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.”

A protest is being held against the sentencing of a young man who hit an off-duty policemen round the head with a skateboard in a late night scuffle. Family and friends of the 20 year old are to gather outside Manchester Crown court tomorrow wearing “Free Dwain Taylor” T shirts.

The Taylor family say that CCTV images of the incident clearly show that the off duty policeman who was assaulted late last night was spoiling for a fight with Dwain and two of his friends. The family argue that Dwain was forced to hit Mr Wilson over the head with his skateboard after the officer appeared to be on the verge of attacking him.

The CCTV footage shows Mr Wilson gesturing towards the teenagers. After being hit over the head with the skateboard the three youths then attacked Mr Wilson with a flurry of kicks and punches as he lay on the ground.

At his trial at Manchester Crown court Dwain Taylor was found guilty of inflicting grievous bodily harm with intent, assault occasioning actual bodily harm and perverting the course of justice after burning his clothes following the incident.

Dwain’s father Wayne, 42 a plumber from Cheetam said

“My son had to make a split second decision that night; you can see that on the CCTV footage. All he knew was that a man was shouting and swearing at him and appeared ready to hit him and his girlfriend. That is why he did what he did. My son and his friend were only trying to defend themselves and protect Craig’s 16 year old girlfriend.”

He added

“He’s not a bad lad; none of those kids are, but to send Dwaine to prison for years, which is what is going to happen, is totally wrong and it’s not justice”

I don’t want to get into the issue of provocation the piece tells us nothing about Mr Wilson’s demeanour or appearance only that he was gesturing towards the youths and that one of them felt that Mr Wilson was about to attack him and his girlfriend. But notice that the family are not arguing that Dwaine acted in self defence but that he was “forced” to hit Mr Wilson over the head. Forced to hit him over the head? I suppose that the three of them were then “forced” to continue the assault punching and kicking Mr Wilson as he lay on the ground. And notice that despite being found guilty by a jury of his piers Wayne insists that his son is not a bad lad and that it is just not fair.

If Mr Taylor’s daughter were to be attacked and raped on her way home from a party I wonder if Mr Taylor (senior) would consider that her daughters assailant was “forced” to attack his daughter after his passions were inflamed by the sight of a scantily dressed female walking by. Maybe Dwayne was provoked and felt threatened by Mr Wilson’s behaviour and appearance. Maybe Mr Wilson had a shaven head, was dressed in a football shirt and had been drinking all evening watching his favourite team go down 3-0. Maybe Dwain initially did lash out in self defence that is not the point. Where is the acceptance by Mr Taylor that his son is at least partially responsible for his actions and is partly to blame? Instead his family parade outside the court house like Dwain is a political prisoner of conscience.

Within the commentary of this discourse, I believe it was firmly and established that this offer of…

I will bet you all a virtual pint that more than 75% of newly qualified nurses are under 25.

…was irrefutably and evidentially proven to be in err by Gallowgate and seconded by Zarathustra with this:

Gallowgate said…

According to the now defunct NMAS (Nursing and Midwifery Admissions Service) website: In 2007, 15226 of accepted applicants were 25 and under and 10260 were 26 and over.

It matters not a jot. Doctors, nurses, all ages, all shafted.
Do I win the virtual pint?

Thursday, April 24, 2008 10:44:00 PM

Zarathustra said…

So, by my maths that’s 59.7% who were 25 or under, well short of Dr C’s 75% claimed (and that’s 25 or under when they’re accepted for training, not when they qualify as nurses). I think gallowgate deserves the virtual pint.

Though this bit…

It matters not a jot. Doctors, nurses, all ages, all shafted.

…is sadly true.

Thursday, April 24, 2008 11:08:00 PM

However, despite this being proven, and the substantiated claims being laid to Doc C in order we might have our pint - he has thus far failed to deliver.

What a mendacious reneging welching bastard (..err.. of a suggestion).

Why have nurses in mental health?

Really, stop and think for a moment. Maybe on in-patient units, where arguably nursing may still have a role for some patients some of the time (but is it RMN stuff?), some nurses may be needed some of the time. But not necessarily.

In the community, shouldn’t they all be banned?

