In a bizarre and unprecedented feat of organisation, my university has put up a timetable for the first term of the second year. So, on the 14^th November, the university is going to teach me how to give an intramuscular (IM) injection. I assume by this they are going to teach us the correct technique, as opposed to those we have been observing and ignorantly emulating on the wards thus far. But it has got me thinking and possibly even, dare I say it, reflecting…

My first IM was quite unremarkable really, despite shaking so hard I nearly injected my thumb with zuclopenthixol decanoate. The opportunity to do one hadn’t arisen during my first placement, therefore I felt somewhat similar to how I had when I was 16, and positive that I was the only virgin left in my school because everyone else had (allegedly) ‘done the deed’. Embarrassed, impatient and terrified at the same time. It could have been worse though, the other student I was there with hadn’t done any yet either, and won’t now get the chance to before the first placement in second year…on an acute ward.

So, my mentor went through the technique with me, made sure I had read up on what I was doing and administering, then told me to get on with it. Luckily the patient had been having this particular depot for over 20 years, and had had hundreds of terrified students prodding at her buttocks looking for just the right spot to shove a big needle in.

Being a bit of a swot (in the irritating definition, not the strengths/weaknesses analysis twaddle) I had researched my technique, and considered the dorso versus ventrogluteal sites. Of course, when it came to it, I stuck it where my mentor told me to, given that she had never heard of the ventro site and was unlikely to allow her student to just take a (well intentioned) punt at it.

The thing I remember most was how bloody long it took to get the stuff out of the needle and into the backside. I actually had backache when I emerged, blinking, from my crouched position. I was assured that it always takes that long, and the patient very kindly gave me a “twenty out of ten” for my technique. In fact, the experience was very positive. The only concern I had was on hearing that the patient had been admitted to hospital the next morning; I think it’s safe to say I nearly crapped myself, in fact. But I’m reassured that the two things were unrelated, and was just unlucky that my first ever depot patient went into multiple organ failure shortly afterwards. (Last I heard she was shouting abuse at the doctors and singing loudly at 4am, so I imagine discharge is imminent).

I am looking forward to the practical session at uni then, just to see if there was anything I should have done differently. There also appears to be a special section devoted to Risperdal Consta; possibly this is the Trust’s way of ensuring its new nurses don’t accidentally bugger up a £150-a-shot injection.

Now that would be embarrassing

When I started uni, I had no real idea what to expect from the people I would be spending three years of my life alongside. So, after careful research, I present a brief but completely accurate portrayal of the major brands of future mental health nurses for anyone considering doing their nurse training.

Students generally fall into two main groups; college-fresh and ‘matured’.

College-fresh

Can be sub-divided into:

A: Keen, eager to learn, start assignments the day they are handed out and get excellent marks. Very rare. Also very, very irritating to work with. Almost never seen in the pub between lectures.

B: Average student. Wandered into nursing with a vague idea that it is a job for life and because they don’t want to sit behind a desk all day. Usually have some notion that nursing involves caring for people, which sounds pretty good, actually…

C: Just finished college and putting off getting a proper job. Want a course that isn’t going to cost them anything and will pay them a bursary. Would have done ’proper’ nursing but don’t like blood or anything icky; little do they know that at some point in their mental health career they are almost guaranteed to get wee’d on. Start assignments the night before hand-in and scrape by with 40% in everything, assuming they don’t manage to convince a member of Group A to let them plagiarise. Often drop out in their third year, when their dissertation is due and they don’t really fancy doing it.

Matured

Tend to come in 2 flavours:

A: People who did psychology first and now want a proper job Or, people who have been working in a soulless profession (often whilst making lots of money) and suddenly decide they want to do something more ‘worthwhile’ (for lots less money). Kind of like a mid-life crisis but without the fun bits. Usually do well; anyone with kids and a mortgage has a huge incentive to pass.

B: Ex-service users; either those who had a bad experience want to ensure that others don’t get the same treatment, or those who have been helped by services in the past and want to give something back. Both very keen and hardworking. Or alternatively, ones who were inpatients up until a month before the course started and have some ‘issues’ with psychiatry as a whole. Generally quite angry and will shout at anyone who crosses them; lecturers, nursing staff, other students and sometimes even patients….

All students are available in ‘male’, particularly in the mental health branch which seems to attract more blokes than others, for some reason. However, only around 20% of my MH cohort were male, and when combined with other branches the figure is even smaller. It is amusing to watch their faces on the induction day when they first realise they are one of 40 men on a course with 340 women. ‘Gleeful terror’ is probably the closest phrase I can find to describing the expression.

So, a brief guide to what you can expect to encounter, based on my own completely subjective experiences. There may of course be other types out there, and in some universities, some of the students may in fact be ‘normal’. If they are, their training is almost guaranteed to fix that.

