Following on from Z’s discussions on Anger Management in kids; NY Times has breakthrough news on how to help kids adjust - it suggests not punishing them for bad behaviour but reward them for good behaviour. Astonishing.

The problem may not be the kids so much as the way parents define discipline. Childhood health experts say many parents think discipline means meting out punishment. But often the punishments parents use end up reinforcing the bad behavior instead of correcting it. Surprisingly, the most effective discipline typically doesn’t involve any punishment at all, but instead focuses on positive reinforcement when children are being good.

They also highlight in Training Young Brains to Behave; how we can

.. err… encourage children to have better self control at an early age by concentrating on brain activities that develop the executive functions of the pre-frontal cortex around the 2 year old mark.

Some children’s brains adapt quickly, while others’ take time — and, as a result, classmates, friends and adults are interrupted for years along the way. But just as biology shapes behavior, so behavior can accelerate biology. And a small group of educational and cognitive scientists now say that mental exercises of a certain kind can teach children to become more self-possessed at earlier ages, reducing stress levels at home and improving their experience in school. Researchers can test this ability, which they call executive function, and they say it is more strongly associated with school success than I.Q.

.. and probably more psychopathy than empathy.

Moving on… it get’s better… schizophrenia and depression is now linked to middle east terrorism … but Down Syndrome people remain cuddly and are no longer vilified.

Psychiatric case files of two female suicide bombers who killed nearly 100 people in Baghdad this month show that they suffered from depression and schizophrenia but do not contain information indicating they had Down syndrome, American officials said Wednesday.

[I feel like I should apologise for drawing attention to this article and may in fact edit the link to direct to the BNP instead.]

Finally from the Numpty Yanks Times, in an attempt to exonerate them - I find an article that looks at the over-medicalisation of normal sadness:

Let’s say a patient walks into my office and says he’s been feeling down for the past three weeks. A month ago, his fiancée left him for another man, and he feels there’s no point in going on. He has not been sleeping well, his appetite is poor and he has lost interest in nearly all of his usual activities. Should I give him a diagnosis of clinical depression?

In their recent book “The Loss of Sadness” (Oxford, 2007), Allan V. Horwitz and Jerome C. Wakefield assert that for thousands of years, symptoms of sadness that were “with cause” were separated from those that were “without cause.” Only the latter were viewed as mental disorders.

With the advent of modern diagnostic criteria, these authors argue, doctors were directed to ignore the context of the patient’s complaints and focus only on symptoms — poor appetite, insomnia, low energy, hopelessness and so on. The current criteria for major depression, they say, largely fail to distinguish between “abnormal” reactions caused by “internal dysfunction” and “normal sadness” brought on by external circumstances. And they blame vested interests — doctors, researchers, pharmaceutical companies — for fostering this bloated concept of depression.

The argument could not be put better. Alas, Dr Ronald Pies MD (is that Ronald “Pies” MacDonald - a new venture?), closes with:

Until solid research persuades me otherwise, I will most likely see people like my jilted patient as clinically depressed, not just “normally sad” — and I will provide him with whatever psychiatric treatment he needs to feel better.

I was going to add a list of contra-indicating research about how anti-depressants often raise the chance of suicide and self harm between 2% - 4% especially in children and young people in the first weeks of use - but eh, what’s the point?

Moving on to news closer to home - my home that is -

They claim they were not warned by the psychiatrist who prescribed the antidepressant that it carried an increased risk — between 2 per cent and 4 per cent — of causing suicidal thoughts and self-harm in children and young people in the first weeks of use.

Crucially, they were not told their daughter would require close monitoring because of this risk. They were also not informed that the drug is not recommended for treatment of depression in children by either Australia’s drug monitoring agency, the Therapeutic Goods Administration, or the drug company Pfizer, which markets Zoloft in Australia. And they were not given a copy of the consumer medicine information leaflet that is supposed to detail these issues when they bought the drug.

However, as they later learned, even if they had got a copy of the leaflet, it would not have told them much of this anyway.

Yay - it’s not just UK MH patients who are not informed on medications then. The girl in this post lived through her overdose. The authorities therefore thought there was no need to report it as a potential adverse reaction. Drug companies always seem to get away with it.