If you need psychological work, the expert is the psychologist. If you need to optomise function, the expert is the occupational therapist. If you need diagnosis or drugs, the expert is the psychiatrist. If you need social and practical support, the expert is the social worker. Informal support from friends and family. Peer support from group work facilitated by a STR worker. Support workers could care coordinate and advocate, too. Non-statutory input from MIND, AGE Concern etc. Depot medication, like insulin or injected vitamin B12, would be given by a district nurse.

Motion for the house : I propose that in mental health, nurses are no longer necessary. Discuss.

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.

QUI ME AMAT, AMAT ET CANEM MEAM
Love me, love my dog.

LUKE SUM IPSE PATREM TE
Luke, I am your father.

POTESTATEM OBSCURI LATERIS NESCIS
You don’t know the power of the dark side.

SIT VIS VOBISCUM
May the Force be with you.

IRE FORTITER QUO NEMO ANTE IIT
To boldly go where no man has gone before.

MAGNUS FRATER SPECTAT TE
Big Brother is watching you.

CREDO ELVEM IPSUM ETAIM VIVERE
I think Elvis is still alive.

FUTUE TE ET IPSUM CABALLUM
Fuck you and the horse you rode in on.

PEDICABO EGO VOS ET IRRUMABO
I will fuck you in the ass, and have you give me some good head.

CATAPULTAM HABEO. NISI PECUNIAM OMNEM MIHI DABIS, AD CAPUT TUUM SAXUM IMMANE MITTAM
I have a catapult. Give me all the money, or I will fling an enormous rock at your head.

MEUM CEREBRUM NOCET
My brain hurts.

SUPPEDISNE
Did you fart quietly?

TUA TOGA SUSPINA EST
Your toga is backwards

VAH! DENUONE LATINE LOQUEBAR? ME INEPTUM. INTERDUM MODO ELABITUR.
Oh! Was I speaking Latin again? Silly me. Sometimes it just sort of slips pout.

FELES MALA! CUR CISTA NON UTERIS? STRAMENTUM NOVUM IN EA POSUI.
Bad kitty! Why don’t you use the cat box? I put new litter in it.

IMUS AD MAGUM OZI VIDENDUM, MAGUM OZI MIRUM MIRISSIMUM.
We are going to see the wizard, the wonderful wizard of Oz.

CLAMO, CLAMATIS, OMNES CLAMAMUS PRO GLACE LACTIS
I scream, you scream, we all scream for ice cream.

MACDONALDUS SENEX FUNDUM HABET. E-I-E-I-O. ET IN HOC FUNDO, NONNULLAS BOVES DOMESTICAS HABET. E-I-E-I-O. CUM MOO MOO HIC, CUM MOO MOO IBI. HIC UNA MOO, IBI UNA MOO, UBIQUE UNA MOO MOO. MACDONALDUS SENEX FUNDUM HABET. E-I-E-I-O.
Old MacDonald has a farm. E-I-E-I-O. And on this farm, he has some cows. E-I-E-I-O. With a moo moo here, with a moo moo there. Here a moo, there a moo, everywhere a moo moo. Old MacDonald has a farm. E-I-E-I-O.

QUISQUE COMOEDUM EST.
Everybody is a comedian.

PLUS! PERGE! AIO! HUI! HEM!
More! Go on! Yes! Ooh! Ummm!

TE PRECOR DUNCISSIME SUPPLEX!
Pretty please with cherry on top!

MAGISTER MUNDI SUM!
I am the Master of the Universe!

ESTNE VOLUMEN IN TOGA, AN SOLUM TIBI LIBET ME VIDERE?
Is that a scroll in your toga, or are you just glad to see me?

PURGAMENTUM INIT, EXIT PURGAMENTUM
Garbage in, garbage out.

TE AUDIRE NO POSSUM. MUSA SAPIENTUM FIXA EST IN AURE.
I can’t hear you. I have a banana in my ear.

QUANTUM MATERIAE MATERIETUR MARMOTA MONAX SI MARMOTA MONAX MATERIAM POSSIT MATERIARI?
How much wood would a woodchuck chuck if a woodchuck could chuck wood?

But if I can suggest the following for a new strap line.

QUIDQUID ID EST, TIMEO NURSE PRACTIONUM ET DONA PROTOCOLIS.

I will be spending time with 3 different CPN’s based in the same office. I will mainly be with the primary under 65 however.

