Estradiol is good for reducing symptoms of schizophrenia in women. A study of 102 female patients in a RCT (not sure single or double blind) published in the Archives of General Psychiatry showed clinically significant reduction in PANSS measurements.

The study seems ok; but only 102 subjects and over 28 days means more research is needed. It’s not a new theory but one that has been progressed by active demonstration with this new study.

Some links are here: PsychCentral; Science Daily; Medscape; Live Science.

It’s hoped they can create a drug version without the same known side effects of hormonal treatment and eventually trial on men also.

This one suggests that the culprit may be nothing more than the common ‘flu’.

Doctors have known for many years that microbes such as syphilis and Streptococcus can, if left untreated, lead to serious psychiatric problems. Now a growing number of scientists are proposing that microbes are to blame for several mental illnesses once thought to have neurological or psychological defects at their roots. The strongest evidence pertains to schizophrenia, but autism, bipolar disorder and obsessive-compulsive disorder have also been linked to bacterial, viral or parasitic infections in utero, in childhood or in maturity. Some of these infections can directly affect the brain, whereas others might trigger immune reactions that interfere with brain development or perhaps even attack our own brain cells in an autoimmune mistake.

In 1973 E. Fuller Torrey, now a research psychiatrist at the Stanley Medical Research Institute in Chevy Chase, Md., published an article in the British journal Lancet that revived an idea that had been set aside for decades—could microbial infection cause mental illness?

For the next 20 years, a few rogue scientists dominated the field, searching for connections between infections and psychiatric disorders—and the closer they looked, the more they found.

The research indicated a high incidence of peri-natal mothers who developed flu, particularly in the first and second trimester and discusses the immunological activity of the host mother being potentially damaging to the fetus who then goes on to develop anatomical and psychological disparities.

The most compelling evidence is for schizophrenia. More than 200 studies have suggested that schizophrenia occurs between 5 and 8 percent more frequently than average in children born in the winter or spring. Scientists realized that viruses, which are most prevalent in the cold, dry winter months, could be one of the factors influencing this correlation.

No shagging on summer holidays then. Wonder if that’ll make it into the MHA?

Brown had also found in a 2001 study that children born to mothers who were exposed to the viral infection rubella, known as German measles, during the 1964 U.S. epidemic were 10 times more likely than other children to develop schizophrenia. Most people today are vaccinated against rubella during childhood, so the risk from this infection is now negligible. But Brown also showed a link between schizophrenia and Toxoplasma gondii, a single-celled parasite that infects about 40 percent of the human population through contaminated water and uncooked meat. One of his studies suggests that if T. gondii antibodies—the human immune system’s soldier cells that are a sure sign of ongoing or previous infection—are elevated in a mother’s blood, her child is 2.5 times more likely than other children to develop schizophrenia.

In 2004 Alan S. Brown, a psychiatrist at Columbia University, analyzed blood samples collected from 1959 through 1966 from 189 pregnant women, 64 of whom had later given birth to children who became schizophrenic. The women had had their blood drawn multiple times during pregnancy, allowing Brown and his colleagues to compare if and when the women had been exposed to the flu. “We showed that if [flu] infection occurred in the early to middle part of pregnancy, the risk of schizophrenia was increased three times,” Brown explains. “For first-trimester exposure, it was increased seven times.”

This Toxoplasma gondii seems to be a key component…

T. gondii is also one of the few microbes that can cross the blood-brain barrier, a protective membrane separating brain cells from the rest of the body. Once in the brain, T. gondii affects its hosts’ behavior. Infected rats and mice lose their fear of cats, making the rodents more likely to approach and be eaten by a cat, which is in the parasite’s best interest—it can reproduce only in a feline.

Of course, Ted will tell you the rats are just making bad choices.

In people, T. gondii appears to subtly alter personality, making its hosts more neurotic and insecure and making men more cautious and women more kind and openhearted.

The parasite probably instigates these behavioral changes by affecting the levels of certain brain chemicals. One study, for example, found that T. gondii increases the production of dopamine, an important neurotransmitter involved in a variety of brain processes, including motor activity, sleep, attention and reward. In a fetus, changes in dopamine levels can wreak havoc on normal brain development, and scientists have long known that schizophrenia is associated with an overabundance of dopamine in specific parts of the brain.

But a dormant T. gondii infection, which may also be correlated with an increased risk of schizophrenia in the fetus, does not cross the placenta and therefore cannot directly affect the fetal brain. The influenza link is equally difficult to understand, because flu does not usually infect the fetus. Something else, then, may be at play.

The article also points out, since flu vaccines tend to work by encouraging the development of an immunity, flu vaccines could not only be detrimental in pregnancy, but might also be contributory to a fetus developing major mental disorder.

