This Week in Mentalists (108)

Apologies for TWIM being a day late, which was due to a hectic day yesterday.

Mad Sad Girl describes an admission to an acute ward.

I was submitted to an interrogation, the technique of which the KGB would have admired. I should remind you that I was being admitted voluntarily, there was never any suggestion that I needed to be ’sectioned’ but you would have thought that I had stolen the Crown Jewels and then run amok slaying the Royal Family to judge by the manner of the nurse admitting me.

All the relevant personal information had been faxed through to the ward so there was no need for me to go through all that again (they also had faxed copies of all the stuff that my GP had given me when he referred me to the first hospital). So the admission process started by me being told to empty the contents of all my pockets onto the table in front of me. This didn’t amount to much; just a few screwed up tissues and a safety pin (no, I don’t know why I had a safety pin in my pocket either). I was then told that I could put the tissues back into my pocket, but the safety pin was confiscated. Then I had to empty out the contents of my handbag and the other bag that I had with me. I started with the other bag (it’s a cloth bag that I bought in the Natural History Museum and which I invariably carry with me all the time) which contained a waterproof jacket (it had looked like rain when I had left home that morning) and a book. these were deemed to be ’safe’ objects so I was allowed to put them back into the bag and keep them.

Last week I wondered if TWIM was becoming a meme. I may be right, since The New Republic has started an autism-themed version entitled That Was The Week That Was In Autism.

Fighting Monsters discusses the relevance of individual budgets to mental health.

I decided that I really needed to be positive and try to actually understand what was to be happening because it isn’t going away and so, in conjunction with a service user and her daughter (main carer) who want to engage with the process and ‘see how it works’, I am doing what I can to work through the systems as they exist.

The main pilots so far have focussed on younger adults with disabilities, people with learning disabilities and older adults with fairly straightforward care packages.

Although at the time, I explained I felt they needed to tackle some of the more complex examples at the time, mental health services were very much left out of the ‘loop’ of information.

Currently, I have assisted in the completion of the self-assessment questionnaires and have validated them. As the service user in question as fairly advanced Alzheimer’s type dementia, there was a significant input from her family and carers and I assisted considerably myself – so the ‘self-assessment’ idea was somewhat lost through that process but I felt it was important to work through the ‘processes’ with a person who has little capacity to engage actively with the assessments and realistically, it will involve many of the users of our service.

I tackled the RAS (Resource Allocation System) although I’m not entirely confident it is ‘correct’ and so my next task is to take the documents to a meeting to discover what the ‘indicative budget’ is and then, assuming all goes well, to return to patient and carer (I am running two different applications side-by-side – one for service user and a different one for carer in her own right).

I might have messed the entire thing up of course, but as I expected to user and carer themselves, the worst thing that could happen at this point is remaining with the status quo while I spend time working things out. The positive outcome would be more flexibility to choose carers and tasks that are more appropriate to their individual circumstances and to have more input into the support packages that provide the best outcomes.

Congratulations to Mentally Interesting: The Secret Life of a Manic Depressive, who won Best Radio Drama at the Mental Health Media Awards, for her excellent play Dos and Don’ts for the Mentally Interesting.

“Dos and Don’ts…” has been surreal- a radio play based on my scribblings here-therefore, my life- was something I’d never even have thought of or imagined anyone would be interested in. And it’s strange for something that’s so intensely personal to be received in such a lovely way. It’s so heartening that people feel it helped make a difference. We all felt quite honoured to even be nominated. And it’s a strange experience, sitting in a room full of people you don’t have to hide from, because they were all there with the same ideology, that there’s nothing shameful about having a mental illness. I was reunited with Lou, the dramatist, Fiona and some of the shortlisters I’d met when I did it two years ago, which was nice. And I think I coped fairly well with people talking to me, thanks to the lovely lovely free booze!

Writing in the Margins of My Mind receives a lesson in the cost of branded mediations.