The Cyber Disorders section includes disorders that have a dependency upon cyber existence as the predominant feature. The section is divided into three parts. The first part describes e-mail episodes that serve as the building blocks for the disorder diagnoses. The second part describes the Cyber Disorders themselves. The criteria sets for most of the Cyber Disorders require the presence or absence of the e-mail episodes described in the first part of the section. The third part includes the specifiers that describe either the most recent e-mail episode, or the course of recurrent episodes.

The Cyber Disorders are divided into Posting Disorders, Flaming Disorders and CC Disorders. The Posting Disorders (i.e. Lurking Disorder, Chronic Posting Disorder and Posting Disorder not Otherwise Specified) are distinguished from the Flaming Disorders by the fact that there is no history of ever having posted a Flame, or Flame-with-Apology. CC Disorders (CC-All Disorder and Spam Disorder) may include episodes of Chronic Posting, Flames, and/or Flame-With-Apologies but can be distinguished by the number of addressees.

Lurking Disorder is characterized by one or more episodes of lurking (i.e. at least two weeks of lurking or loss of interest in answering mail accompanied by at least four additional symptoms of Lurking including high on-line time balances, walking away from the computer while logged on, composing posts and deleting them without sending them, etc.)

Chronic Posting Disorder is characterized by at least 4 weeks of posting to a newsgroup or listserv more days than not, accompanied by additional Cyber symptoms such as checking mail several times per day, posts in which the content is shorter than the message header or sig, and messages of extreme anxiety when list volume drops.

Posting Disorder not Otherwise Specified is included for coding disorders with posting features that do not meet the criteria for Lurking Disorder or Chronic Posting Disorder.

Flaming Disorder is characterized by one or more episodes of hot-tempered posts, usually posted within seconds of receiving the ‘trigger’ message, but can be distinguished from the Flame-With-Apology in that the sender has a sincere belief that he/she is 100% correct and morally entitled to his/her feelings of outrage. Flaming Disorder is often accompanied by Chronic Posting Disorder.

Flame-With-Apology Disorder is a milder form of the Flaming Disorder, in which the poster sincerely apologizes for the first portion of the message and yet sends it anyway. A variation of Flame-With-Apology exists in which posters staunchly defend their position for 3 to 4 days, then abruptly back down and revert to Chronic Posting or Lurking.

The specifiers described in the third part of the section are provided to increase diagnostic specificity, create more homogeneous subgroups, assist in treatment selection, and improve the prediction of prognosis. Some of the specifiers describe the current or most recent episode (i.e. Pine, Elm, Anonymous, With Humorous Features, and With Uncomplicated Internet Access).

From Mental Health Humour

Top ten signs you are approaching burn-out,
For mental health workers.

by Storm A. King
August 1996

10) You think of the peaceful park you like as “your private therapeutic milieu.”

9) You realize that your floridly psychotic patient, who is picking invisible flowers out of mid air, is probably having more fun in life than you are.

8.) A grateful client, who thinks you walk on water, brings you a small gift and you end up having to debrief your feelings of unworthiness with a colleague.

7) You are watching a re-run of the “Wizard of Oz” and you start to categorize the types of delusions that Dorothy had.

6) Your best friend comes to you with severe relationship troubles, and you start trying to remember which cognitive behavioral technique has the most empirical validly for treating this problem.

5) You realize you actually have no friends, they have all become just one big case load.

4) A co-worker asks how you are doing and you reply that you are a bit “internally preoccupied” and “not able to interact with peers” today.

3) Your spouse asks you to set the table and you tell them that it would be “countertherapeutic to your current goals” to do that.

2) You tell your teenage daughter she is not going to start dating boys because she is “in denial”, ”lacks insight.” and her “emotions are not congruent with her chronological age.”

And, the number one reason you may be burning out….

1) You are packing for a trip to a large family holiday reunion and you take the DSM-IV with you “just in case.”

The DoH has a current consultation:

The Nursing and Midwifery (Amendment) Order 2008 was made on 11 June. It makes a number of changes to the constitutional arrangements for the Nursing and Midwifery Council. Instead of the constitutional details of the NMC being set out the in the Nursing and Midwifery Order 2001, these details must now be set out in a separate Constitution Order made by the Privy Council.

You see, there’s been some shenanigans down at the Old Bailey for Nurses & Midwives and now parliament is taking the NMC’s ball away until they learn to play nicely.

It’s not new news - the NMC has been under this review by the CHRE since March 2008 so I doubt much of this is a surprise. The review was released last month and has been widely accepted as, well, pretty damning.

CHRE Chief Executive Harry Cayton said: “We have serious concerns about the inadequate operation of the NMC’s fitness to practice processes, governance framework and lack of strategic leadership, the inconsistent availability and provision of information to council to ensure effective planning and decision making and its ability as an organisation to retain the confidence of key stakeholders.”