Some studies suggest that infections per se are not responsible for disrupting brain development; rather the body’s immune response to infection affects the nervous system and does the damage. “When the immune system becomes activated, it can influence the functioning of the brain and, in turn, emotional and behavioral responses,” explains Christopher L. Coe, a psychologist at the University of Wisconsin–Madison who studies the effects of psychological and environmental factors on the immune system.

The Centers for Disease Control and Prevention currently recommend that all pregnant women get flu shots—a dangerous proposition if immune response, rather than infection itself, is responsible for harming the fetal brain. “I don’t think they have considered this risk. In fact, I know they haven’t considered this risk,” Patterson says, referring to the CDC. “If you take it seriously and vaccinate everybody, then what’s going to happen?” Researchers cannot yet predict how often a prenatal immune response might lead to fetal brain damage, but even if it happens less than 1 percent of the time, vaccinating an entire population of pregnant women could affect thousands of children

Of course, this does nothing to aid the ongoing treatment but it (yet another) potential cause that can perhaps be easily eradicated.

It would be interesting to see the response of the great Doc Crippen to this contentious hypothesis. As we know, the MMR/Autism debate (debacle) was hugely detrimental to many children. But what if, as suggested in some of the research data, this phenomena does exist?

Having flu when pregnant, which may later lead to the child developing schizophrenia, is an unfortunate event.

Developing flu from a dose of flu vaccine that later develops a child with schizophrenia is iatrogenic.

Someone needs to get the calculator out again and start costing the balance of risk probabilities, I think……

As pointed out by beakie, not all hallucinatory experiences are bad ones. But is it the bad ones that cause violence in mental illness?

There remains much debate in the recent theorising of the threat/control override (TCO);

Appelbaum et al <> (2000) suggest “Neither delusions in general nor threat/control override delusions in particular were associated with a higher risk of violent behavior”

Threats are where delusional thinking may influence behaviour eg paranoid persecution

Control override is related to passivity and perceived interference from outside forces; eg ideas of reference from a TV where the recipient infers messages within the local news giving specific instructions to them alone or other forces control their movements.

Neither of these two phenomena includes hallucinations.

Studies by McNeil indicate:

“There appears to be no evidence that auditory command hallucinations are dangerous per se. However, there is some evidence that voices ordering acts of violence toward others may increase compliance and thereby be conducive to violent behavior. Finally, the evidence for or against the existence of a possible violence-escalating interaction between delusions and hallucinations is inconclusive”

Essentially, the current research seems stuck. They have singled out those components of mental illness that are potential to creating an at-risk situation. TCOs and hallucinations. Sounds reasonable and I don’t think they are wrong in their assumptions. But I do think they are missing some rather basic considerations.

Firstly, more recent research into TCO by Teasdale et al (2006) reports:

“Specifically, we find that men are significantly more likely to engage in violence during periods when they experience threat delusions, compared with periods when they do not experience threat delusions. In contrast, women are significantly less likely to engage in violence during times when they experience threat delusions, compared with periods when they do not”

So, when the violence does occur, and in the context of threat delusions, it is more likely for men than women that do so.

This is no great news. Men have always been more likely than women to act out violently (please don’t make me find research evidence - just google names like Attila the Hun, Conan the Barbarian and Hagar the Horrible).

But what this might tell us; there are (potentially) linear gender-specific correlations between the behaviours of those with threat delusions to those without (ie Mr & Ms Not-Mad).

So where next the research? Well I’ve been keeping loose tabs on a guy called Baumeister over in that North American state of Canadia. He’s been doing some work on a theory called ego-depletion.

Some stuff can be found here; here and here. There is some lighter reading at the end of the post.

Essentially he has completed studies that show the will power to be an expendable energy force, one that functions just the way a normal muscle might; it requires replenishing as it grows weak with use. People who engaged in concentrating on one activity performed worse at another activity than those who were not forced to complete the first activity; activites designed to display self-control.

I began wondering the relevance to mental health and especially violence disorders.

What extra stress and strain must be imposed upon people who are struggling to retain a sense of reality, normality and restraint against such symptoms - TCO or hallucinatory?

Then recently I discovered this little article:

Command Hallucinations Among Asian Patients With Schizophrenia (2004)

Of the patients, 53 (53%) reported command hallucinations. Of these 53 patients, 58% were women and 48% were men; 62% reported complying with the commands. They were also more likely to comply with nonviolent commands. A history of self-harm predicted compliance. Those patients who did not comply with the commands adopted various methods of coping, of which praying was the most common

What struck me most was this last line:

Those patients who did not comply with the commands adopted various methods of coping, of which praying was the most common

Now I’m not the most religious of people; but I understand spirituality and hope.

I also understand prayer to be regarded as one of the most frequently used forms of ego restoration - ie God give me the strength.

What if, in fact, the reason people with mental illness act out violently is actually no different to how ‘normal people’ act out violently?

It is a presumption of fact, given the right set of circumstances, that anyone is capable of murder.

