This Week in Mentalists (105)

Quite a long TWIM this week. Also, I’ve decided to spice up TWIM by adding what I’ve decided to call the Wildcard.

The Wildcard is a blog post on any non-mental health related subject that’s tickled me over the past week. Basically something to add a bit of variety into TWIM.

What will be the subject of this week’s Wildcard? You’ll have to read on to find out…

Aethelred the Unread critiques Harry Guntrip’s definition of a schizoid personality.

There are nine alleged characteristics of this personality type which Guntrip pulled out of his arse described, one of which is withdrawnness:

While there are many schizoid individuals who will present with obvious withdrawnness (a clear and obvious timidity, reluctance, or avoidance of the external world and interpersonal relationships), this defines only a portion of such individuals. Many fundamentally schizoid people present with an engaging, interactive personality style. Such a person can appear to be available, interested, engaged, and involved in interacting with others; however, in reality, he or she is emotionally withdrawn and sequestered in a safe place in an internal world. […] withdrawnness or detachment from the outer world is […] sometimes overt and sometimes covert. When it is overt it matches the usual description of the schizoid personality. Just as often, it is a covert, hidden internal state of the patient.

Isn’t that just marvellous? If you’re shy, timid, introverted, emotionally unavailable, withdrawn from the world and reluctant to engage with others then you have a schizoid personality. On the other hand, if you’re the exact opposite – if you’re bold, outgoing, extroverted, emotionally available, engaged with the world and keen to interact with others – then you still have a schizoid personality. This is because all your clearly-not-schizoid behaviour is just a front for your ‘covert, hidden internal state’, which you give no sign of.

This is patently, inescapably nonsense (I mean that quite literally – it is non-sense). It’s a recipe for a psychologist to take any behaviour pattern whatsoever and cite it as evidence for a diagnostic decision s/he has made in advance, and irrespective of the patient’s actual behaviour.

Fighting Monsters discusses Community Treatment Orders.

This was one of the more controversial parts of the amended Mental Health legislation in England because it allowed for conditions relating to treatment to be placed on patients in their own homes. It allows for a process of ‘recall’ to hospital is the conditions relating to treatment are not met.

We, in our training and discussions, are often signposted to people who may have a very clear history of ‘revolving door’ admissions with similar sets of circumstances and the CTO provides a means of enforcing treatment with the threat of recall to hospital in the background and a legal framework being provided in order to do so.

The general discussions that I’ve been party to in my local trust area seems to revolve around a few consultants being very much in favour of using them and others not using them at all so the national figures are high. It is another way of managing risk through compulsion and in an increasingly risk averse culture, it can be seen as an additional safeguard.

Marine Snow has a harrowing post on the physical and cognitive effects of eating disorders.

It’s odd to notice the way those all familiar games begin. I’m thinner, I’m thinner, check the mirror, check the mirror. Then suddenly whale like in proportions. Sleeping fully clothed with a hood up and three pairs of socks. Waking up violently after just a couple of hours, feeling my heart fitting madly and watching the veins on my arms stand up like wires under cling film. Fingers swelling. Too soon, it’s happening too soon (Please-god-don’t-let-me-die-before-I’m-thin-or-at-all-perhaps-I’ll-eat-tomorrow-I’ll-eat-more-tomorrow-just-let-me-live). Light on, shivering under the duvet, forcing down a weight watchers wafer just to get enough calories to be able to fall asleep again. Having a secret bath in the early hours of the morning, which takes an age to fill, but knowing it’s the only way to get the feeling back in my feet, and the icy hands from stroking my shoulders. Jack Frost bestowing me with a bear hug from behind.

CBTish looks at the marketing of CBT training to the NHS.

When production capacity exceeds demand, one way for the business to adapt is to divert production into other products whose markets are not yet saturated. Applying this logic to the CBT training industry, you would expect to see its marketing machine promoting related products.

But what products are related? How can the NHS be persuaded to buy the product of some other kind of training related to CBT? What other training is there?

What there is, and what you will increasingly see being marketed to the NHS, is additional training in relation to IAPT. This will not just be the training that’s needed so that IAPT workers can do their jobs. It will be additional, unnecessary training to help absorb excess capacity in the training industry as primary sources of funding go into decline.