A CHRE press release identifies the origins of the review as:

a response to a request from the Minister of State for Health Services, Ben Bradshaw MP on 14 March 2008 to address the central question of whether the NMC was fulfilling its statutory functions.

Which shouldn’t have been too difficult, since the CHRE put out a report in May 2007 already that:

..praises the NMC for its approach to partnership working and provision of advice including:

– focus groups involving patients and members of the public to inform the development of policy and provision of help and advice to stakeholders
– seminars to enable employers to understand their responsibilities to nurses and midwives and
– the creation of an on-line ‘A-Z of Advice’ allowing nurses and midwives easy access to advice on best practice and guidance.

I did try to find the CHRE original May 2007 report - but couldn’t. However, the commendation in that 2007 report didn’t stop them making widespread recommendation in the June 2008 report; which suggests a troubled 12 months at the NMC.

There’s been a lot of in-house tantrums and dramas; accusations of over-spending on legal budgets (particularly in relation to Council disagreeing with Executive it seems) and there’s further Tribunal matters afoot on claims of “bullying and harassment”. The report includes significant references to the ’sectional’ disparities - something better explained by, at best, “the left hand not knowing what the right hand was doing” and, at worst, “territorial terrorism”.

The NMC has managed, amidst such apparent disarray, to re-develop the Nursing & Midwifery Code of Conduct, the Code that directs nurses how to act responsibly and accountably and a Code that is used as a point of reference for Fitness to Practice before striking nurses from the Register.

It is therefore ironic to note that the CHRE report specifically recommends:

• The NMC should commit itself to work towards more effective governance. This should include reviewing its committee and accountability structure and agreeing on the level of detail of reporting to meetings. It should also include introducing and enforcing an effective statement of organisational values and code of conduct for Council members and staff, and appraisals for all Council members. Collectively and individually office holders and other Council members accepting responsibility for the current difficulties and for future resolution.

All rather a bit embarrassing for an organisation that is appointed or elected specifically to uphold standards of conduct.

A top London hospital has been asked “what the fuck” after it was thought that a new species of giant rat had been discovered by government ministers visiting the hospital. What was thought to be a giant rodent was spotted by Health ministers Ben Bradshaw and Lord Dazi during a recent visit to the hospital’s A&E dept.

But the giant rodent turned out to be a Mrs Saeneen O’ Shea who was spotted asleep in the waiting room by the ministers after she had popped in for a cup o tay and a warm by the radiator but had fallen asleep remaining in the dept all night unnoticed by hospital staff who had stepped over her and round her after the modern matron had declared her to be “someone else’s problem”.

Minister Ben Bradshaw said to reporters shortly afterwards:

“I was just about to visit the new scanning department when I saw this huge fucking monster of a rat just sitting there asleep on one of the chairs in the waiting room. So I says to my mate Dazi, I said Oi Dazi look at the size of that fucker, and Dazi was like, Jesus Christ man it’s a fucking monster!!”

“I then shouted over to Dr Lindsay who’s our expert in infectious diseases, and said, Jodi get a look at this bastard out here, and she said, like no way man that’s totally mental”

Dr Jodi Lindsay later added,

“Ben was saying it’s a rat it’s a fucking rat and I was going nah man it’s some kind of beaver or a weird fucked up looking sort of cat, but then the hospital administrator came up and he said it was a mutant otter or something and that it was bigger than his dog. The infection control nurse was saying shouldn’t we like catch it or something, and I said, you fucking catch it.”

Lord Dazi then took up the tale,

“So anyway we tell Ben that’s it’s his turn to do something for a change and he’s like really pissed off but he tears his shirt off anyway and goes after it shouting, come here you dirty big bastard I want you to ride you like the bitch you are”

It was then that the A&E charge nurse said that the “rat” was in fact a Mrs O’Shea a homeless person living in the area.

“She is homeless so we sometimes let her sleep in the waiting room, don’t worry she hasn’t breached or anything every 3 hrs 59 minutes we book her out to radiology or somewhere for a few minutes before bringing her back. She’s been all over the hospital tonight”

(shamelessly plagiarised from the Daily Mash again)

You may want to join a well known new religious movement. By new religious movement I mean cult. Then you will be told what to think and how to argue very badly. You will also probably become very poor very rapidly.

There you go, you have nothing to lose but your mind itself the one step plan to becoming an antipsychiatrist.

Step 2: Slightly Harder

You do not have to be an idiot Scientologist to be an antipsychiatrist. Reading enough will probably start you thinking more critically about mental health issues.

According to Wikipedia antipsychiatry started as a protest against the abuse of the system to lock up otherwise sane people. The example given is men having their wives incarcerated for being disobedient. Back then of course a proper diagnosis would have included a wandering uterus. Generally things meandered along with a bit of an upswing when cutting out bits of brains and ECT began coming into fashion.