But how do we avoid acting on our impulses to do harm to others in the normal world?

In psychopathy, we understand the absence of emapthic awareness or emotional attachment. But we are not all psychopaths and neither are those with just a major mental illness.

In substance misuse, we accept the existence of “Dutch courage” and the perhaps extrapolation of that, as losing judgement entirely. But we are not all substance mis-users (to the same degree) and neither are those with just a major mental illness.

But in “just a mental illness“, where psychopathy and substance abuse are absent; what reason is there now?

I would suggest only by the reason of ego depletion; where the internal fight for control against the symptoms of metal illness has drained the person of the ability to protect their moral reasoning. Where there has been no rest and no rejuvenation of the soul and will.

In such cases of homicide by uncomplicated mental illness (ie no co-morbid psychopathy or substance misuse- however rare that might be), it may not be a case of what experiences were they having alone, as the above research would indicate. But it would also be directly relevant to the level of ego depletion - or removal of will power - the person had endured over what length of time.

Will power is a unique personal ability - like fitness, or intelligence. In fact Baumeister’s work would suggest we can learn to exercise our will power to increase it’s capacity. I would think this is true. Achievement begets achievement - reward bolsters our resolve to seek more reward. Thus far the use of this research seems destined for dieting, smoking cessation and watching whole episodes of Entertainment Tonight.

More recent commentary on ego depletion can be found here and here where they even talk about blood sugars being depleted by behaviours requiring concentration… and then I start thinking again… symptoms of hypoglycaemia… aggression…. I’m onto a doctorate here….

But getting back to the point:

Media and the link of violence to mental illness - Well, I’m sorry chaps - but my money lies on three theories; that violence is linked to those who:

• have psychopathology that does not allow them to feel empathy
• have impaired judgement by use of substances
• just can’t fight the frustrations off anymore - and that includes Mr Road Rage and the abusive finger.

By this theory, I believe strongly that uncomplicated mental illness does not predict violence at all. Yes, it adds to the stress and frustration of someone who is trying to fight off the urge to react. Just like we all do. It is weariness and suffering that eventually wears down the protective will power to prevent acting out on such experiences. But the true ‘fault’ of acting violently is in the ability or not to cope with the experiences.

Would this theory, if acceptable, not also have serious implications for changing treatment interventions for those deemed at risk of violence - when we are pumping them full of ego depleting dopamine blocking drugs?

That’s for next week on “Mr Ian - the Journal of Mental Health Nursing of the Internet”

Ed note: Special thanks to Dr Crippen for allowing me to post on his internet with my own opinion.

“New schizophrenia drugs no better, Dutch team find”

The research apparently shows that the new generation of atypical antipsychotic drugs are no more effective than the older first generation of antipsychotic medication. Seroquel, Zyprexia, Geodon (available in the US), and Solian were compared with Haloperidol. Although the newer drugs were not found to be any more effective in treating psychotic symptoms the compliance rate was significantly better.

Over the following 12 months, 63 patients on Halopreidol stopped treatment compared to 51 on Seroquel, 32 on Solian, 31 on Geodon and 30 on Zyprexia

HI there. The dad of my baby has been ill of Schizophrenia for 6
years or so, and have been 8 times in hospital. He takes ABILIFY 25mg .

He only heard voices or see visions when he stops his
meds and has a relapse, but even taking meds, his behaviour is not
normal, or at least I dont think so. I wrote a letter to his dad,
sister and social worker explaining how he behaves and they all see
that He is ok. I know his dad does not accept his diagnosis, his
sister is not close to him at all and I cant understand how his
social worker told him -your girlfriend wants to convince me you are
ill but I reckong you are doing really well-. Here it is what happens
and all I have been thru for the passed 3 and half years:

- Is loving and kind towards me but one day and suddenly tells me he
does not love me and push me away. In a few days he apologizes and is
loving and kind again

- In the same conversation he says -I dont love you and I dont want
to be with you- and then in a few minutes -Life has not meaning
without you-

- A few days ago he gave me some money for the baby and said it was
ok for me going with him to take a walk in town. I was quiet, just
talking about normal things, when he suddenly said -I want you to
leave, dont come with me- I could not believe how he changed his mood
in a second. He started to shout at me in the middle of High St, -
Bitch, leave me alone, I am not your friend anymore, I dont love you
and I never did,,,!!!!!!!!-

- Buys something (sometimes very expensive things) and he says -I
love it, it is really good,,,,- and in a few days or weeks when I ask
him where the thing he bought is, he says -Oh, it was a shit, I gave
it to my mate or to a Charity shop-.

- Starts a new course, IT, Yoga…. and he says it is really good and
then soon he leave it and says it was not that good

- Receives benefits every 2 weeks and a week or so before he gets
benefits again, he has spent all and has not any money left for food.