In other Aussie news;

FOUR criminal charges against Pan Pharmaceuticals founder Jim Selim were dropped yesterday but the company was later fined $10 million for 53 offences related to altering the ingredients of therapeutic drugs it exported to Vietnam.

In April 2003, Pan, worth more than $300 million, collapsed after the TGA suspended Pan’s licence and issued the recall of all Pan’s products, the largest recall in the world. Earlier that year, consumers had reported hallucinations and severe illness after taking the Pan-manufactured travel sickness drug Travacalm.

I think it was advertised under the slogan : “The trips are better with Travacalm”.

In another Aussie story that must have come as a huge surprise -

Assisted suicide advocate takes her own life

The story is actually a very sad indictment against the criminal treatment of those who support euthanasia which highlights an increasing need to support open and accessible real discussions on the issue.

VOLUNTARY euthanasia advocate Caren Jenning has taken her own life to avoid dying in jail.

The 75-year-old, who had cancer, was three months ago convicted of being an accessory before the act of manslaughter over the death of dementia sufferer Graeme Wylie.

Jenning’s crime? She was the “drug-mule” who bought the Nembutal in Mexico and illegally into Australia.

A statement released by euthanasia advocacy group Exit International said Jenning “died peacefully from an overdose of the barbiturate Nembutal”, the banned sedative she obtained from Mexico for Wylie’s partner, Shirley Justins.

Friend and fellow euthanasia campaigner Phillip Nitschke, who discussed Jenning’s decision with her over a “final dinner” last week, said she saw no alternative.

“She knew that if she did get a custodial sentence, she couldn’t just nip home and end her life,” Dr Nitschke said. “She said over and over: ‘I am not going to die in prison’.”

Justins, 59, was found guilty of manslaughter for killing Wylie, 71, after claiming his death in 2006 was an assisted suicide.

The manslaughter charge appears to have been made simply because “Justins was found to have killed her de facto husband without establishing whether he was capable of choosing to die”.

Both were facing up to 25 years in jail.

Prosecutors had argued that his death was motivated by greed. Wylie changed his will a week before his death, leaving most of his $2.4 million estate to Justins.

So he has capacity to change his will - but not to end his life? Pah.

Finally from Oz, this interesting advance in the disease-modifying treatment of dementia:

“We believe that as you age, the brain’s ability to control the concentration of zinc and copper fatigues,” Bush says. “You get an abnormal interaction, a build-up of zinc and copper in the synapses, the connection between nerve cells, and it causes beta-amyloid to accumulate and become toxic.”

The result is an abnormal beta-amyloid complex that forms the plaques so characteristic of Alzheimer’s disease.

Bush and colleagues have therefore taken the approach of trying to remove the zinc and copper ions from the abnormal beta-amyloid, using a compound they’ve called PBT2 after the Australian company involved in its development, Prana Biotechnology, which Bush helped found in 1997.

This compound has the ability to seek out the abnormal beta-amyloid, with its unwanted baggage of zinc and copper.

“The drug manages to selectively find this abnormal complex and helps to pull the zinc and copper off the beta-amyloid,” Bush says. “The zinc and copper then returns to the tissue and the beta-amyloid clears — it gets moved away completely and destroyed.”

ok.. so what super news has the UK got?

A swimmer has been banned from his local pool because of his unusual goggles.

Roland Grimm, in his late 60s, said: “I’m very upset because it seems mad. I’ve used these goggles in more than 100 pools and no one else has ever complained. After you’ve been swimming for 40 years all over the world you know what works best for you and what’s safe.”

Gary Dark, manager of the leisure centre in Swiss Cottage, northwest London, said the goggles were a health and safety risk because the glass was not shatter-proof and the nosepiece could cause breathing difficulties.

I’m not so sure it’s the goggles mate, or just the paedophillic look it gives you.

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).

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.

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.

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.

Health & Safety will hereafter be referred to as H&S (or UB, for “utter bollox”, depending on context and my mood). I’d like to resurrect the Health & Safety argument (without mentioning the “R” word), and try to consolidate a few ideas on this wonderful ‘guiding principle’ of H&S in modern health care; mostly because today I was accosted by a junior nurse who declared that patient X was kicking a ball in the garden with no shoes on; and what was I going to do about it?

