of gender in
their imagination or pornography of course and there are few people who
would honestly say they chose to be autosexual. Much of that may be to
do with the sexual-normative politics that govern straight and gay
sexuality but aren't necessarily the only way of thinking.

THe funny thing is being a wanker isn't illegal and it's not really a
mental illness though excessive masturbation has been noted in some
people with mental illneses. It's a big social taboo to speak about it
because of the social shame but it's not really a bad shame as such..
Virginity may have the same or higher levels of social shame. That
wasn't an option either.