The initial reasons given to persuade the NHS that this training has to be purchased will be a pick’n’mix of the usual blather that everyone is used to from politicians — to protect the public, to save the planet, for the sake of children everywhere, to help those least able to help themselves etc. etc. — known in the US as “motherhood and apple pie” reasons. The blather will soon be followed up by “research evidence”.

Schizophrenia – A Carer’s Journal has an uncomfortable look at the future.

“Am I going to be in a psychiatric ward forever?”

Sam has often asked such things. It may be a sign of him getting better. Planning for the future.

“No Sam. Of course not.” And I started talking of possible futures.

More perhaps to persuade myself than him.

DeeDee Ramona receives a CPN visit.

We talked mostly about my problems sleeping and my plans to return to work. She advised me to have relaxing music to listen to when I wake up at 4am. I explained that I did not want to wait potentially months for the sleep to sort itself out before going back to work, but thought I could manage 4 hours of work a day, ie part-time, which work are ok with, on 5-6 hours of sleep a night, although it would not be any fun.

She pointed out that we tend to naturally scale back our activity during the day when short of sleep, and if I increase my activity by doing work I could trigger another episode of hypomania or depression. This worries me, as I cannot, if the sleep doesn’t sort itself out by the end of the month, spend months sitting around waiting for the sleep to resolve itself just like that – that will not help my mental health either.

Frontier Psychiatrist weighs in on the sacking of Professor David Nutt.

When it comes to drugs, Mr Johnson is not the only person who has admired scientific advice only insofar as it agrees with current policy. As well as ignoring the AMCD’s advice regarding cannabis, Jacqui Smith also vetoed their recommendation that ecstasy be downgraded from a class A drug, a conclusion that involved the AMCD reviewing four thousand scientific papers over a twelve months period. Internationally the situation is hardly better. In 1995 the World Health Organisation conducted a thorough survey on global cocaine use. Although eventually leaked, the full report was never officially published as the US representative to the WHO threatened to withdraw funding unless the organisation dissociated itself from the conclusions of the study and cancelled its publication. The report had suggested that use of cocaine did not necessarily lead inexorably toward either individual or societal collapse.

The debate on drug legalization appears, as Professor Nutt has found, to be almost uniquely charged. The reasons for this are complex but perhaps are rooted in drug use’s consequences being, at worst, easy fodder for any right wing commentator: people enjoying themselves, youth running amok and slothful hippies; successive governments have run scared from sections of the popular press that purport to represent the attitudes of the public. It is reasonable to be very wary of drugs as some, but not all, of them have the potential to do great harm but our current debate is distorted and muddled and the focus on illegal drugs in isolation blinds to the damage currently visited by the excess use of alcohol.

Despite the positioning of politicians, Dr Nutt’s resignation shows us that UK drug policy is clearly driven not by sober reflection of evidence and what this tells us about harm, but rather lip service is shown to scientific opinion which then partially conceals an unacknowledged moral and political agenda.

Neuroskeptic also discusses the Nutt sacking (oh come on, I had to get at least one “nutt sack” pun in there)

Nutt’s mistake was to think that it’s possible to have a serious debate about a serious political issue. In fact, it was probably not such a bad mistake, since the job of the ACMD, as the Government sees it, is a fairly pointless one: their job is to give expert advice and then let it be ignored. As various ACMD members have noted, they work for free, in the public interest. If I were on the Committee, I would resign now, not just out of sympathy for Nutt, but because it’s a crap job.

In his dismissal letter, the Home Secretary told Nutt, “It is not the job of the Chair of the Government’s advisory Council to initiate a public debate on the policy framework for drugs”. I would have thought he was exactly the person who should do this if such a debate was necessary, as it obviously is. Well, now we know better. It wasn’t his job. Although, thanks to the government who sacked him, a drug debate is now going on in the British media for the first time in years. In the long run, Nutt’s most important action as Chair of the ACMD may well have been getting sacked from it.

Obsessively Compulsively Yours is undergoing exposure therapy.