- When at his place I say something that bothers him or he does not
like it, he asks me to leave, and If I dont leave straigh away
because I prefer to talk about things, he calls the police to get me
out of there.

- Today he says something against his father, or his friends,,,and
tomorrow he says his dad and friends are great.

- Buys someting really expensive and re-sell it in a few days for
little money

- Once he bought some books in a charity shop just to sell them to a
seconhand book-shop, as it was closed, he took the books to another
charity shop as a donation.

- His closest friends are also ill and on benefits. He is scared of
meeting new people because he reckons they will judge him as he is
not working. He gives money to his friends and then he is with a few
pennies in his pocket, not even enought to buy some bread.

- He said that my mum judged him and looked at him in a dirty way,
says my friends dont like him…nothing of this is true.

- Is afraid of going to far away places, even going to London is an
adventure for him (we live in Essex).

- Changes his hobbies and interests quite often. NO long time ago he
threw his bible away because he did not believe in God, and now he
says he believes in God.

- Changes the decoration of his flat very often, buys new things, get
rid of them a few weeks later…..

Well, what do you reckon? Do you think he is doing really well??? Why
no-one listens to me??? What do I need to do to be listened?
specially when we have a 7 months old son who sees his daddy really
lovely towards me one day and pushing me away the next,.

What do you reckon of his social worker, does he sounds
proffesional?? He threw the info and letter I gave him, away…..

Thanks for reading x

I’ve become somewhat (and perhaps momentarily) drawn into the world of ‘blogging’ and ‘posting’. Sat here at 4am, it’s possibly become something of an obsession (although I’m only awake cos some mozzie decided to take a banquet out of on my back) .

So in my ponderings, I began to wonder … what attracts me to this new-age techno forum?

Dr Grumble pointed me to an interesting site. Apparently the government is monitoring weblogs for opinion and ideas on interesting or important government matters. I suppose this is one way of getting that seemingly muted opinion out there a little closer to the people that can make a bigger difference than you or I, the real decision makers.

However, I’ve also noticed that personally, I tend to only post on issues in which I hold strong opinion on or believe my experience or knowledge may be of some ‘expert‘ help. One thing is certain, I’ve never been so keen to read up on latest material and happenings to stay up-to-date, so as to limit the embarrassments of any ill-informed postings.

I note that current debate is now afoot for renaming schizophrenia. Although they use the term ‘rebranding’ which leads me to already think of putting my money on McSchizophrenia.

So through reading about current issues in treating schizophrenia, I stumble across some comments. Some are useful, like the thesis on non-dopaminergic antipsychotics. However, one which grabs my attention moreso is, unfortunately, not as replete of such enlightenment.

The post can be found here, as can my reply. However, I will summarise here that the main gist is it seems to be the comments of some aged old has-beens who have spent most their careers perpetuating the fraudulent myth of “Doctor knows best”, along the ilk of Fab Morvan and Rob Pilatus, which usually amounts to a large portion of neuro-debilitating polypharmacy at the demise of any other alternative or conjunctive interventions such as CBT.

So, returning to my ponderings, why is it I enjoy this new found pasttime?

I have no idea. And the strange thing is, I was originally going to write a post all about how stupid someone else’s opinion is because it doesn’t match mine.

In the end I didn’t, but then, it passes the time while the mozzie bites die down.

Nigh night.

Before you read on, I would note I tend to write in an academic style, not a ‘blog’ writing style. Sorry about that!

This opener looks at my own recent dealings into the “insight” of two distinctly different people.To clarify, my understanding of ‘insight’ isn’t “How well do they understand what I tell them about themselves and how to be better”; it’s more “How well do they know themselves and the effect they have on themselves.”

I recently came across the Mental Health timeline which turned into an interesting read.Amongst many interesting things there, there is reference to writings by John Locke, English philosopher (1632 – 1704) “An Essay on Understanding”, on the mind and the origins of ‘ideas’.

Essentially he proposed ‘ideas’ come from ’sensation’ and ‘reflection’; ie what we sense and how we interpret that sense. He also furthered that we take simple ‘reflections’ and can put them next one another or add them together to make more complex ideas or even reduce them down to more simple ideas.

Eg

Side by side: Sun is out = it is warm. Dog is panting = he is hot. Side by side – sun makes dog hot.

Adding: Sun is out = it is warm. When I get warm I need less clothes – wearing shorts is a good idea

Reducing: sun is out; dog is panting and I’m wearing shorts. It’s probably hot then.

(I have no idea if that is a good analogy of what he was trying to say – but it’s how I understood it!)

Bearing in mind his writings were nearly 300 years ago, he laid down here the basis of social learning theory.

A suitable extract from the essay, in the vein of “insight”:

There is scarce any one that does not observe something that seems odd to him, and is in itself really extravagant, in the opinions, reasonings, and actions of other men. The least flaw of this kind, if at all different from his own, every one is quick-sighted enough to espy in another, and will by the authority of reason forwardly condemn; though he be guilty of much greater unreasonableness in his own tenets and conduct, which he never perceives, and will very hardly, if at all, be convinced of.