Things really hit their stride in the sixties when people everywhere discovered LSD.

The people you want to read up on are:

R.D. Laing

Laing argued that the strange behavior and seemingly confused speech of people undergoing a psychotic episode were ultimately understandable as an attempt to communicate worries and concerns, often in situations where this was not possible or not permitted. Laing stressed the role of society, and particularly the family, in the development of “madness,” (his term). He argued that individuals can often be put in impossible situations, where they are unable to conform to the conflicting expectations of their peers, leading to a ‘lose-lose situation’ and immense mental distress for the individuals concerned.

Thomas Szasz

The myth of mental illness: It is a medical metaphor to describe a behavioural disorder, such as schizophrenia, as an “illness” or “disease”. Szasz wrote: “If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic.” While people behave and think in ways that are very disturbing, this does not mean they have a disease. To Szasz, people with mental illness have a “fake disease,” and these “scientific categories” are in fact used for power controls. Schizophrenia is “the sacred symbol of psychiatry” and, according to Szasz, simply does not exist. To be a true disease, the entity must somehow be capable of being approached, measured, or tested in scientific fashion. According to Szasz, disease must be found on the autopsy table and meet pathological definition instead of being voted into existence by members of the American Psychiatric Association. Mental illnesses are “like a” disease, argues Szasz, putting mental illness in a semantic metaphorical language arts category. Psychiatry is a pseudo-science that parodies medicine by using medical sounding words invented over the last 100 years. To be clear, heart break and heart attack belong to two completely different categories. Psychiatrists are but “soul doctors”, the successors of priests, who deal with the spiritual “problems in living” that have troubled people forever. Psychiatry, through various Mental Health Acts has become the secular state religion according to Thomas Szasz. It is a social control system, which disguises itself under the claims of scientificity.

To be a proper antipsychiatrist you do not want to read the above authors too closely. Honestly, it really helps if you manage to disengage all critical thinking faculties, please see Step One and how to hand over your thinking parts of an external organisation.

Effectively if something classed as a mental illness has a poorly known, or even unknown, physical basis it does not exist. If something currently classed as a mental illness has a known physical cause (dementia) it is a physical illness. Therefore mental illness does not exist.

Step Three: Deny Mental Illness Exists

This really will be the foundation of everything else. There are a few stages here.

Argue the definitions of words and how subjective other people’s considered opinions are.

Mental: Mr Smith currently believes the Mafia have replaced all the members of his family with perfectly accurate body doubles who mean to do him harm. I would consider him to be suffering from a mental illness.

Perfectly Logical Antipsychiatry Knowledge Argument, hereafter known as the PLANK argument or just PLANK.

PLANK: There is no such thing as mental illness! Can you point at what has gone wrong? Can you? CAN YOU!?

Mental: *Points at Mr Smiths head*

PLANK: Shut Up!

Other PLANK arguments include “what gives you the right to say what is right or wrong”, “you need ‘ill’ people to keep you in a job”, “he is not ill he is in an impossible situation and expressing it in a socially different way”.

Mr Smith: I think the Mafia are trying to kill me. They have infiltrated my family. I suspect I may be suffering from a Mental Illness.

PLANK: You are not ill, you have been brainwashed by the coercive powers of BIG PHARMA and the Mental Health Services. Your internal experience in this case does not count.

Remember as an antipsychiatrist that everyone who disagrees with you is either deserving of your patronising sympathy (people who think they have an illness) or are evil servants of BIG PHARMA (doctors & nurses) and deserving of wild attacks, slurs and accusations of wickedness.

You must presume that everyone who considers mental illness to exist believes only in the medical model. Ignore evidence to the contrary. Those that work in the mental health system dealing with ill people day in day out do not understand that the concept of mental illness is complex and multifaceted. Nurses and Doctors have never noticed that often peoples states of mind are influenced by environmental, social, familial factors.

Does Mental Illness Exist? (anti)

Does Mental Illness Exist?: One and Two

Stage Four: Living In The Past

The psychiatric system does not have a pleasant past if you go looking for nasty bits. The american history of the lobotomy is particularly nasty. Also you need to treat this book as a documentary account. If you can not be bothered reading just see the movie. All Mental health nurses aspire to be Nurse ‘Sexpot’ Ratched.

The point here is to take the worst examples of what you see, read, hear or just plain make up as representative of the whole. You can be international here. If in one country they continue to use a technique or intervention that is widely regarded to be inhumane this can be used to to condemn everywhere else. Time is no barrier. Something horrible was done many years ago? Use it to condemn the totally different practices carried out today.

Psychiatry: an Industry of Death Museum (warning link contains nuts)

Please note Thomas Szasz’ link to Scientology.

A particularly fabulous argument is to compare Nazis and the Mental Health system. Like here.

Psychiatry, euthanasia, and Hitler’s holocaust

Please be clear that the problem here is not that these Nazis were murderous scum, the point is that some of them were psychiatrists.