Having gained almost all of my knowledge about CPN’s from this site (ha), I was expecting even better treatment that I have previously had in ward based placements, the truth, however, was not comparable.

In the entire week I have been there……prepare yourself, the following story is not nice.

I have only had 3 cups of tea! 1 was a herbal tea from a lovely lady we visited and the other 2 I made myself. I was left in the office when my mentors visits did not wish a student present.

Not a single biscuit of any kind to be seen anywhere. Not even a rich tea!

How am I supposed to grow and develop in such a harsh environment?

I am self-referring for some 1:1 counselling very shortly.

Mental Nurse website, you are misleading and further action may be taken.

I just googled and found this. I didn’t google before I started writing this, but the article linked isn’t what I was going to say, so I shall carry on to share my thoughts.

Feel free to read the short article above, that is advertising the The Harvard Mental Health Letter, whereas I shall give you my ill-informed opinion for free!

Using the BBC as a means to explain morbid obesity and ignoring the fact that the photo shows a man with a bit of a beer belly, my experience of people suffering from morbid obesity is largely off the telly-box, therefore I am obviously an expert.

I watched Lose 30 stone or Die on ITV tonight which further fuelled my thoughts. There have been several programmes on over the last year or so, with varying levels of intrigue, some more poignant and thought provoking than others, helping the viewer either be repulsed or to empathise, depending on the quality of the programme.

The common theme mentioned in these programmes is the background to why the person has gotten so large and eats so unhealthily. There is usually an underlying issue that has not been dealt with or considered by the person. In the case of Colin in tonight’s programme, he grew up with an abusive father who regularly beat his mother. This was discussed in the programme.

It is often mentioned that there is little, if any psychological support offered to people who are morbidly obese. They are treated medically and left to get on with it. For example, Colin had to lose 10 stone before he could have the operation to reduce his stomach. The main motivation being, if he didn’t, he would die (the title gives this away somewhat).

Thousands of pounds are spent on the gastric bypass surgery, and if the person is successful and loses the weight, they may be eligible to get the layers of excess skin they are left with removed as well (on the NHS).

Our health service should be preventative, so in an ideal world, Colin’s problem should have been spotted a long time ago with help and support offered, before he got to the stage of being a recluse, living in his bed and being told he has to lose weight or die.

When I am enjoying hours of interesting power point presentations at Uni, we have it drummed into us to look at the patient holistically, from a bio-psychosocial perspective. This is ignored with obesity at the moment as although it is a recognised medical condition, it is not recognised in the Mental Health field, unlike, say alcohol misuse, which is seen as an illness, for different reasons.

Looking at alcohol misuse, or even drug abuse for a moment, a common complaint from my peers, staff nurses and patients, is that the person is given detox and sent on their way with minimal support. Often the person goes straight back to the same problems encountered before and it doesn’t take long before they turn back to alcohol or drugs as their means of an inappropriate coping strategy (described in that link as an avoidant coping strategy). Similar to the person who self harms to deal with their emotions until the nurse/therapist steps in and fixes them with the wonderful CBT.

Surely food to the obese person, is the same as alcohol to the alcoholic? (I’m sorry, I am aware I am not supposed to use that word, I am meant to say alcohol problem, but you get my meaning, hopefully without being offended and turning defensive.)

Alcohol abuse/misuse/enter up to date term here, wasn’t always viewed in this way, therefore, I predict in the future, Mental Health workers will be working with morbidly obese people at coping with or dealing with underlying issues, much as we should be doing for alcohol abusers now.

N.B. I am not suggesting CBT for this!

What`s this got to do with mental health ?.  Well at the end of the day our brains are just big lumps of fatty acids and proteins and meat is a pretty good source of that.  Of course the human body is mightily resilient, finer men than me built the Burma railroad on a cup of rice a day.  However, for optimum health, particularly mental health, I think you need a well balanced diet.  Has anyone else noticed that an unusually high percentage of women utilising services seem to be vegetarian ?. Is anyone else struck by the number of times we record poor diet on admission documentation

There`s another element to this argument aswell.  I suspect I`m a typical male, I`m incapable of filing anything and I can`t find a bloody thing in the fridge.  Is this because I`m better suited to spotting a wildebeest on the horizon ?.  I`ve mentioned the OSB hounds on MentalNurse before.  They came from the dogs home but I have to admit they were selected with hunting potential in mind.  Fortunately for the local rabbit population they have significantly more enthusiasm than ability.  I don`t seek out hare but I spend a lot of time in the countryside and I do encounter them.  I can relax in the certain knowledge that my dogs won`t catch them but nevertheless there is something quite thrilling about the spectacle of the chase.

