This Week in Mentalists (85)

Apologies for TWIM being a day late. I was a bit lazy busy yesterday.

Anyways, on with what’s been happening in the mental health blogosphere.

Fighting Monsters discusses the case of a social worker with a conviction for conspiracy to murder.

I am more than happy to work alongside those who have spent convictions and have done, however I had always thought that any conviction for a violent offence would automatically bar me from practising (as opposed to a fraud or non-payment of tax type conviction).

Norman’s argument that such a conviction should not automatically disbar Barnes from registration as a social worker sits a little uncomfortably with me. Possibly due to the GSCC’s lack of action but I think back that it is because of the nature of the conviction. Perhaps that makes me over judgemental. I suspect it does so will be pondering more on that over the next few days I imagine.

The GSCC confirm that

a criminal conviction was not a bar to registration.

And I absolutely support that without any question but I do think the nature of the conviction should be taken into account. Particularly, as The Independent notes, things may not have been as straightforward as they were presented

Marine Snow went on a date, and it turned into a threesome between her, him and her eating disorder.

I think this has been a pretty good experience for me. It’s taught me a lot, in a very simple evening. I’m not ready to settle down, but I am ready to try this again. Getting out there and experiencing everything that life has to offer, positive and negative feelings, is what recovery is all about. Recovery is supposed to be freedom, but what seems to have happened recently is that freedom has been a carefully measured plan. I’ve been tying myself up with recovery rules, just as much as I was with ED rules. To avoid falling into a rut again, I’ve decided I need to stretch myself. In the spirit of living spontaneously, I am going away for a week as of tonight. My Grandmother is on holiday, and I’m off to house sit for her in the town where I grew up. I’m going to spend a week living out of a suitcase, negotiating buses and new routes to and from work. Staying with friends random nights here and there. I’ll be away from my safety zone of a stocked fridge of safe foods, and routine. It’s going to be good for me, and I am quite excited. Oh and cacking my pants….

Not Another Nursing Student has an encounter with Big Pharma.

But today I actually had a lesson in which the tutor didn’t lower the level to that of the thickest person in the room. It felt nice to be treat as an intelligent individual, and to be stretched for the first time in ages. As a result, I paid attention and actually learnt something that I didn’t have to teach myself from a book.

Unfortunately, this individual wasn’t a member of staff at the uni, so it’s unlikely we’ll ever have him again. There is a good chance I’ll meet him in the course of my career though….because he was an Evil Drug Rep. Yes, Big Pharma is in your classrooms, teaching your student nurses the stuff the Trust can’t be arsed to.

The session was on delivering the Risperdal Consta depot. Yes, another one. And no, we still aren’t allowed to give it, since the Trust is apparently reviewing some guidelines or something. To be fair to Evil Drug Rep, he actually spent a fair bit of time explaining the pharmocology of antipsychotics, which isn’t something anyone else has bothered to try and teach us yet as they seem to think it’s too hard. It is hard, but damnit we should be able to handle it. He didn’t focus excessively on Consta, nor on the downsides of the other drugs….although he did occasionally slip into salesman mode, most notably when asked about the cost (around £148 per 50mg vial).
He did bring free USB sticks…but I was disappointed by the lack of sandwiches and post-it notes.

Schizophrenia – A Carer’s Journal discusses mental illness and smoking.

Currently I normally take Sam eight 12.5 gram packs of tobacco each Saturday. The notion is that there is one a day and a spare one. That seems to have been working out okay recently. Then last week he asked if we could take some more in when we were joining him for a meeting on the Wednesday. So I took in four more packs. On Friday there was an urgent call. Please could we take some more tobacco in for Sam.

He has been smoking a bit more recently but it does seem to be getting out of hand. Yes he will be bored … but perhaps he shouldn’t be if there were more activities available. He has few pleasures – but smoking is a danger to his health yet it is a nurse ringing me asking to take it in. His increased weight gain is a risk to his health – but again it is a nurse asking me to give him some more money to buy take-away food from the pizza and burger bar.

Smoking tobacco also works against the effects of the anti-psychotic medication. Perhaps that is another reason that many psychiatric patients smoke – to alleviate the affects of their medication. When smoking has been banned on some wards they have had to reduce the medication as a result.

Writing in the Margins of My Mind is engaged in transition from CAMHS to adult services.

1) CAMHS will keep me until September. After my twice weekly therapy officially ends in July, my therapist, her supervisor (who I hate but eh) and my psych will cobble together enough of their time to keep me seen fairly regularly until I leave. This is nice of them. I suspect it has also been forced upon them because AMHS will not want the hassle of a transfer when I will hopefully be leaving very soon.

2) The practice manager at the university health centre has been contacted. Whilst she cannot do anything about anything before I get there, if I phone her as soon as I arrive she will arrange for me to be registered and seen by a doctor immediately and contact the CMHT for me. This is nice of her, and it seems the best that can be done in the circumstances (although I still think the mental health trust should have a better fucking policy for this because it isn’t so radically out of the ordinary for a crazy person to move house).

I feel a bit more secure now, but still… frightened. I don’t deal well with uncertainty – I need plans and structures. Not being able to be certain about anything until after my results come out on August 20th is going to be really, really tough for me. I’m glad I’ll have continuity of CAMHS and won’t be left alone for the summer as previously seemed a possibility, but I’m still pretty scared about the whole thing. Nyahhh! Heh.