Anyhow, back to my recent dealings;

1. A young guy with long illicit drug use history and anti-social traits and a 6 year history of revolving door syndrome; in-patient detention and community restriction under the MHA.

His story is not dissimilar to many others; broken home, violent father and step fathers. Introduced to cannabis by one step father. He remembers his childhood for what it was worth and pretty much understands how he got heavily into illicit drugs and consequentially acquisitive crime. One bad dose or 3 of amphetamine IV and he flipped out. He admits it, he was ill. The man up his nose stealing his oxygen can confirm it. He got treated and the psychoses more or less passed. He had a relapse after winning a substantial amount of money – wonder where that went? After that, he quit IV amphetamines. He continues to have psychotropic depot, despite his clearly evident akithisia side effect. He still imbibes in the weed and occasionally self medicates with benzodiazepines (Valium) to combat the muscular tension of akithisia.

Regardless of the medical recommendation, he continues to use illicit substances tho (tells me he) abstains from amphetamines. Sometimes he self medicates, other times he needs relaxation. He knows IV amphetamines run the highest risk of mental relapse and does not discount the paranoia potential of cannabis. He’s actually taught me a huge amount (more) about illicit drugs; the psychology, physiology and the lifestyle.

Regarding “insight”; the doc records him as a) lacking insight and b) having poor judgment.

This is based on the notion that

a) He says he’s not mentally ill

b) He refuses/fails to cease taking illicit substances.

The point in this matter on both those issues is:

a) He isn’t actively mentally ill, but he knows he has been and runs a risk of becoming so again – even with just stress. He knows the man up his nose who was stealing his oxygen was crazy talk. How that isn’t insight, I don’t know.

b) He chooses to self medicate for genuine reason. Either need to relax (avoid the stress that may bring on the mental illness) or to qualm the akithisia (that prevents him sleeping without Valium and wakes him every morning after it wears off). He might be limited in his knowledge of how to deal with himself in other ways. I would say his judgment is only limited by his knowledge and ability to remedy his issues. So is mine.

He understands the chances he takes in relapsing. He understands his ‘personality’ issues and how they originate from past experiences and his responses. He’s not altogether sure on how to do things differently. Of course, all he has to do is change his coping mechanisms of the last 15 years and he’ll be fine….

I think there needs to be a 3^rd aspect that covers c) ability to choose to act more wisely – his ability is impaired or compromised, not his understanding, and this is for discernible reason. It’s the nature of his issues that are the problem. He’s well aware of them. If it wasn’t his problem, or he had a better way to cope, he wouldn’t be taking drugs or stealing stuff (or under MHA detention).

Locke again…

in all cases where any idea is called true or false, it is from some judgment that the mind makes, or is supposed to make, that is true or false

or….
We only know what we know.

2. A man of late 30’s, ex service man (originally I assessed PTSD as he served in the Gulf – but it seemed unlikely as he was not directly in any conflict. I’m re-evaluating that now based on his stories of only being allowed to sleep 3 hours a night on a good night for 6 months or so).

Diagnosed schizophrenia. Has been maintained in the community. Recent involvement with the police caused him to be re-admitted.

He is recorded as ‘no insight’ but judgment is ‘ok’.

Before I relate the detail, Locke again….

“there is a degree of madness in almost everyone. This is because emotions force us to persist in falsely or unreasonably associating some ideas. Madness is the inability to let reason sort out ideas by relating them correctly to our experiences.”

Locke thinks madness is an inability to reason ideas. Although he says ‘emotions’ force us to be irrational in our thinking when we go mad, I would disagree, and in further comments, he disagrees with himself.

“For our ideas, being nothing but bare appearances, or perceptions in our minds, cannot properly and simply in themselves be said to be true or false, no more than a single name of anything can be said to be true or false.”

Where here he says; we only believe what we believe is true.

Distorted perceptions and hallucinations may be of ‘false origin’ but just because we don’t experience them, doesn’t mean they’re not real to the person. We remember that from training don’t we?

Beliefs (reflections) originate in rationale thinking of experiences (sensations). But in ‘mental illness’ it depends on the false origins of the experiences and subsequent reflections of the person that often lead to false beliefs, or ‘delusions’.

Sherlock Holmes puts it better, if you apply this edict to how people can turn ‘crazy thoughts’ or hallucinatory experiences into fixed deulsional beliefs…

“when you have eliminated the impossible, whatever remains, however improbable, must be the truth”

So back to guy #2. He is schizophrenic. He does hear voices. He does see faces in the floor. He did think his dog wanted him to open a bank account so they could sell puppies and the dog’s live in luxury. He thinks lots of things happen (like clocks stopping, or inconsequential coincidences) as a miracle. He also believes in coincidence though too. I know this, because he tells me, just like he tells the doctor.