Stage Five: Only Your Labels Have Meaning

The mental health system is only there to control social undesirables that can not be easily imprisoned. People whose only crime is thinking different. No connection to Apple. The system imposes this control by labelling people as mad, bad or ill. These labels gain power by being forced on us by a bunch of quacks in the pay of BIG PHARMA who have the appearance of respectability. The same power of words and cultural manipulation is the reason we all believed Tony Blair about the Oil Iraq War and believe anything else were are told by the media.

To be fair there might be something in this argument I know people who believe the Daily Mail prints news.

Labels and How To Abuse Them.

Labels Used By Psychiatrists and what they really mean.

Mental Illness: A non existent condition used by a conspiracy of BIG PHARMA and psychaitrists to control undesirables. See Soviet History and Chinese present (pdf link).

Treatment: Torture

ECT: Torture with plug sockets.

Medication: Brain destroying poisons.

Psychiatrist: Quack, fraud, shrink, trick cyclist, Nazi

Sectioning: Use of state powers to force torture upon people.

Mental health Act: Undemocratic, government sanctioned powers used to allow the torturing of people.

Pharmaceutical Company: Paymasters to the Quacks. BIG PHARMA.

ICD10 or DSMIV: The Book Of Lies!

Patient: Victim.

Ward: Prison

Mental health Services: Government sanctioned social control services.

Schizophrenia: A particularly non existent condition.

All the words on the right above can be usefully used to make sure any discussions with psychiatrists can be conducted in the proper terms. There is a useful post here on how to refine your excellent debating style. How To Win Any Argument On The Internet.

Make sure you at all times stress the least pleasant aspects of psychiatry. talk about coercion all the time. The legal safeguards, advocacy groups, agencies, tribunals, nurses, doctors  etc are all ineffective and part of the system.

Mental: Hello. I work in an average acute psychiatric ward.

PLANK: Does it have doors? Does it? Does it have them? Doors?

Mental: Yes. We have doors. Otherwise people would have to climb in and out the windows. *light giggle*

PLANK: YOU HAVE DOORS!

Mental:*confused* Yes?

PLANK: Do you lock them?

Mental: Yes, at night to keep out riff raff, Daily Mail readers and gigantic moths.

PLANK: YOU HAVE DOORS!!! YOU LOCK THEM!!!

Mental: *sinking feeling* G…

PLANK: You are a PRISON you LOCK UP INNOCENT PEOPLE!!! You are just like the Nazi Consternation[sic] Camps!!!

Mental: Oh go Fu…

You see how it goes. Here the antipsychiatrist has quite clearly won!

If there is an argument about risk to others or self respond that people should not be locked up before they have killed themselves or someone else. They should be banged up in prison afterwards. Apart from suicide of course, bit late really.

Hooray.

Later on ask if the ward has plug sockets and see where you go from there. Think electrodes.

If any health worker accepts that there actions can be seen in a negative light, even evil, this means they enjoy using statutory powers. They enjoy using these powers to remove the rights of patients without rhyme or reason, used at the drop of a hat. Patient refuses medication? Reach for the Acuphase. If they try to justify use of coercion in any forms please move on to the Nazi argument as follows:

Mental: Sometimes we have to use physical coercion, legally sanctioned, to ensure a patient takes their medication or in an emergency situation.

PLANK: That is evil.

Mental: From the patients perspective at the time probably yes. But …

PLANK: You admit it it. You NAZI!!!

An automatic win for antipsychiatry I think you would agree.

Stage Six: Mines Are Bigger Than Yours

Make a big deal of the rights of people in a democratic society. Really. To argue against this is a sign on total buffoonery. The reverse applies in mental health though. As you are an antipsychiatrist you are also and antidemocratician. Numbers be damned!

One plucky expert on your side (doctor, psychiatrist, bad political philosopher, washed up drug addict) is worth more than an overwhelming majority of similarly qualified experts that disagree. If 99% of psychiatrists say that mental illness exists and 1% argue against … plainly the minority are correct.

Anyone argues against your superior logic tell them they thought Copernicus was mad differently sane. Good eh? Brilliant!

Stage Seven: Discomfobulataliation

link

Read the comments. If someone scores a point against you ignore it and it will eventually go away. Redefine words as needed, even in the middle of a sentence. Ensure your opponent does not know. Use the small list of labels above as a starting point.

Discomfobulataliate as much as you can.

Mental: Most of my patients are entirely voluntary.

PLANK: But you would try to section them if they tried to leave.

Mental: No.

PLANK: They must imagine they will be sectioned if they try to leave.

Mental: No.The majority are able …

PLANK: They must only be staying in hospital because their lives outside are worse.

Mental: Well possibly, many of them are very ill and …

PLANK: There is NO SUCH THING as mental illness!