I am sure we are all aware of the wonderful advances H&S has brought to create a healthy and safe working and living environment of our staff and clients. However, when first introduced, I believe there was a UB oversight in not assuring there was an adequately installed braking system applied, and consequently, it has now flattened virtually all of us (except UB officers, who are not allowed to leave their office by virtue of their own work instructions to remain safe at all times).

I have witnessed some bizarre and ironic UB decisions and behaviours over the time (like putting “wet floor signs” in the middle of walkways for people to trip over; not allowing staff to do simple chores because they aren’t ‘trained’ in, say, replacing a light bulb - so you must work in the dark until the electrician arrives or attending a 2 day “food handling course” to butter toast and make tea).

Anyhow, I can just about live with the ones that only make my job harder; it entertains me to call out the plumber on double time to open a cupboard and turn off the stop-cock for a leaking shower.

However, I get a little more agitated when such ‘precautions’ spill over into the patients’ daily living. The event today involved a patient with history of hurting his toe before - and concerns that the family were litigous prompted the nurse in question to seriously consider the fact we had a “duty of care” to instruct (not ask) him to apply some protective footwear to kick a ball. She declared this to be an UB issue that, as senior supervisor, I was responsible for.

Now, having already become a little peeved at this sort of over-restrictive UB practice, I’ve already reviewed some of the legal, professional & ethical parameters that are called into question on such issues. I shall attempt, in educational fashion (so I can use this for my portfolio, of course) to summarise them here.

Duty of Care: The legal garb.

DoC is important when it comes to “negligence”.

Lord Atkin determined that a ‘duty of care’ was similar to the principle of ‘love thy neighbour’:

You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour.

When a service is provided to someone, there is a professional duty of care. This means, as health care workers, we must ensure we maintain a safe and healthy environment for our clients to avoid being “negligent”.

The principles for negligence of duty of care are generally laid out:

1. Was it foreseeable that the action (or inaction) of a particular person or organisation would expose another party to harm or damage?
2. Is there a relationship of ‘proximity’ between the two parties?
3. Is the action or inaction of one party the cause of the other party’s damage or loss?

It is also necessary to recognise the legal principle of volenti non fit injuria, which means “to a willing person, no harm is done”. Essentially, this means, a practitioner is not liable for the damage caused by another person to themselves as a result of action or inaction they took if they knew such act could have led to harm (bearing in mind that mental impairment may be relevant for impaired judgement and insight here tho).

Professionally, my governing body requires me to promote good health. Nowt wrong with that idea. Nowhere though does it tell me I’m supposed to whip and coerce that person into doing my bidding because they choose to make a dodgy decision, and this is for good reason. It’s called the right to self-determination. This is something nurses certainly could do with remembering. It covers a wide range of issues too - like when and what to smoke (let alone ‘if’!); how to spend their own money; what to eat or drink (especially relevant when a diabetic comes on the ward - how many patients have a choice to consume a “non-diabetic” food substance if they so choose?).

Ethically; well, let’s see. On the one hand, I’m meant to protect and preserve the patient’s overall wellbeing. But I’m also meant to support their individuality and recognise their uniqueness. The overall wellbeing doesn’t just mean not breaking a toe either. It might include the sense of feeling like a grown up, perhaps?

As a student nurse I remember my cohort getting 2 wards of EMI patients out to play cricket on a rare sunny warm day. The staff weren’t too impressed. One fella who took a turn at bowling, took a turn at falling over too. Staff began to set in ‘panic’ mode but once he’d tried and found out he couldn’t really do that so well anymore, he modified himself and bowled underarm. Which at 80+ was probably a wise thing.

The recent UK Capacity Act will be an interesting Act to follow in this regard. Proper use of the provisions of this Act may lead to indicate that (even mentally ill) patients can actually make decisions for themselves, about themselves.

I kinda hope it does go that way and isn’t used to simply prove who can’t decide for themselves. In the near future, I hope the “panic/common-sense” divide becomes the battle of the H&S vs Capacity Acts.