The doc told him “You have schizophrenia”

“No I don’t. I’m clairvoyant”

“Insight – nil”.

I talked to him about his experiences. He told me the spirits offered him guidance (?command hallucinations), but he never acts on it without applying his own moral judgment to the issue. He always has the final say. The only time he became angry at the spirit guides was because they didn’t advise him on a particular issue.

He tells me he gets stressed and angry with his dad who yells at him when working on the farm. Or because his dad doesn’t care to hear about his goings on. I’m going to take “A Beautiful Mind” in for him when I can find a copy. He’s never seen it he told me.

My issue with this “insight” is the ’semantics’. He knows exactly what experiences he is having. And they are happening. He doesn’t act on them always, only when he chooses to. Much as Mr Sane would act on his conscious thought or decision-making considerations. He doesn’t act irrationally on the guidance – I asked him if the spirits told him to kill a child, would he. He looked at me as if I were mad – “No! Of course not.”

The fact he doesn’t want to call it shizophrenia shouldn’t matter a fig.

As for the dog and the bank account; I haven’t got to that one with him yet. But I’ll bet there’s a truthful experience and reflection somewhere at the heart of his false belief.

I’ve posted this because, for those who may have read my earlier PTSD posting, I have often (and recently again) come across those ‘deluded’ or ‘psychotic’ patients who, by discussion and discovery, have made more sense to me within their psychotic state than those who seek to treat them.

Psychological therapies with delusions can work. The ‘trick’, I believe, is to accept their world as it is, understand their beliefs from within their world and seek to help them rationalise the context of their experiences. I think that’s psychotherapy. Anyone who doesn’t take the time to get into the world of the person they are treating will never truly know them. That would be known as lacking insight.

Applying unconvincing drug therapies to a supposed disease of unknown origin in which the clinician has no understanding or insight and, even when it stops, improvement is believed only to be because of the medication they’re on – and so they shall stay on it forever – in my reasoning, constitutes poor judgment.

To close, I’ll let the clairvoyant have the last say:

I asked him why he seemed to accept the spirits for who they were and not be distressed by them.

He simply said “Ah, well if I didn’t do that… then I’d probably go mad”.

David Shayler, for those of you who don’t remember, was a former MI5 officer turned whistleblower on dirty tricks by MI6. He later became a 9/11 conspiracy theorist, and has just taken an unexpected new direction by doing a David Icke and declaring himself to be the Messiah.

Seaneen comments:

I have been thinking about David Shayler and come to three conclusions:

1) He has a mental illness or a severe personality disorder

2) We have no idea what the MI5 and MI6 are capable of and they may have wrecked havoc on his mind

3) He might be, or truly believes he might be, the messiah

Madness is such a fragile concept. Throughout history, the innovators, the pioneers and the geniuses have been labelled mad at one point or another. Madness can come with an explosive, fearsome energy, an almost superhuman drive. And there is the crash into terrible depression that follows

This strikes me as being a new twist on the age-old debate as to where one draws a difference between the mystical visionary and the madman.

If any of you are interested in what David Shayler has been saying, here’s a clip of a news report about his recent pronouncement. It really is a bizarre piece of footage.

Like it or not, there are a lot of overlaps between mystical experience and psychosis. The obvious one is the hearing of voices and seeing visions. Another one - of which you see a lot in the Shayler footage above - is the perceiving of deep significance in the apparently random and meaningless. It’s probably no surprise that Shayler has gone for Kabbalah, the system of Jewish mysticism that uses lots of symbolism, wordplay and numerology to encourage the practitioner to find all kinds of symbolic meaning in just about everything.

Aleister Crowley, who was heavily influenced by Kabbalah, encouraged the budding Kabbalist to take this to extremes.

When you have got everything properly correlated, your central consciousness understands and controls every tiniest detail. But you must begin at the beginning—you go out for a walk, and the first thing you see is a car; that represents the Atu VII, the Chariot, referred to Cancer.

Then you come to a fishmonger, and notice certain crustacea, very mala chostomous. This comes under the same sign of Cancer. The next thing you notice is an amber-coloured dress in Swan and Edgar’s; amber also is the colour of Cancer in the King’s Scale. Now then you have a set of three impressions which is joined together by the fact that they all belong to the Cancer class; experience will soon teach that you can remember all three very much more clearly and accurately than you could any one of the three singly.

So how is this finding of the symbolic in the apparently random different from a person in psychosis who believes that the way in which a passerby walks across the room conceals a coded message that is being used to insult them?

The main difference is that the pronouncements of mystics tend to be more coherent and more culturally appropriate than those people declared to be simply mad. RD Laing put this in rather more poetic language:

Mystics and schizophrenics swim in the same ocean. But the mystics swim whereas the schizophrenics drown.