Now before I`m deluged in hate mail I should point out that I`m a committed environmentalist,  I recycle everything and I`m ridiculously proud of my veg patch and compost heap.  I`ve never hunted seriously.  However, I am concerned that mans activities have created huge imbalances in wildlife populations.  There are too many foxes, crows, magpies, rats and grey squirrels about.  Deer and rabbit need thinning too.  I`m just wondering whether the mental health community should be doing more to support the hunting lobby.  A bit of hunting and some game stew on the table might just be good for you.

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.

I notice in recent comments both Bloo and Zarathustra have foreshadowed what I intended. I intend to totally steal their ideas.

Intervention: Building A Therapeutic Relationship - One
Action: Ignoring Clients With Challenging Behaviour

“Just ignore him nurse, he is only banging his head off the wall to get attention”

All time classic this one. Generally used with ars people with a diagnosis of personality disorder, or just those who decide to be loudly unwell when it is time for a tea break. The theory is that time spent with nursing staff is such a wonderful experience that clients will do anything to repeat it. If they do something loud and messy (slash wrists, kick doors, take a tiny overdose) they will get time from staff. The untaught response to a client in distress, like this, is to ignore them. Otherwise they will just do it again when they want something. Ignoring them reduces the reward leading to a cessation of the disturbing behaviour. Fabulous lack of intervention. Very person centred and never ever leads to increasingly bad behaviour leading to an admission to IPCU or even more fun discharge ! If nothing else makes the nurses look like a bunch of … to the rest of the ward.

Intervention: Time Management
Action: Using “paperwork” as an entirely spurious excuse for not talking to patients (Zarathustra)

“I will be with you in five minutes just after this paragraph.”

In modern nursing there are two schools of thought. One; there is too much paperwork, preventing quality time to ignore patients. Two; there is not enough papaerwork making it difficult to avoid patients. The best time to do paperwork is just when someone is going to need a fair period of attention coming up to the end of a shift, a tea break, lunchtime or sundowning time. The best way to
do the paperwork is at a desk in the office, with the door half open. Have your side on to the door so you can comfortable give a hard stare to the side when you get disturbed. Be surrounded by piles of papers and folders, contents irrelevant. Use defensive body language, pretend you are newly in D wing and your current paperwork is your first meal. Hug it and protect it. When disturbed say you will be out in five minutes. Use this excuse three times. Then say if you do not get it done you will be in trouble, glance Heavenwards and try to look frightened. Another approach is to say:

“Can you stop hanging around the office door please”

in a suitably condescending manner. (Zarathustra)

Intervention: Looking After Your Own Health
Action: Taking Time Off Sick

“My granny died again. No, the other one this time.”

If you need to go off sick, do so. Be prepared though. Even if you come back with a brand new stoma and an amputation at least one quarter of your colleagues will think you are a malingerer. The rest will just want to feel your stump. Prepare yourself by ensuring you put the worst possible interpretation of another staff’s sick time. Point out that it was a Monday, or a Friday. Suggest they did not seem that unwell when they collapsed in a yellow heap. Nod and make hmm noises. By making others seem bigger wasters you decrease your owned perceived wasterness levels.

Intervention: Maintaining A Safe Environment For One
Action: Unobtrusive Special Observations

“No I am not following you, remember you are paranoid !”

Sometimes patients need to be kept safe. Requiring a member of staff to keep them in sight at all times. It is difficult to avoid some patient contact in this situation. You must be sneaky. Whenever the patient makes eye contact with you whistle, any tune will do, I suggest ‘Always Look On The Bright Side of Life”.

Intervention: Mentoring Student Nurses
Action: Encouraging Self Directed Study

“Why don’t you go and research that yourself, it would be a better learning experience”

Students get taught stuff in University. Often they take this book learning and ask mentors about it. Some mentors have difficulty reading the Nursing Standard without following the words with their finger and moving their lips. We get asked things we have no idea about. The secret nurses code for:

“I have no idea what you are talking about!”

is the above comment. When I did my training we got taught about models of nursing. We got taught a lot about them. I, a bright eyed young thing, asked “What model of nursing do you use on Slow Rehab ward.” did actually meet with the response of “What is a model of nursing?”. Eventually the mentors got wise and told me they used “an eclectic approach combing holistic proactive person centred theories.” I think I know what that means now. It means nothing.