I did, however, find out that whereas it costs about £1.50 a month to treat me with citalopram, as duloxetine is only available as a branded drug (Cymbalta), it costs about £30 a month. Because I’m worth it.

Just wait until you see the cost of, say, aripiprazole…

Frontier Psychiatrist has a quick primer on Capgras Syndrome.

Capgras syndrome is one in which a patient has a delusional belief that a person or persons, usually well known to them, have been replaced by an identical impostor(s). It usually occurs in the context of a psychotic illness (more than half of cases are associated with schizophrenia) but may be seen with other psychiatric illnesses, including brain injury or dementia.

The Capgras delusion is one of a number of delusional misidentification syndromes, a class of delusional beliefs that involves the misidentification of people, places or objects.

Joseph Capgras (1873-1950) was a French psychiatrist who first described the disorder in a 1923 paper co-authored with Reboul-Lachaux about the case of a French woman who complained that various ‘doubles’ had taken the place of people she knew. They called this ‘L’illusion des sosies’ (the illusion of doubles).

Current thinking as to the cause of Capgras syndrome has focused on dysfunction of the inferior temporal cortex and the amydala. The former is involved with recognising faces and the latter with the simultaneous emotional reaction. These two structures can be damaged independently; if the ability to recognise faces remains intact but the emotional reaction which makes them familiar is absent, it is hypothesised that the conculsion drawn will be that the person in question is an identical impostor.

More number-crunching from Neuroskeptic, who analyses whether countries with higher rates of mental illness also have higher suicide rates.

I decided to see whether or not there is such a correlation. The World Health Organization (WHO) provides the relevant data here. There have only ever been three studies attempting to measure rates of common mental illnesses internationally (1,2,3), and all three were run by the WHO. The WHO also collates national suicide rates (here) for most countries, although a few are missing. No-one seems to have published anything looking for a correlation between these two sets of numbers of before, or if they did, I’ve failed to find it.

So what’s the story? Take a look -

In short, there’s no correlation. The Pearson correlation (unweighted) r = 0.102, which is extremely low. As you can see, both mental illness and suicide rates vary greatly around the world, but there’s no relationship. Japan has the second highest suicide rate, but one of the lowest rates of mental illnesses. The USA has the highest rate of mental illness, but a fairly low suicide rate. Brazil has the second highest level of mental illness but the second lowest occurrence of suicide.

FWD/Forward discusses negative self-talk.

One of the hardest things for me in dealing with my mental health condition is my very strong theory that everyone else is having exactly the same problems that I am, but they’re just 8 million times better at dealing with them, and hiding them from everyone else. And thus, I don’t talk about my mental health, much, because everyone else is obviously coping with the same thing, and I’m just a big whiner who can’t cope and fails at everything and is useless and should just run away and everyone will be better and– stop.

For extra special bonus points, my mental health condition will also remind me that if I just try hard enough, if I just do more things, I will prove that I’m coping Just Fine and everyone will love me and why would anyone want to talk to someone who isn’t doing all this extra stuff and if I just could cope the way everyone else did I wouldn’t have these problems and I would just be good enough and not have to do all these things and– stop.

It’s a fun game my brain chemistry plays with me and part of the reason it’s so successful is because of how mental health conditions are portrayed in popular culture.

This week’s Wildcard comes from the Encyclopedia of Decency, an excellent snarkblog devoted to dictionary definitions of the various talking points/trolling techniques used on a certain kind of political blog. This week they provide the definition of something called “The Hitchens Formula”.

Income-generating wheeze

Rhetorical cash cow guaranteeing regular payments of Decent Dole to newspaper columnists who have become too senile and incoherent to earn a living, as regularly paid by Slate, The Guardian, Standpoint and the Times.

Originally attributed to Comrade Hitchens, the Formula is expressed thusly…

Did (American action X) cause (atrocity Y)? No!

Rinse and repeat as needed. See also: Condemnit!