This Week in Mentalists (109)

This week, Mad Sad Girl continues her excellent first-person account of being on an acute ward, Prozacville offers us some Christmas nihilism and more. We’ve also got an apocalyptic-themed Wildcard.

Fighting Monsters looks at media responses to the findings of the Social Work Task Force.

The Independent focuses on the tagline of ‘better pay’ for social workers but no money to fund it – which is the crux of the problem really. Similarly, the Times also looks at the ‘elephant in the room’ – namely funding for the additional money that might be spent to implement the recommended changes. The comments though are a little disheartening. There seems to be a perception that anyone with a bit of ‘common sense’ and ‘life experience’ can be an effective social worker. I think there is so little understanding of the importance of training that it is almost frightening.

The Daily Mail meanwhile go for a whiny

‘Social Workers to be given pay RISES in the wake of the Baby P scandal’ which is a disgustingly ignorant headline. Their capitals by the way. It is a plain misrepresentation which panders to their insufferable readers. The comments are enough to make my stomach churn. I would love that reporter to come to my office to see the work we do on a day to day basis.

The Sun’s agony aunt, Deirdre Sanders who actually sat on the Taskforce tells her readers

‘How we can stop another Baby P’

She seems to put things in patronisingly simplistic terms but it gets the general message across although I think that relating all the changes to a single child’s tragic death is not entirely a fair explanation of the scope of the work done. There is a generalised thought lingering in my mind that there should be a wider understanding of what we do as social workers in adult and mental health services rather than the focus solely on child protection issues as the Task Force was to concentrate on social work as a profession rather than one aspect of it.

DeeDee Ramona has a list of films not to show on a rainy day on an acute psychiatric ward.

1. Bladerunner
Some of you will recall, when visiting me in the Royal Ed in 2008, a particular young man who spent his time walking around the ward scanning for androids with his lighter. I failed the Voight-Kampf test so he was rather suspicious of me. Luckily, a supplementary scan revealed that I was, in fact, human, and sense prevailed. Watch Terminator instead.

2. Ordinary People
An idiot nurse decided to show this excellent 1970s film starring Donald Sutherland and Mary Tyler Moore to the young adult program in St Pat’s because she thought it would ‘stimulate discussion’. It did not, instead it made everyone feel guilty and self-hating and intent on cutting themselves. You’d think that someone would think twice about the suitability of a film showing the breakup of a family over the mental illness of their kid for an audience of mostly suicidally depressed teens, but no. If you’re not depressed, I recommend you do see this film, BTW.

3. The Truman Show
I don’t need to say more, do I?

4. Schindler’s List
Or anything at all to do with Nazi Germany. I was sitting in the dining room of ward 6 at one stage, talking to V., a friend of mine, about Primo Levi’s The Periodic Table. I hadn’t read anything of Levi’s although I knew a fair bit about him and V. was telling me about the book. Another woman joined us and wanted to know what we were talking about so we explained. Later on, this woman spent about 2 hours walking up and down in the corridor screeching, “I know how many people died in ww2!”. It sounds funny but she was probably being bothered by horrible hallucinations, so, leave Hitler and the concentration camps alone.

5. Twilight
Because it’s SHIT.

Made With Awesome, who has to navigate the US healthcare system rather than the NHS, discusses the costs (financial and otherwise) of medication.

I had been managing pretty well on medication for about a year before I decided to try coming off them. I didn’t want to take medication my whole life if I didn’t really need to just because I had never tried to come off. Medication has done some pretty wonderful stuff for me, but it does come with a price. Economically, I have to pay for the drugs and the psychiatrist appointments to get the prescriptions for them, which isn’t cheap, even with insurance. Beyond that, I also have to carve out the time to see my psychiatrist and go to the pharmacy. But, of course, the side effects of the medications are the cost that loom largest. The medications that worked for me (venlafaxine/effexor, escitalopram/lexapro) exacerbated my orthostatic hypotension, gave me head lightening when I was late for a dose, and made me very very sleepy. I was okay with the idea that I might find I needed the medication to keep the depression and anxiety at bay, since I would much rather take the pills than live through that hell, but I didn’t want to continue to pay the price of taking the medication unnecessarily.