I’m interested to know if the UB Act still invokes performance to this extent of idiocy in the international arena. Please, tell me I’m not the only one who suffers this madness?

For the most part, this has been well received and  has resulted in major positive advancements in terms of nurse/patient interactions and facilitating events such as community leave better than ever before.

However, now the night staff start at 9pm instead of 11pm and some staff are having a problem with working out who should give out the Milo……

It’s not funny!

Day staff used to put out the Milo at 9-30pm. Now they are going home at 9pm and it’s really screwed their heads up.

The place is in turmoil and I think one of the regular staff is now considering long term sick leave because someone messed up the routine.

How on earth do these people think they can help someone who is going through a major psychotic breakdown when they can’t even work out what time to put the Milo out?

Does anyone else suffer from this level of institutional neuroses?

It could be a piece of torn clothing, or a broken CD player, but it’s sitting there.. ready… intriguing…. just waiting… for a story to be told…

Am I the only one to notice this? Or is it something that only I have come across? I don’t think so. I’ve seen it in the UK and abroad.

You come into the handover room and sit down and sitting there on the desk is an item. It’s usually something innocuous that, by itself, serves no purpose other than to tell the story of how it came to be.

Most frequently it’s something like a piece of torn clothing that was used during the shift before by a patient to attempt to harm themselves. Or it might be a broken CD player that a patient destroyed in anger. What I am amused by, more than anything, is how it is kept and brought out to add some substance to the story like “show and tell” as if no-one has ever seen one or can’t imagine what one would look like. Or maybe it’s there for evidence to show the oncoming shift “Look what we found!”.

Some examples I’ve seen:

Torn hem of t-shirt.

Broken CD disk or CD walkman

Ripped headphone cables

Torn (shredded) magazines or pictures

Two small round stones (like garden pebbles  - apparently the staff were concerned they might be used as a weapon?)

I only bring this strange nursing phenomenon to the forum as only last week I turned up for a hand over and someone had saved the torn hem of a t-shirt that a patient had in their possession. After the hand over I went to discard it in the bin and one of the staff flew across the office and retrieved it from the rubbish saying “You can’t throw it away” - When I asked “Why?” (plus a few other words) he said “You need to show the rest of the staff”.

What the bloody hell for???

I can’t help but think I must be missing the point somewhere….

Does anyone share this observation or have any idea why nurses do it?

You snivelling little worm. So you went and finished your nursing studies, did you? Well, you may have spent the last three years trying to live off £6000 a year, and as a result be about £8000 in debt, and you may be still waiting for your first month’s pay, but we’re still going to have our wicked way with you.

We want £76 off you. Just for the right to be able to call yourself “nurse”. Yep, 76 quid. Just make the cheque out to “My New Overlords and Masters, The Nursing and Midwifery Council”. While we’re at it, can you also bend over and drop your trousers so we can get some “executive relief” in your cornhole?

Yours Sincerely

The Nursing and Midwifery Council

PS You are now our bitch. And you will be forever. Well, at least until we decide to strike you off.

This has caused endless discussion and debate about exceptions, if any, to the rules.

This post, however, is not about that. I am hoping this is not too much of a rant, but has a point to it.

Talking to an acquaintance, I was hearing about one hospital in Scotland (where the ban has been in place for about a year) which has both Medical wards and Mental Health wards in the same building. They are pushing for the outright ban of smoking in the grounds. This is probably true of lots of hospitals, but depends on the extent it is enforced.

The theory is that there is to be no smoking including the car parks (and in the cars). Patients and visitors may regularly flout this, standing at the front door. Staff, however, are another matter.

Since the ban was implemented, staff have been sitting in their cars hiding away, filling their ashtrays and smelling more like an ashtray than previously when smoking in the open air. Hospital management did not like this. They enforced the rule that staff must not smoke in their uniform at all.

Makes sense I hear you say. Yes, it does, for a few random arguments too boring to put down here, one major one being the ever important infection control.