DeeDee Ramona is talking to her GP.

These days I don’t have much trouble making eye contact when I talk to people. There’s one exception – when I’m being asked to give an update on my mental health and it hasn’t been so good. I know I keep going on about this, but I find it absolutely soul-destroying, to the point of having difficulty not bursting into incoherent tears, to sit there and tell this other person, who is there for professional reasons and is not my friend or confidant, no matter how nice he may be – and my GP is very nice and competent – something like this:

“This week has been ok. I’ve been having problems with antidepressant withdrawal – dizziness, the runs and the like. I have had really strong urges to take a razor blade to myself and cut myself from shoulder to wrist, over and over, but I’ve managed to resist them. I’ve also gotten into incredible, terrible, potentially violently destructive rages about things that are not really that important and found it hard to handle them but I know they are caused by the withdrawal and that allows me to stay in control. I’ve burst into tears regularly while hugging my husband or my cats, much to their alarm”.

Could you look at someone and hold their gaze when saying that to them?

Becoming Hannah is having difficulty with a therapeutic metaphor.

In today’s session, Rehab Nancy explained to me that if I was on my way to Heathrow, and I didn’t like the idea of sitting in clogged traffic on the M25, then I had the choice of several other routes and no one would judge me or think it odd if I chose to take one of these others available to me. Especially in this doomed age of sat-nav technology {{Hann spits and curses}}. The crucial moral of the story she explained, was that I would ultimately arrive at my final destination of Heathrow, and I would be unflurried and able to board my plane along with everyone else….
….Until I realised I’d forgotten my passport, suffered a huge anxiety attack at check-in and resigned myself to being a complete failure at everything I ever attempt, the concluding resolution to stay locked in my grief hole of a flat and never embark on these far-fetched adventures for the rest of my days; watched all the while through oval portholes by the laughing smug gits shmoozing up and down in their reclining chairs, flaunting packs of complimentary earphones and salty crackers.

OK, so I added the last bit, but she said we’d get to dealing with my self-deprecation and hatred of the general public eventually, for now I should just try to accept the concept that there is more than one route to Heathrow.

Made With Awesome considers overcertainty among mental health clinicians.

While it is appropriate to present the world as very certain and settled to elementary school children, I think this is entirely inappropriate at the college level. At Shimer College, the world definitely came across as being very uncertain, but I know that many colleges present the world as being very certain and settled. I wish it were reasonable to assume that all college students should already understand that the world is not as certain as high school history textbooks present it, but I know better than that. Taking those two factors into account, I can see how people might graduate college, even earn a graduate degree and go on to practice as a mental health care professional, still believing that everything they were told in their psychology classes is hard fact. I have had some very confusing interactions with professionals that this would explain very well.

I’m imagining it like this: A student goes through school and graduates high school never having been told or having considered on her own that things aren’t as straightforward as textbooks and teachers have presented to her. She goes to college and majors in psychology. In her classes things are still presented as being very certain; she is comfortable with this and accepts it at face value. She graduates still thinking everything she has been taught has been determined quite certainly. She goes to graduate school and still accepts things that way. She gets a job in mental health care and interacts with patients based on this certainty. When patients doubt the science behind psychotropic medication, she dismisses them. When patients explain the genesis of their illnesses and this doesn’t fit in with any of the schema she was taught, she dismisses them. When patients express any of the questions of the sort that she neglected to consider as a student, she dismisses them. Perhaps she goes on to teach the next generation of mental health care professionals. Because she never questioned the certainty of our knowledge of mental health and mental health care, she cannot encourage her students to do so and she cannot engage in discussion with her students even when they do question this certainty.

Carole at the Mental Health Nurse Lecturers Tea Party takes issue with mental health jargon.

Maybe it’s on to “Unconditional positive regard”. The good old statement that says I’m not really troubled that you have been violent and aggressive to people in the past, that you beat up your girlfriend so badly she lost her baby, or that you threw your 9 week old puppy down the waste disposal chute, I’ll accept you as you are now because I believe you were lacking “insight” at the time. But what it really means is that I will try and disguise the disgust I feel for your actions because I’m only human and because I’m told you have a mental health problem – but I’m not promising anything.

Speaking of insight…….The Collins English dictionary defines insight as;

“The ability to perceive clearly or deeply”

And “a penetrating and often sudden understanding, as of a complex situation or problem. There is also, “3. psychol; The capacity for understanding one’s own or another’s mental processes”

“4. Psychia; the ability to understand one’s own problems, sometimes used to distinguish between psychotic and neurotic disorders”.

Now I consider myself to be a fairly rational, responsible and capable human being, but am I always insightful according to the definitions? I don’t think so! So why do we often hear, “Mr Jones, suffering from schizophrenia, lacks insight”. How dare we? A double whammy there – who says that everyone suffers from or with schizophrenia? I know of many people who have and still do enjoy their experiences.

I’m not so stupid as to think we can, or should get rid of this type of language, but I think we need to consider the implications of using it. Are we really being honest in our use of it? Does it exclude people because we as mental health professionals have a shared, common understanding of its meaning and others don’t? Is it a cunningly disguised way of stigmatising and discriminating against “service users/patients/clients” (there’s another area that we should really get sorted!)