Writing in the Margins of My Mind has some anecdotes from A&E.

* Me (when asked about my diagnosis): “everyone hates a borderline…” / Charge Nurse: “I don’t hate you. And believe me, at 2am in A&E, if we don’t like you we tell you straight”
* Registrar: “ALRIGHT I’ll go and deal with the brat germs if I have to…”
* Overheard a conversation between the registrar and a nurse where the registrar was asking about stitching techniques and the nurse was explaining… whilst the doctor graciously admitted her lack of knowledge and learned. Mental Nurse would love it!
* I hyperventilated in the middle of my psych evaluation, and I got up and stood with my palms on the wall to breathe deeply because I find something solid helpful to ground me. As it turned out, the wall stank, and I pointed this out once I’d calmed down. My assessment, which my CPN showed me today, lists this as “odd behaviour” which gave “some cause for concern”!
* Psych nurse told me she wouldn’t normally come out to a simple self harm case where there was already community care (because there’s little she can do), but was convinced because the doctor that saw me was really concerned. That’s immensely sweet, because he was an FY2 (aka baby doctor) and must have had to push quite hard to get her out considering his lack of seniority. Bless! I asked him how often he gets told he’s not old enough to have a medical degree… he admitted it’s several times a week.

Frontier Psychiatrist continues his look at psychiatric eponyms with De Clerambaut’s Syndrome.

Also know as erotomania, De Clérambault’s syndrome is one in which a delusional belief is held by a patient that another person, usually older and of higher social status, famous, wealthy or in a professional relationship with the patient is deeply in love with them.

Pursuing the object of their affections and repeatedly pestering them by telephone, by letter and with gifts is typical. Some people suffering from this disorder arrange ‘holidays’ or ‘weddings’ with their supposed lover.

Key features are:

* The conviction of being loved
* Supposed lover does nothing to encourage or sustain the belief, usually making clear their lack of interest or concern
* Words or actions of supposed ‘lover’ are reinterpreted to maintain belief in requited love
* Belief that supposed relationship will eventually result in a permanent and loving relationship
* Preoccupations with supposed love form a central part of the subject’s existence.
* Repeated attempts to approach the supposed lover creating at least embarrassment and distress.

The condition is rare and has various aetiologies; it can surface in association with schizophrenia or affective disorders, or on its own as a single delusional disorder. It is seen in forensic populations as a result of criminal acts secondary to the delusion and is one of a number of behaviours that may be associated with stalking.

The disorder is named after French psychiatrist Gaëtan Gatian de Clérambault (1872–1934), who published a review paper on the subject (Les Psychoses Passionelles) in 1921. The syndrome has featured in popular works, perhaps the best well know of which is Ian McEwan’s Enduring Love. It is thought to have effected John Hinckley, Jr. who shot President Regan in 1981 in an attempt to impress actress Jodie Foster, who he believed wanted a sign of his devotion.

Neuroskeptic reports on an interesting study in which psychiatrists medicated themselves.

Thirty healthy psychiatrists and clinical psychologists took paroxetine 20mg per day, or placebo pills, for 4 weeks. Paroxetine (Paxil, Seroxat) is a popular SSRI antidepressant – popular with doctors, at least. It has a bad reputation amongst users as causing serious withdrawl symptoms, even compared to other SSRIs. These psychiatrists decided to wean themselves off with a week at a reduced dose of 10mg before stopping completely – after just one month on it! Make of that what you will.

Anyway, what happened? The participants experienced no changes in mood or anxiety, although since they weren’t depressed or anxious to begin with, this is not surprising. However, the people taking paroxetine did report reduced “Internal Emotional Experience” as measured with the Emotional State Questionnaire (designed by the same people who ran this study.) That means they were less likely to answer yes to questions like “Do you feel anger when faced with a familiar face with expressed anger?”

This sounds as though they experienced the “emotional blunting” reported by some people who take SSRIs, although it’s not clear what exactly this questionnaire is measuring, or how powerful the effect was. The paroxetine group also reported feeling sedated and suffered many more side effects – 70% of participants presented with an adverse event for more than 3 weeks, vs 20% of placebo.