The part that makes no sense and that I find rather infuriating, is that the same hospital do not enforce their staff to change in and out of their uniforms before starting and finishing a shift. Almost all staff come and go in their uniform. There is a huge amount of money spent on awareness, training and procedures in reducing Hospital Acquired Infections, just look at the website for hand washing from the Scottish Executive that reportedly cost silly money to produce.

Why have they decided to worry about the smoking nurses, yet leave all of them and the non-smoking nurses to wander in and out of work, in their cars, on buses, trains, shops, supermarkets, into their homes in their uniform? But if you are caught having a fly puff still in uniform you may face disciplinary action?

That question baffles and annoys me. As a Nursing Student, we were told that we had to change out of our uniforms, not be walking around in it after shift (as if, have you seen what we have to wear!?) but the qualified staff do as they please. In fact, many of the wards I have been in where I have had to wear a uniform, do not have proper changing facilities unless you want to go into the bowels of the hospital and squeeze in the tiny locker room. I have changed in several toilets, which is hardly gleaming with cleanliness.

Fortunately for us in Mental Health, this is less important, but it does not mean we should ignore it!

So after a few weeks of Crisis In The Community she turns up in the police cells after shouting and screaming in the street. Just boyfriend trouble but it spilled out and the neighbours got involved and there’s a touch of arson and a bit of self harm….anyway upshot is, she’s in the cells and then gets assessed and ends up voluntarily on the ward. Boyfriend wants nothing to do with her now. Its over, he’s had enough. Remember that.

Maria makes friends quite quickly on the ward. This makes staff suspicious. They report that she doesn’t need to be there. But she’s now homeless. She’s taking up a much needed bed. Gradually she has no input from staff and spends her days doing her own thing. Only sleeping in the ward and bringing Macdonald’s in for some of the other patients. A CMHT member is on the case for housing. Eventually a hostel place is found. She’s discharged. Remember that.

Maria makes a big fuss at the hostel, there’s lots of trouble, it’s not working out. She goes to the CMHT. She’s been discharged. She needs a referral letter. A&E phone the CMHT a couple of hours latter. She’s there. A mild overdose and drunk. They’re very concerned. They want to discharge her to the CMHT. She’s not on the books. Remember that.

A&E need to make a referral. No - they want a psychiatric assessment before she’s discharged. There is no agreement between the Hospital Trust and The Mental Health Trust about who pays for this. Maria can take herself to the Mental Health Assessment Unit when she’s sober. SHO at A&E isn’t happy but has no choice. Sends Maria by ambulance for assessment. Once assessed she is referred to Crisis Team – but she has been discharged from hospital – not mentally ill therefore not eligible. Remember that.

Referral sent on to Psychology, except Psychology only sees people who are mentally ill these days, she’s not for them. Are you remembering?

Referral sent back to Crisis Team. Crisis Team write to GP –Days later the GP phones the CMHT – furious! He wants her seen – pointless ranting, no joy, but routine referral accepted. Maria is discussed in Team Meeting. Decision: this is a not a secondary care case. Needs Primary Care counselling. Outcome fed back to GP, in the full knowledge that there is no Primary Care Mental Health Service because the PCT haven’t commissioned one. Manager explains – “the more we send back the more chance there is they will stump up the cash – this is war!” CMHT starts getting brave – referring back to GP’s with abandon. A stamp is bought – NOT FOR SECONDARY CARE! It is ker-clunked on to GP’s letters and couriered back to them. Team morale is high. The war is being won.

Remember Maria? She is dead of course. Drowned herself in a river. The GP let the Team know, out of anger more than politeness.

“Unprofessional really, to let emotions show like that,” says the Team Manager.

Ward round on the psych ward. The various members of the multi-disciplinary team are filing in. Professor Whiggy the Consultant Whychiatrist. Bright Eyes the Eager-to-Please SHO. Zarathustra the Devilishly Handsome Stoodent Mental Nurse…

In strolls the physiotherapist. He has brought a student physiotherapist with him…

Stoodent Physiotherapist is a icon of physical perfection. His arm muscles pulsate with raw power. His jaw is so square you could use it for geometric measurements. His hair is spiked into a work of art. His teeth gleam blinding white. He is flawless.