Mental: W…

PLANK: They have to check with staff before leaving?

Mental: Yes, the Fir…

PLANK: You are a prison of the badly labelled differently sane!

Mental: What?

PLANK: DO YOU HAVE DOORS!?

Mental: *softly cries to self*

Stage Eight: Stylistic Concerns.

Blog for Outlaw of Psychiatry

Admire the bold use of colour, CAPITALS, speling and grammer. Gaze in awe at the lack of links to primary sources. Look at the shock news that companies exist to make profits.

Encouraging people to check references and sources will only distract them from the brilliant purity of your argument. If you must link to an external source please ensure it does not confound the issue by engaging in rational discussion or debate. Only link to articles that are reminiscent of being attacked by a rabid antipsychiatry poodle.

If you must respond to a point made use proper Internet etiquette.

Mental: Mental illness does exist.

PLANK: You are wrong.

A weak response. Better would be:

PLANK: YOU ARE WRONG!!!

Triple exclamations are a sure sign of the strength of your argument.

Stage Nine: Bringing It All Together.

An example with commentary.

Mental: I am a mental health nurse. I help treat people suffering from mental illnesses.

PLANK: There is no such thing as mental illness.

A gentle start. The nurse here should rightly see the clarity of your argument and ignore many years of training and experience and give up.

Mental: Yes there is. Many people I work with suffer from problems which affect their ability to think rationally and interferes with their ability to live their lives.

PLANK: Who are you to define rationality? What gives you the right?

Here we have cunningly moved the argument away from the fact of mental illness to a philisophical debate. Here we can argue meanings and human rights.

Mental: Umm. Well I can define rationality by looking it up in a dictionary. I suppose I gained the ‘right’ by studying hard, using life experience, being aware of social norms etc and working as part of a system devoted to studying this very type of thing.

Good. We have moved the nurse off the topic of mental illness and he or she is trying to defend him or herself by appeal to expertise and logic. we could discomfobulataliate here for several paragraphs with a discussion of rights, who made you an expert and examples of where people who do not conformto social norms are beneficial to society etc. For the sake of this example please assume there are several paragraphs of philisophical verbiage following. We will move on to the BIG PHARMA attack.

PLANK: BIG PHARMA makes millions billions from selling so called psychiatric medications.

Mental: Pharmaceutical companies make money do they?

Here the nurse is trying to be flip. On to the next stage.

PLANK: Mental illness is an invention of Psychiatrists and BIG PHARMA. To disempower the different and make money.

Mental: You do know a group of psychiatrists probably could not organise themselves enough to teach a monkey to eat bananas, never mind take part in a Machiavellian conspiracy?

Somehow the nurse is still resisting your wonderful words. More vitriol from a random direction!

PLANK: The NAZIs KILLED people labelled as Mentally ILL! PSYCHIATRISTS ARE NAZIS.

That should do it.

Mental: Eh? What?

Got him.

Will end the example here with a clear win for the antipsychiatry movement. This is only the briefest of examples.  We will leave it as an exercise for the reader to come up with better examples. We have not even used the “my expert is correct your vast majority of experts are all wrong” argument. Nor have we mentioned ECT or lobotomies.

Summary

So to be an antipsychiatrist:

1. Attack
2. Rant
3. Never debate
4. Redefine words
5. Attack at tangets
6. Never reference a dissenting voice
7. Ignore tricky points
8. Call your opponent a Nazi.

For an example of this you know the post to read.

A Mental Production

All seems to be just how I remember it.

So it is somewhat shocking and revealing to find this article that provides a new and significant departure from what might be considered traditional medicine.

In this article it is clearly stated:

People who have more birthdays live longer

What implications is this astonishing fact going to have on healthcare for now and the future?

New government targets are aiming to achieve a target of 70 birthdays for each person.

Special task forces have met and have identified the formidable outcome improvements for people who have in excess of 80 birthdays in a life time! How is this longevity occuring? Argument has erupted around whether it is the type of birthday party or the number of presents people receive at birthdays.

Either way, the government have wasted no time at all in making an immediate mandate to increase the number of birthdays each person has from 1 a year to 3. But the implications for this are going to be costly.

Already the NHS has priced the replacement of the pharmacy with a bakery and has approached HJ Wedding Cakes suppliers to purchase as many birthday cakes as they can knock out for an immediate improvement in the nation’s Capital health outcomes. Australia has similarly purchased several Cheesecake Shop franchises in attempt to get ahead of the game.

Senior NHS staff are undertaking research into the maximum amount of birthdays that can be held in a hospital admission. Some departments have given most surprising results, such as one A&E setting with patients who have been able to hold 2 or even 3 birthdays on each attendance. They have subsequently been awarded a Centre Of Excellence Gold Standard Award for this innovative achievement.

One NMC spokesperson has revealed that planned changes to the Nurse Training will include learning to sing “Happy Birthday” in 26 different languages.