[WORK IN PROGRESS - posted to allow contributions, comments will be moved into main post -Mental]

You might be quite surprised to be receiving a letter from yourself. I remember that I was.Or do I ? Do you remember that Italian patient, Chris Agliostro ? Said he was immortal. Well that turned out not to be the case. But it turned out his claim of having invented a time machine was a bit more accurate. So I thought I would post me this letter on my way back in time to assassinate Margaret Thatcher, hopefully she will not turn out to have been my grandfather !

The future holds some surprises. Oldschoolbaby as head of the NMC was a shocker. Zarathustra as RCN spokesperson not so much. We get outed by one too many Guardian articles and fired from work. It causes a flurry on the Interweb but nobody pays any attention. Luckily we use our new found fame to publish a line of Mills and Boon Stories. The ECT: Doctors and Nurses series was a best seller. The first book is to be called The Atmosphere Was Electric ™.

On to the future.

Or roughly the next ten years. I forget. Turns out Alzheimer’s disease was viral. No one saw that coming.

Swings and Roundabouts

Many conversations about how the old ways would come back and services would be recentralised. Not true. Services continue to get pushed out into the community as fast as the NHS can get rid of them. Only essential services, acute wards and admin offices remain to populate the hospitals. Once the community services are set up the remaining wards to get centralised, on cheap land in the back end of nowhere. Any wards remaining on nice land is sold off for development.

Nurses Get Cleverer

All nursing courses become degree level. This gives the RCN confidence to demand higher wages for nurses, yet again. Being the RCN the pleas are ignored. Nursing student numbers go down. Universities in an attempt to bring the courses into line with their other courses make them even more academic. Mentors complain about a repeat of Project 2000, especially those that did Project 2000 in the first place.

Public Private Partnerships

Not much money to be made from the average mental health unit. Private enterprise will not touch it with a bargepole. The Trusts need to make the books balance though and cutting costs is the name of the game. They subcontract the long term, elderly, rehab etc wards to non-profit organisations. The health boards negotiate tough contracts. The non-profit organisations forget to ask for the budget to go up each year in line with inflation. Staff contracts are changed.Things go bad for a while. Get better eventually.

In The Name Of The Law

With the ever increasing amount of care in the community and the haemorrhaging of experienced staff disaster strikes. Some people with mental health problems do very bad things. The tabloids go into a lock ‘em up frenzy. Only the mental health charities point out that the number of people with mental health problems who are victims of crime and abuse has gone up by a much greater degree. No one listens to them. New draconian mental health laws are introduced. Protections are tokenistic. Everyone is meant to get the services of an advocate, advocacy services are refused Government funding. Government sets up new targets to reduce number of killings by the mentally unwell. More people get locked up. Due to closure of NHS wards they tend to end up in private forensic units. Who as they make money from each person in their care are unwilling to discharge in a timely fashion.

What Is In A Name ?

All references to illness are removed in a fit of political correctness. Replaced by the term Differently Sane.

Proles Unteachable

A new anti-stigma campaign by the department of health backfires. Advert composed of a long list of offensive terms used in the past to describe the differently sane. Followed by some instantly forgettable tag line. The general public love it and take it to their hearts. It has taught them new words with which to insult those they see as a menace to society.

Nurses Become Terminators

Well they will be when the Government’s NHS IT project is finished. Still waiting. Every ward now has an out of date computer that is connected up to nothing at all. All NHS trusts routinely block access to the entire Internet, except for managers. No staff have training on how to use computers properly. They only get used by the night shift to play Tetris.

Nurses Level Up To The Max !

In an attempt to become more ‘professional’ lots of new nurse positions are created. Nurse practitioners, consultants, prescribers, managers, advisors, phone line operators, specialists, voice whisperers etc. Almost every nurse now has a fancy title to go with their degree. Over 65 care in tatters as no one left to wipe bums.