The effect on the secretary and the deputy ward manager, both slightly hormonal ladies of a certain age, is immediate. There is an immediate *thunk* as their jaws land on the table.

I mean, they say guys are unsubtle about staring when an attractive woman enters the room, but these two women were practically radiating, “Ooooh, young man! Give me a physiotherapy assessment, young man!”

Physiotherapists, eh? They make me sick, with their total physical perfection and finely sculpted bodies. I’d give them all a good kicking, but they could probably tear me apart with their bare hands. But then I guess it’s understandable that if your job is to encourage a healthy musculoskeletal system, then it should attract sporty people who look after their own physiques.

After all, this is why mental health nursing attracts well-rounded, stable individuals who absolutely never abuse drugs or alcohol, and are all self-actualising so hard that we’ll all achieve Buddhahood some time next week. Right?

I was sitting in a coffee shop trying not to drool on my purchases when I heard a conversation:

Person: Oh yes, Mildred, my daughter, was not very well at all.

Other person: Did you try the fairy dust then ?

Person: Oh yes, I sprinkled some on her, it fixed her right up. She was fine after a few days.

Other person: Yeh, it’s really good stuff. Well worth the money.

One of the people had just served me my drink. I took a very close look for some powdery residue. Though looking back at this conversation I could have been hearing some encoded conversation to do with a drugs deal ? My feeling is though they were actually talking about Fairy Dust.

Is Fairy Dust made out of ground up fairy folk or made by them ?

Many clients feel they can mysteriously affect events at a distance. Often involving rays, or energies or waves or something. Often this results in them being offered a little something extra in the medicine pot.

Nurses can have the same idea.

People can believe what they like. If a client wants to believe try alternative therapies, and if there is no medical reason to prevent this, nurses should help them to do so. We are there to help clients live their lives to the best of their abilities (said abilities often being better than nursing staffs) not impose our own values.

Staff can believe what they like. But should not bring their lunatic ideas to work and impose them on others.

Dylan Evans has written an excellent book (the one I was reading in the coffee shop oddly enough) about the Placebo effect. To summarise:

1. The Placebo Effect exists.
2. It only really helps with pain relief, mild to moderate depression and anxiety.
3. It is of no use for anything else.

Go read it.

Most alternative therapies work on the placebo effect.

There was a member of staff who wanted to set up Reiki Therapy sessions for the clients. He had a high quality certificate that qualified him as a master Reiki healer or some such thing. Everyone, all the staff, though this was a wonderful idea. There was much discussion of acupuncture, homeopathy, aromatherapy etc. To speak out against it was to be ostracised by the herd.

The patients on the whole did not really give a monkeys. They were too busy influencing or being influenced by distant events due to fluctuations in the aetheric realm.

I don’t think I would have minded really if it had just been a chance for one to one time with staff amd some pampering. No the Reiki Nurses had to explain the theory to the patients and encouraged them to believe it was true.

From Reiki Therapy UK:

How does Reiki work?

The Reiki healer acts as a channel for this life energy. The energy is channeled into the recipient’s energy field and physical body. Reiki goes to the deeper levels of a person’s being, where many diseases have their origin. It works wherever it is most needed within the body, mind and spirit, releasing blocked energies, cleansing the body of toxins and working to create a state of balance.

I was going to go through that paragraph and bold the nonsense bits …

Reiki essentially involves moving your hands around a persons body byt not actually making contact. Normally up quite close. I’m sure advanced Reiki Ninja can do the same thing at a distance, probably without even leaving their sofa.

For the nurses reading this what would you do with a patient who claimed they could heal your ailments by waving their hands around near your body ?

Another wanted to teach Yoga. Primarily though as a means of gentle physical exercise and some breathing techniques.

I would have been upset if he had wanted to teach the philosophical / religious background and encouraged clients to accept it.

Many of the alternative therapies are based on religion (yoga), bad science (homeopathy) or bizarre beliefs (reiki): or a combination of all three.

If ,as a God Squad member, I came in to work and encouraged patients to read the Bible and pray for healing I would be met with horror. Quite rightly so. My purpose is to care for the unwell not beat them about the head. I’m sure if Zarathustra came in to work and encouraged clients to use some of Crowley’s, possibly tongue in cheek, techniques he too would be met with horror.