There are ultimately two interpretations one can make from all this:

1. That people in psychosis sometimes access the same truths as that of the mystic, but are unable to cope with the experience.

or

2. That mystical experience is simply culturally sanctioned psychosis.

Feel free to delete according to your own personal beliefs and prejudices.

Patient: “Oh, brilliant! I’ve just seen the Virgin Mary! She’s sexy as fuck!”

Just how many blasphemies are in that statement, eh?

Today I was working with a patient who regularly insists that he’s “the Messiah.”

I wasn’t sure whether or not to mention the fact that it’s Good Friday. Might be a touchy subject.

You have no idea how much I am struggling to write this letter. I want to write to you about the issue of cut backs in mental health services in our area, but it’s very difficult to find the words to express how I feel. However, I feel compelled to at least try, after someone recently said to me: “You might only be one voice saying what needs to be said but there are lots of people in the community that share the same problems that may not be able to speak out.”

Read the rest here. Please leave comments expressing your great Love for Mr Mans Wife and keep your fingers crossed for a positive response.

I was there not so long ago, waiting to attend a training seminar. As I waited for the trainer to arrive, I sat outside, chatting with some of the other students.

As we were chatting, a middle-aged gentleman strolled up to our group and starting talking to one of the other students. I couldn’t make out what he was saying to her, as he was a few feet away and talking rather indistinctly, but as he did so, he opened up a briefcase and began handing out some typewritten sheets of A4 paper.

Hmmm, I thought. Is this the trainer?

He handed one of the A4 papers to me. It contained a long, stream-of-consciousness account of his meetings with Jesus, and how Jesus had explained the mysteries of the universe to him. It mentioned how Jesus had shown him various religious symbols to him and explained in detail what they meant.

It was beautifully written, really. I should have kept it. Admittedly rather incoherent, with plenty of flights of ideas, but definitely the work of a man in the grip of an incredibly profound religious experience.

At this point it occurred to me that maybe this wasn’t the trainer.

In another period in history, we’d have either worshipped him as a prophet, or burned him at the stake. One or the other.

These days, we’ve found a compromise between the two. We give them Olanzapine instead. It may make you put on shedloads of weight, and may possibly give you diabetes, but hey, at least nobody’s tying you to a piece of wood and setting fire to you.

The food was marvellous, mostly high fat nibbles….and for the weight conscious, some fruit and little pots of couscous. Eli Lilly paid for the grub who are of course the proud manufacturers of Olanzapine.

The Fat Controller is doing research….well more of a pilot study really. Trying to find out how many people with a diagnosis of Schizophrenia also match the profile for developing Metabolic Syndrome – that is Diabetes, high blood pressure, high cholesterol and a big fat belly. His study, which took all bloody morning to go through, found that the mentally ill population of Sodom has the same incidence as the rest of the mentally ill population the UK and the conclusion was that SOMETHING NEEDS TO BE DONE, and by jove, Sodom CMHT is leading the way in doing it!

Now, have a look at this

Ever since Olanzapine was introduced, nurses have noticed that some service users piled on loads of weight, sometime transforming their appearance of young men and women from athletic teens to bloated 30 year olds in months. The drug reps always, when challenged, “suggested” that this was more a side effect of Schizophrenia and the general trend towards obesity rather than a problem with the drug, and that the solution was the encouragement of healthier lifestyle choices, better monitoring of those at risk of Metabolic Syndrome, better screening for genetic factors….in fact anything rather than point the finger at the drug. The responsibility was ours, as mental health service providers, to do something about the weight gain, which will cost the NHS a great deal of time and money.

It’s hard enough trying to lead a healthy lifestyle myself – with all my social advantages. Drinking water instead of tea and coffee is fairly low on my list of priorities, and I don’t have to be worried about getting dragged in for a holiday on the ward.

Eli Lilly’s defence is: “there is no proof of a cause”…which means that any observations in this post are invalid and purely conjecture.

Anyone fancy doing some useful research?

POINT 1: The human brain weighs just over 2lbs. Yet it has the capacity to consume 15 – 20 % of our energy.

POINT 2: Dr. David Horrobin wrote an interesting book named “The Madness of Adam and Eve”. Among other things he focussed on our evolutionary history. Man moved out of the east African rift valley along rivers and coastlines. Our ancestors ate a lot of fish, game and foraged on nuts, berries and the like. Dr. H emphasised the importance of diet and the particular importance of Omega 3 fatty acids. He believed that if we don’t provide our brains with the nutrients that evolution suggests we require then our mental states become increasingly vulnerable to illness.

POINT 3: By the age of around five I was aware that “fish makes you brainy”. In fact, I went through a phase when I believed that my brain comprised of a mesh of fish bone. For the curious amongst you, the MRI scan and X-Ray were inconclusive.