Last night I made a huge advance in my exposure therapy. I only kissed my youngest brother once before bed, rather than the usual requisite of twice. I cried, I screamed and I shouted, but I did not give in. The thing is, I would be prouder of myself, I would think more of this achievement if it were not for the fact that I did all of this in front of my family.

I think that it’s pretty well accepted that mental illness does not pick and choose – anyone from David Beckham (yes, another OCD sufferer) to the girl down the road can be struck down by an invisible illness. The thing that has got me thinking is the affect that this has on the family, on those that care for and love the crazy people of this world.

Whether it’s the endless reassurance that I demand in order to satiate the dragging doubt or the complicity in my rituals that I require, they certainly don’t get an easy ride. I will never have enough words to tell them, but I appreciate the fact that my mother will reply to the endless questions that I ask, repeating again and again that yes, it is off, I am thankful that my father will push me into doing the exposure therapy, that he will challenge me and yet give me a great big hug when I do make it. I will never be able to thank my youngest brother enough – at the age of ten and without any understanding of the condition he is my greatest cheerleader.

Mentally Interesting: The Secret Life of a Manic Depressive reports on visual hallucinations.

I got tipsy (I didn’t mean to, it was a tiny amount of whiskey, I had an empty stomach), then rapidly sobered up. Few hours later, I heard a loud rattling. Looked to where it was coming from (above the computer desk) and saw a gigantic fucking spider-thing with huge legs trying to pull the poster off the wall, shaking little black things from it, which looked like they were being peeled from the poster. They fell down the back of the table. I sat frozen in complete fear for a moment then it disappeared, reappeared at my fireplace, still rattling and I fucking legged it out of the room, still holding my Macbook, into the kitchen, petrified. The kitchen felt too bright and exposed, so I went into the bathroom, knocking a load of shit over on the way. But that felt too dark so went into the kitchen again.

I KNOW it wasn’t real. It couldn’t have been. It was huge and a spider thing can’t take a poster off the wall nor shape shift and reappear. So I’m logical and aware. Spider things are my thing- I’ve seen them before. I am aware- so I’m not telling my CPN because if you’re aware they don’t believe you anyway. I know it’s not real so it’s okay. This is not the first time this week something has happened. I had been hearing some stuff earlier in the week. But I can’t tell how much of the stuff I’ve been hearing was real or not real. Sometimes I can just think, “This can’t be real” sometimes- well, when I don’t know, I don’t know so I don’t know if I’ve been hearing other things, if you know what I mean. Was the spider thing a hallucination or am I just tired or is it because I’ve been fucking around with medication or stressed? I am stressed. So I don’t think it’s a problem, and listen to me here, I’m coherent, I’m fine. I don’t think anything is wrong because I’ve been functioning mostly fine (need a bath though, will have one) and I’m okay. I think it must be just stress. But if it’s stress and I tell my CPN I’m scared they’ll try and slap me with BPD and I can’t take another “problem”.

From the cartoon blogs, here’s My Medicated Cartoon Life.

And Prozacville

Our inaugural Wildcard is Ministry of Truth, an anti-pseudoscience blog. They report on the Sniffex, a “portable explosives detector” being sold to police and security forces in Iraq. So what’s wrong with that? Surely if it saves Iraqi lives by detecting explosives, that’s a good thing? Ministry of Truth, however, spots the flaw.

The Sniffex is a dowsing rod.

Actually, its a very expensive dowsing rod, as the NY Times reports that these device retail at anything from $16,000-$60,000 for each unit but nevertheless its still the same device that you can quickly knock up in your own home with the length of wire and an empty biro tube, as this image of a near identical device, marketed by a British company as the ‘ADE 651′ neatly illustrates.

If all there was to this story was a tale of a very American stock market fraud then that would be that, but despite this device having been exposed as being utterly useless, companies in the UK and Germany continue to market it to various police forces and other security services across the developing world.

To those who believe in dowsing, here’s a test of faith for you. Do you really, sincerely believe in dowsing? Enough to walk across a minefield with nothing but a Sniffex to find the landmines? Good luck with that.