Nurse Practitioners have begun setting up some protocols on how to hold a birthday party and special training courses have been set up at the amazing price of 4-99 uk sterling each.

Some centres of excellence are developing ways to encourage patients to hold more than the new government minimums to having 5 birthdays a year and thus improve health outcomes. Others have suggested a complex case-mix scenario where every young patient admission should be matched by the admission of an older in-patient partner in order to avoid distorting average ages. However, this has been considered by some as cheating.

Other Parliamentary questions that have been asked:

Should we un-ban smoking? Tho they are out of breath from smoking and can’t blow out the candles, at least someone will have a light.

We should include the 9 months gestation period to improve outcomes.

Of course, this also means that those born on a leap-day will be likely to die at a much younger age and this issue is currently before the European Ethical Council for Abortions Help to Meet Targets.

Next week: Birthday Party Polyclinics.

I wanted to share it even further and decided to post the link here as well.

Who would have guessed that when you remove Garfield from the Garfield comic strips, the result is an even better comic about schizophrenia, bipolar disorder, and the empty desperation of modern life? Friends, meet Jon Arbuckle. Let’s laugh and learn with him on a journey deep into the tortured mind of an isolated young everyman as he fights a losing battle against loneliness in a quiet American suburb

Garfield is one of my favourite cartoon strips and I find this idea fascinating. It works so well, it’s often very moving.

Garfield Minus Garfield

The Grand Old Duke of York was unusual in that he was neither up nor down. Most people often get down and then need a bit of help to cheer up. Doing nice things for people is a way of cheering them up, but be careful: when someone is struggling to hold themselves together, an act of gratuitous niceness can instantly reduce them to tears.

Do not attempt to cheer someone up by telling them you’re suffering more. This will not make them happier; it will just add an icing of irritation on their cake of sadness. Saying that worse things happen at sea is not a good idea, either, especially if you are on an expensive cruise at the time.

Telling people jokes is a very bad way of cheering them up. If it were a good way, the Samaritans would be famous for their light entertainment. A better way is to recognise that people are not themselves. It shows that you’re paying attention, and more often than not it is lack of attention that makes people sad in the first place.

Time is a great healer, but with a long waiting list. If you’re bent on getting someone cheered up, timing is crucial. Sometimes people need to be brought out of themselves, but only after they’ve spent some quality time alone with themselves, a box of chocolates and a bottle of wine.

Naturally cheery people are rubbish at cheering people up because they can’t understand why anybody would be down in the first place. Clowns are great in children’s hospitals because kids are naturally cheery; the flipside is, clowns are an absolute menace on adult wards.

The medical profession’s way of cheering you up is to prescribe anti-depressants. This is like taking botox internally, in that they freeze you emotions but limit your capacity to regain your natural smile. Jigsaws are a much better way of cheering youself up because they totally occupy the mind. Just make sure the completed picture isn’t a giant photo of your smirking ex-husband.

Occassionally you can cheer people up by telling them to count their blessings - but consider beforehand if they’ve actually got any, otherwise you’ll just be rubbing their nose in it. On the other hand, if they’ve got to 500 and they’re still counting, this can be a bit of a downer for you.

Guy Browning

He thought it was a titillating idea. In an effort to make his calf tattoo of a buxom cowgirl more shapely, Lane Jensen gave the tattoo silicone breast implants. But after two weeks, the Edmonton tattoo artist’s body rejected them 

Quite frankly the man is a nutter. Silicone implants into a tattoo to make it more real? Albeit, a creative and humorous nutter.

Should such body modification come with pre-surgical counselling? Or perhaps some limb-gender-identity crisis counselling? Or then again; it’s his body. Not sure if he cost the “free” healthcare for his stupidity when requiring script for ABX but…

When it comes to what to do with your own body, I reckon, go for it and knock yourself out. But don’t come running to me when your legs go septic and get amputated.

In the meantime, it’s Christmas, so let’s talk about something fun. Let’s talk about nursing superstitions.

If we’re talking about superstition and mental health nurses, there’s one that everyone will have heard at some point, which is that on a locked psychiatric ward, the patients become more agitated and aggressive at the full moon.

From experience of doing long night shifts on wards, my own view of the “patients act up at full moon” claim is that it’s a variant of the Subject-Expectancy Effect. I’ve noticed that nurses and HCAs will comment on the fact that it’s full moon if they’re having a hectic night shift, but they won’t necessarily comment on the full moon if it’s a quiet shift, or indeed if that hectic shift quietens down later on during the night. Also they don’t comment on all the hectic shifts they have when it isn’t a full moon. So personally I think it’s just a myth. Surprisingly, there seems to be quite a few published research papers on this topic.

There’s also that other great psychiatric nursing superstition, which is that you never, ever, say the “Q word” on a psychiatric ward unless you want all bedlam to break loose.