Most described adverse events were psychiatric (sleepiness disorders, libido decreased), gastrointestinal (nausea, diarrhea), or neurological signs (headache).

There’s a twist, though, in that while 20 of the subjects got placebo or paroxetine in a double-blind manner (10 each), the other 10 got paroxetine unblinded, i.e. they knew they were not going to get placebo. Strangely, the unblinded group experienced much weaker effects than the double-blind paroxetine group, including many fewer side effects. What’s up with that? It’s hard to say. It doesn’t make much sense. To be honest, with just 10 people in each group, any or all of these results could be random chance anyway.

Mad Sad Girl continues her account of being on an acute ward.

Having been so exhausted both physically and mentally from the day I had hoped that I would sleep through the night, but it wasn’t to be. At 2am I was wide awake and in desperate need of something to drink. I got out of bed, put my cardigan on over my borrow nightwear and headed out of my room to the dining area in the hope of finding something in the fridge or at least the makings for a cup of tea. No chance; the area containing the sink, fridge and tea and coffee facilities were shut up behind a shutter. Desolate, I headed back to my room.

Just as I made it back in my room, one of the night staff came out of the office to see what I was doing. I explained that I had woken up in desperate need of a drink and had gone looking for something to quench my thirst. I would have loved a cup of tea, but I was offered hot chocolate instead. An hour later I was still wide awake and it was decided that it was too late in the night to give me something to help me to sleep.

I was reading my book at about 5am when I was startled by an alarm sounding. Why had nobody bothered to tell me about the alarms that were activated when there was trouble with a patient and extra staff were required from the other wards? The alarm went on for about 5 minutes before being silenced; all I know was that it was not my ward where the emergency was.

Obsessively Compulsively Yours is benefiting from exposure therapy.

I have made huge progress with a fear that has gripped me for so long – I am now able to hold a sharp knife in the same room as my brothers. I still have the overwhelming anxiety that comes with the utter certainty that I will kill them, that I am actually a horrible, terrible person and that I have no desire stronger than that of stabbing them to death… but I haven’t done so, and surely that says something?

I suppose this is the point of the exposure therapy – I am testing out the hypotheses that the OCD has forced me to put in to practice, and each time I realise that they are a little more, well, wrong. I have messed up my shoes, and yet nobody has died, I have kissed my brothers just once, and yet they are still all in one piece, I have passed a knife to my mother and yet she is not lying in a pool of her own blood – something is not right here, and I’m starting to think that the bugger that is OCD has been tricking me all along.

I’m starting to think that it’s a load of old bollocks.

Prozacville is getting into the seasonal spirit.

This week’s Wildcard is the Dear Commander blog. Apparently every Royal Navy Trident missile submarine has a safe containing a letter from the prime minister, to be opened only in the event of Britain having been wiped out by a nuclear attack. The blog invites readers to send in their own versions of what they would write in such a letter. This week has a contribution by Shangeetha Rajah Kumaran from Malaysia.

Dear Commander,

I pray that this day would never come and you do not have the burden of reading this as much as I have when writing this letter. It is indeed a sad day that our world has lost its sense of humanity if you are reading this.
You and your men and women must be angry and hurting but do not let it blind your common sense. Do not, under any circumstances, retaliate by firing that nuclear missile on innocent people. It must be chaotic up there but you and your men and women must be strong and remain calm. All of you were chosen because you are the best among equals. Do not let blind fury rule and put an end to civilisation. The world as we know it might be coming to an end but the future lies with you and your brave men and women. You are in a position to start a New World. A world that will not have to see what nuclear devastation does. A world that lives with a strong sense of humanity. A world that does not look at violence for an answer. A world where all men and women are treated equally.

Go now with my blessing and prayers and may you and your fine men and women find a place where a new civilisation will begin. Do not let History repeat itself but learn from our mistakes. Take care Commander and may God bless you and your men and women,

Shangeetha Rajah Kumaran

Finally, don’t forget to check out The New Republic’s That Was The Week That Was In Autism.