POINT 4: There is a rapidly growing evidence base suggesting that a healthy diet can combat anxiety disorders, depression, bi-polar disorder, schizophrenia, ADHD and Alzheimer’s disease. A balanced diet will also contribute towards improved memory, concentration and a decrease in aggression and anti – social behaviour

POINT 5: Spirit of `76`s site has recently reported that a single Risperdal Consta depot injection costs £148.55.

POINT 6: The NHS is very adept at surreptitiously sweeping any financial deficit under the nearest available carpet but I do know that last year my ward alone was overspent on medication by a sizeable five figure sum.

POINT 7: I know of no in-patient psychiatric facility that doesn’t provide embarrassingly cheap, processed, largely re – heated meals.

So where did it all go wrong. I think it’s indicative of the power of the medical profession and Big Pharma but nurses aren’t blameless. Mealtimes used to be an extremely important part of the nursing day, now they’re almost incidental. We also defer too much to the “evidence base” and are reluctant to try anything before the researchers report their findings. Why? Wasn’t the nursing process supposed to be fluid? There are endless care opportunities, enhancing diet being just one of them, where there is nothing to be lost by trying something. If it doesn’t work evaluate and re – assess. Simple.

It’s time to flex our nursing muscles. Let’s put diet back on the agenda. Evolutionary history demonstrates its importance, my Grandmother knew its importance, commonsense tells us it’s important and now, at last, the “evidence base” agrees. What, exactly, have we got to lose?

Footnote: Dr Horrobin didn’t worry too much about referencing and balanced argument. He had an opinion and he wasn’t slow to share it. He upset a few people. He has passed away now and I understand that he was the first medic ever to receive a less than glowing obituary in the BMJ. Make of that what you will.

Mental has written about his experience of the death of a patient (I usually say service user – but need the distance for a minute), I want to get mine off my chest too, so this is the first of two posts on the subject.

Today is Sunday, at least, I’m writing this on a Sunday. It was on a Sunday not so very long ago when my mobile went off (it doesn’t just ring), after a very lovely roast dinner which I was about to finish off with some Sara Lee™ Apple Strudel and proper custard. All was good with my world.

The phone call was from the on-call manager who was sorry to disturb my weekend but she had some bad news for me. This was said in a voice that sounded neither sorry nor about to break bad news. The upshot was that Sue (name changed to protect my career) had been found dead this morning.

No details. But I should be aware that my notes would be required at (mis)Trust headquarters first thing in the morning.

Things became clear at that point. This wasn’t a courtesy call. This was a call with subtext that advised me that if my notes weren’t up to date I should make sure that they were so, because the care that she received would now be under scrutiny. It wasn’t me who was being protected - the Sunday phone call was for the benefit of protecting the (mis)Trust – should anything come of it. My notes were up to date but that didn’t stop me foregoing the Sara Lee™ Apple Strudel in my rush to get to the office and check my notes – just in case any blame tumbled downwards.

Nothing came of it; it was death by natural causes. Heart failure at 52 years old. Of course it’s well known that long term use of typical anti-psychotics can lead to early death, but to all intents and purposes it was a natural death.

But the sad thing was that Sue hadn’t had a natural life. Of her 52 years 27 had been spent in hospital, and only six months before her death she had been discharged to a privately managed group home.

Where she flourished.

She was known for being aggressive and uncooperative. Her notes were a terrible record of a life filled with psychosis and anger, incident after incident of violence towards staff and steadily increasing use of major tranquilisers until the limits were reached with each one and polypharmacy emerged.

At the discharge planning meetings staff had warned how if she was crossed she would shout and push staff. Some ward staff were clearly frightened of her, and their whispered advice was to leave her to her own devices, while braver ones stated that Sue needed to have very clear boundaries set for her to “help her to learn to manage her behaviour”. Boundaries of course mean saying no when she wanted anything.

But Sue was a different person in the group home and although she wouldn’t admit it, the smile suggested she was in fact……….happy.

“How come?” I asked one day while visiting.

The support worker (unqualified – by the way) told me how they managed her.

“Susan”, she told me, “says no to everything. Whether it’s a cup of tea, dinner, a trip to the shops or the hairdresser. Ask her, and she’ll say no”

“So how have you got her looking so clean and happy?” I enquired.

“Its easy……we let her say no.”

“Um……what do you mean?”

“She says no, we say ok, and then 10 minutes later she comes up and asks us to do something with her or take her out.”

“So she just likes time to think about it?”

“That’s it! And then we go out and she’s like a kid in a sweetshop.”

Sue had six months of happiness before she died, maybe because of some staff who had taken the time to get to know how she worked, had given her some genuine human respect, and accepted her right be who she wanted to be. And she wasn’t in hospital anymore.

Maybe her change was more complicated than that – but I can’t think of anything else that was different.

I don’t know whether to be glad for the six months or sad for the wasted years.