And of course there’s the ghost stories. Most hospitals have a few ghost stories, especially the older ones. The Faerie Realm Hospital has its own resident “white-haired lady” that various nurses insist they’ve seen. As with the full moon thing, I tend to take most of them with a bit of a pinch of salt. What could cause a stressed, sleep-deprived nurse to start seeing things at 4am in iffy lighting conditions? Still, a lot of the nurses at the Faerie Realm firmly believe in the white-haired lady.

Recently, an old hospital in my city was being gutted and refurbished to provide new office space for the Community Mental Health Team. Partway through the refurbishments, they had to stop work for a day and send in a team of spiritualist mediums, because the builders were all complaining of ghosts. The mediums (I’m told the NHS trust didn’t have to pay any actual money for this, which is probably a good thing) wandered about, did their Derek Acorah thing and talked about there being a “stern-faced matron who had a secret love affair”, which admittedly sounds like it could be just about any matron that ever worked at that hospital.

The CMHT are now safely installed in there, and haven’t reported any more ghosts. There were some reports of sad-faced, lifeless entities wandering the corridors, emitting great wails of despair, but this turned out to be just the social workers.

Having an awareness of anit-disciminatory laws and the such, I am amazed at the information that employment agencies still ask of you and the types of things you need to put into a resume.

In my bid to provide equal opportunities for all, I have constructed a non-discriminatory letter others may wish to use when they apply for their next job.

======================================================================

Address withheld

due to potential for

geographical discrimination

Dear Sir/Madam

I may wish to apply for the job advertised. This does not necessarily mean I need the job or I want the job as this may indicate that I am employably challenged. Any reasons for me being so challenged, if I were, may be based in matters for which you should not discriminate for or against me.

I may be able to do the requirements of the job but will not say here as any disability to do the job may be held against me.

I can work some hours as available to me but cannot indicate what those hours are in case they are not suitable to your needs as the hours I can work may or may not be restricted by children, religious commitments, health care needs or political commitments. It would be discrimination if you were to know that information in making your decision as you may use it against me.

I am sure my previous work experience would be of some use to you, but that may also lead you to discriminate against me on the basis of age or if I had little work experience, lived or worked abroad, or had never held a consistent job because of any aforementioned child care, health matters, political activities or if I had taken a religious pilgrimage in recognition of any spiritual beliefs or been sent to prison but rehabilitated or hospital to be treated which I may or may not have, or may or may not have happened, which you may use against me.

If I have worked in a particularly capacity or role for a long period, I understand I might also be considered ‘over-qualified‘ for the job and this may lead you to further discriminate against me.

I cannot provide you with my educational ability as this may or may not have been impeded by an intellectual disability, mental illness, juvenile detention or learning difficulty.

Should you wish to offer me the position, that I may or may not want or need, I will then be able to let you know if there are any issues for which you must pay due recognition at a later date.

I am unable to provide a photo or attend for interview as this may lead you to discriminate against me on basis of ethnicity, gender, age, disability, religion or just being too darn pretty and sexy.

I look forward to your response, which should be in letter, audiotape, braille, translated to all known languages and left under the tree outside your offices for collection. Alternatively, if you wish to reply via internet based capabilities, please ensure your format is accessible and delivered to this address.

Should you not invite me for interview then I will assume that you are discriminating against me based on the information I am unable to give you and will seek legal action against you for your discriminatory practices.

Yours faithfully,

Anonymous

One of the recurring themes in these e-mails is “You know you’re [blank] when…” This got me thinking, what would a list of “You know you’re an RMN when…” look like? Let’s create that list, so that we can then e-mail it to everyone we know, and our friends will curse us for cluttering up their inbox and wish a slow, painful death upon us. Fun, eh?

A few from me to get the ball rolling:

You know you’re an RMN when…

You start to think of an 8 and a half hour shift as being a “short day”.

You’re unable to walk across your house without writing a care plan on how you should do it.

At the end of a tough shift, you head off to “de-escalate with PRN vodka.”

Every time you change your clothes you find yourself emptying latex gloves, universal containers and those plastic tags they use to close clinical waste bags out of your pockets.

Your definition of “in a minute” can be stretched to ten minutes, half an hour or even not at all.

You come off shift and get drunk…at 8.30am.

These things are apparently called Crocs. People keep telling me how comfy they are, and that they’re practical because you can lob them in the washing machine, thus cutting risk of hospital-acquired infections.

I refuse to wear them myself because, well…because they look bloody ridiculous, that’s why. I don’t care how comfy they are. I’m not walking around looking like I’ve just stepped into a child’s Duplo set and can’t get them off my feet.

And now, apparently they’re a safety risk. It seems they cause electrical equipment to explode. Ha! Take that, We-Love-Our-Crocs Brigade! You cause stuff to explode! Mwahahahahah!