The treatments we promote must be based on the best evidence possible. The best science. There is already enough nonsense in psychiatry without making it worse.

Medication is not the answer to everything. Psychiatry is not the answer to everything. 42 is the answer to everything.

Or possibly 23 ?

I know this because I’ve been told this repeatedly, usually by nurses close to retirement. They’ve alway been keen to tell me that all this university book-learning is politically-correct nonsense. Nurses don’t need to be educated. They just need to know how to nurse.

I have to say though, I’ve always been of the opinion that they were talking bollocks. I had a BA and an MA before I even started on the nursing degree, and it hasn’t stopped me from getting my hands dirty. Yes, nurses need to know how to give practical care at the bedside, but they also need critical thinking skills, and the only way to get that is at university. Without that ability to not just do things but to think about why you’re doing it, you get dullard, unimaginative nurses who follow bizarre rituals and inflexible hierarchies.

Confirmation of my opinion comes from Flamingfairy, a nurse lecturer, as he looks back upon his own nurse training.

Back in the day, when I was a student of the kind he longs for, we did things mainly because they had always been done that way. Research evidence was derided as no substitute for hands-on experience, even if such experience comprised of misinformed or ritualistic practices of dubious value to patients. Individual ward sisters had their way of doing things and woe betide anyone who dared to question why - for instance - respirations had to be charted in green pen as opposed to blue pen. Third year students were often left in charge of wards, especially at night, and we were more or less an easily exploitable source of cheap labour for whom the learning took second place to the labouring.

Nowadays, my students are presented with a wealth of information from a wide variety of theoretical frameworks. They have access to electronic databases, and their assignments encourage them to engage in the kind of critical thinking that would have Sister Jessop (the name of a particularly foul old bag from my student days) spinning in her grave (she may not be dead, but we can hope). They are educated to a far higher standard than we ever were in our schools of nursing (although of course some of them aren’t touched by this education, and not all of them can successfully negotiate the demands of such a course). Some of them will go on to become the kind of dependable workhorses who turn up, do their job, collect their money and maybe attend one study day a year. But some of them will use this education as a springboard to become the future leaders, innovators and - yes - teachers of nursing. Without a degree-level education available, it’s my guess that the number of them who turned into these valuable people would be far smaller.

Read the rest here.

This pretty much confirms what I’d always suspected, that the old days weren’t better, when matron was in charge and student nurses knew their place. I also think that, although the Project 2000 system (which took nursing out of the old apprenticeship training and into the universities) was probably lacking in sufficient grounding in the clinical area, the reformed nursing curriculum under Making a Difference/Fitness for Practice (which took over from Project 2000 in 2002) is much better. Through the course of my degree the ratio of academic to clinical learning has been pretty much 50:50, which to my mind is what it should be. Also, the academic side of things has always had a strong grounding in the actual problems we’re likely to encounter and deal with.

The Daily Mail and certain doctors who should know better may scream with rage at me saying this, but education is not wasted on a nurse. Far from it, nursing needs imaginative, critical thinkers, and shouldn’t be expected to apologise for it.

Service users are time-wasters. They want to be in hospital, are happy to be dependent on professional carers and are ready, willing and eager to become institutionalised as soon as they fall into our grasping hands.

Sound familiar to anyone out there?

…probably not, but now replace the general with the specific, and I wonder who many staff have either heard these words uttered from the mouths of colleagues…or even, dare I say it, have said it themselves:

“Patient x shouldn’t be here, s/he’s just wasting our time…..not mad, but bad. S/he really likes being in hospital/getting a community service, and (the final convincer for anyone who thinks this is just prejudiced opinion……..) we need to discharge him/her before they get institutionalised/too dependent on us.”

The last comment of course refers to the mystical processes of institutionalisation and dependence that have nothing to do with the behaviour of the professionals who are supposed to care for them.

I’ve heard these comments all my nursing career, and have always thought……..”Jesus Christ! How bad do their lives’ have to be that they would want to live in a mental health unit or have the likes of you visiting them at home?”