Health Care Assistants Hang On To Coat Tails

The NMC finally convinces the Government to let it run a Health Care Assistant register. As they need to pay the rent on their expensive London offices and expensive fact finding trips to hot and pleasant countries.

As no nurses are are left lowly enough to provide hands on care a new level of staff is created. Senior Health Care Nurse Assistant Auxiliaries. Essentially they now do most of the things nurses used to do. Except for less money.

Well Mental that is it for now. I may post off another when I am going forward.

Hugs and Kisses,

Mental Nurse (Future)

On the wards among the nurses, there is a similar gift economy in action. However, instead of circulating necklaces made of seashells, the commodity is pens.

The pen first enters the gift economy at a lavish ceremony known as the “drug lunch.” This is hosted by a drug rep who lays on a sumptuous feast of sausage rolls, savoury eggs and Tesco Finest sandwiches. As is typical in such societies, the purpose of the feast is to instil gratitude in the nurses and remind them of the massive wealth and status of the drug company (an organisation believed to be linked to the cult of Cthulhu). The drug rep lectures the nurses on how their drug is more effective, and warns of the dangers of worshipping false idols from other drug companies.

Provided the nurses show a sufficient level of subservience and don’t ask any awkward questions, they are rewarded with the pen. As is usually the case with gift economy items, the pen has little material value. It is merely a small piece of cheap plastic. However, it is inscribed with words of power, such as “Seroquel” and “Abilify”. The pen now enters the gift economy of the ward.

On the ward, a nurse is often heard exclaiming, “Does anyone have a pen?” Without a pen, the nurse is robbed of power. He or she has no authority to sign medication notes, fill in care plans, or write up notes. The status of the nurse has dropped.

If a nearby nurse has a pen, he or she has a dilemma. If they wish to do so, they can offer the pen to the other nurse. This will cause the receiving nurse to become indebted to the giving nurse, and will be obligated to offer future gifts of pens, should that nurse request it. Alternately, the nurse may wish to retain the pen and benefit from holding its power.

Assuming a gift of a pen has been made, the recipient will usually make a promise to “give it back as soon as I’ve finished with it.” However, detailed ethnographic observations have shown that the receiving nurse rarely, if ever, gives the pen back to the original owner. Instead he or she will “forget” to return it. Hence the “return of the pen” is clearly a convenient social and cultural fiction designed to mask the true role of the pen-exchange. The nurse will retain the pen, thus benefiting from the status and power of “having a pen”. At some stage, another nurse will start asking, “Does anybody have a pen?” That nurse will then have to decide whether to give or retain the pen. And so the gift economy of the pen continues.

A few days later, along with three of my classmates, I went on placement to the acute admissions unit at the bin. It was a therapeutic community which focussed almost exclusively on group work. Like everyone else in the ward we had to attend the 9am community group. We were all anxious to make a good impression on our first day and when one of the patients recounted an anxiety attack she had suffered during the night we got our chance. There was silence after she stopped speaking and we racked our brains to remember what we had learned in college. Empathy! Of course, empathy! We recalled the tutor’s words and suddenly the silence was broken as four student nurses said in perfect unison “That must have been very frightening for you”.

It didn’t just sound fake and phoney, it sounded like we were taking the piss. I was utterly mortified and was determined never make the same mistake again. As the group stared at us in disbelief, I immediately made up my own new “empathy phrase” for future use. Later in the group, attention was focussed on a man who had lost a lung due to cancer and was now severely depressed, convinced he was riddled with cancer despite having the all clear from the medics. One of the staff nurses was trying to get him to focus on the reality of his situation and asked “is there anything you used to do when you had two lungs that you can’t actually do anymore?” The man pondered for a while, then said “Well yes, actually there is. I used to play the saxophone and I can’t do that anymore”. Quick as a flash and obviously without realising the dreadful pun, I threw in my new empathy phrase… “That must have been a great blow for you”.

I was thinking about superstition.

I’ve found one other post on this. From a general nurse.

There seem to be some common nurse superstitions I have come across.

The biggest is to never use the Q word to describe a shift. Never ! To do so is to invite a sure and certain doom of epic proportions.

Death apparently comes in threes. Also remember to open the window after the event.

Nights of the full moon are always a little … busier. Plenty of people are convinced that this is true.

Every hospital has a ghost.

I can not think of any specifically to do with mental health nursing. Anyone want to help me out ?