Here is something we can all get into a self righteous lather over. I am not sure if Iris Robinson is a British MP or a member of the Northern Ireland assembly her husband, Peter Robinson, is the leader of the DUP and First Minister, but Iris is reported by Hansard as saying;

“There can be no viler act, apart from homosexuality and sodomy, than sexually abusing innocent children.”

She later clarified her comments by saying

“I cannot think of anything more sickening than a child being abused. It is comparable to the act of homosexuality. I think they are all comparable. I feel totally repulsed by both.”

However she now says her comments were misrepresented and that at no time did she say that homosexuality was worse than child abuse. However after checking the recordings Hansard is satisfied that the comments were reported accurately. The comments were made at a Northern Ireland Grand Committee meeting last month where risk assessment and management of sex offenders was being discussed. Mrs Robinson has been reported as saying that with help gay people can be “turned around.”

Mrs Robinson asked Health Minister, Michael Mc Gimpsey, of the Northern Ireland assembly if he would agree that some people in their teenage years are sexually confused and could do with “therapy” to help them realise their true sexual orientation. This was after Mr McGimpsey had said there was no evidence that homosexuality was a disorder in itself but that gay people could be suffering from specific mental health issues unrelated to their sexuality.

Now should Iris have her views censored or should she be allowed to air them repugnant as I find them. As Ian Dale comments on his blog:

It’s a free country and I fully defend Mrs Robinson’s right to come out with such bigoted, ill judged claptrap. But by doing so she just reinforces existing prejudices among certain people who then feel expressing them in a violent way is somehow acceptable and can be defended because of the “scriptures”. Not long ago a gay man in Belfast was beaten to death in a violent, homophobic attack. While I am sure Mrs Robinson, being a good Christian, would never condone any form of homophobic attack, she should not be surprised if her remarks give succour to those who perpetrate them.

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).

First off, I have made the decision that quotes from or links to BNP websites are not permitted on this site. I know that some of you object to this on free-speech grounds. The likes of the BNP are free to speak elsewhere on other websites, as far as I’m concerned. Anyway, I’m not going to debate the matter further. The decision is made and that’s it.

Second, some of the debates have at times descended into personal attacks. That’s not acceptable. By all means be as forthright as you like in debating ideas and issues, but don’t lower yourselves to insults or abuse. Attack the ideas, not the individual. As a rough guide:

Acceptable: “That suggestion is blitheringly idiotic”

Not Acceptable: “You are a blithering idiot”

If a comments thread is starting to turn into a slanging match, I will simply close the thread. Repeat offenders will be given a warning, then a temporary ban if they persist, and then if necessary a permanent ban.

There is no comments thread for this post because this is not a matter for debate. It’s simply a statement of how it is.

Works and pensions secretary, James Purnell, says the plans are “revolutionary” and that people who have been signed off long term sick will experience a new pathway back to work with drug addicts denied benefits if they refuse treatment and an end to the something for nothing benefits culture. The changes are seen as a return to the original ethos of the Welfare state as envisioned by William Beveridge. Mr Purnell says the welfare reforms will transform lives and;

“People will have an obligation to work, the benefit system will not be there to give a choice between benefits and work; it will be there to help you when you can’t find work. People who do not take up the offer of support will lose benefits”

He said it was the government’s intention to get a million people off benefits by 2015.

You and Yours’ interviewed an activist for Encephalomyelitis (ME) sufferers. A sufferer with ME herself she obviously felt that she would be one of those at risk of loosing her current incapacity benefit and forced back to work. The sufferer explained that prior to her illness she had been a financial manager with the NHS but since falling ill she was unable to wash herself, wash her clothes, cook or make a telephone call. The former NHS manager explained that it could take her anything up to a week to return a call because of the physical and mental effort it cost her. She doubted that she would even make it to work let alone be able to complete a full day at work once she got there. She had put these points to James Parnell himself earlier in the day and while he had been sympathetic she did not feel he fully appreciated how disabling her condition really was.

The good Dr Crippen has blogged on this subject before and his views, shared by many in the medical profession, on ME are clear. But ME has commonly been associated with Chronic Fatigue syndrome (CFS) and Post Viral Fatigue Syndrome (PVFS) to the extent that these terms are thought by some to be one and the same thing. Both these syndromes (CFS and PVFS) are also thought to be linked with Fibromyalgia (Fibromyalgia syndrome FMS) and FMS, CFS, PVFS, and ME may all be part of a common neurological, endocrinological, or immunological disorder.

CFS/ PVFS/ ME is a poorly understood disorder affecting men and women mainly in their 40,s and 50,s often starting with flue like symptoms. The sufferer then experiences chronic symptoms including myalgia (widespread muscle pain) cognitive difficulties (including confusion, forgetfulness, poor concentration, difficulty with information processing, perceptual and sensory disturbances), chronic mental and physical exhaustion sleep disturbances, ataxia (clumsiness and lack of balance) muscle weakness and myclonic twitches. There may also be photophobia and a hypersensitivity to noise and stress.

Sufferers from ME report reduced levels of physical activity and depressed mood. The Pathology of ME is poorly understood but after 3,000 research studies there is evidence that CFS/ ME is a real physiological illness and both CFS and ME have been described in a 2008 Toxicology journal as

“a constellation of multi-system dysfunctions primarily involving the neurological, endocrine and immune systems.”

While a 2007 journal in Autoimmunity summarised that:

“The current concept is that CFS/ ME pathogenesis is a multifactorial condition in which an infective agent causes an aberrant immune response”

The causes of this group of disorders is not fully understood but some likely candidates are

• A recent viral infection
• An immune/ endocrine/ neurological dysfunction.
• Mental illness
• Oxidative stress
• Genetics

Treatments include

• Adaptive pacing (taking a measured approach to life and avoiding undue mental stress or physical exertion)
• Cognitive therapy
• Graded exercises
• SSRI anti depressants
• Anti oxidants.

This brings us back to where we came in. The government says it intends to give the long term unemployed, (including some of those currently on incapacity benefit), work advisors who will help them find work and support them in their return to the work place. The task of helping the long term unemployed back to work may be contracted out to private employment agencies that will be paid by results. The advisor would be there to help the former manager interviewed on You and Yours’ back into work and help support her there. The Government would only use the stick of withholding benefits as a last resort, although I think it unlikely that they will want to be seen to be stopping benefits to those thought of as disabled this close to a general election.

It could be argued that a phased and supported return to work for the unfortunate woman interviewed on today’s edition of You and Yours’, could form part of a therapeutic regime although I suspect the government’s incentive is more pecuniary than therapeutic. However, I could not help reflecting after the program had finished that the former NHS financial manager who was incapable of washing or cooking and who took a week to return one telephone call appeared to have no difficulty in giving radio 4 interviews or in putting her case to government ministers.

BOM has some intersting and slightly technical comments on the proposed changes here

My response to this is the same as my view of the compassion index and the Productive Ward scheme. Which is that by and large doctors, nurses and other healthcare professionals don’t need an endless slew of top-down schemes of incentives, monitoring and reorganising. What they need is to be granted the freedom to do their job.

Most clinicians want to do their jobs well, and are happy to get on and do it. Simply ensure that clinicians have a minimum of bureacracy to contend with, keep staffing levels above a safe minimum, and make the NHS disciplinary system a bit more robust so that we can effectively weed out those bad apples who don’t want to do the job. Make those changes, and it’ll make far more difference than somebody monitoring your smiles or sending you on a training course on how to tidy a cupboard.

Over at Kings College Hospital, nurses won’t be getting bonuses like the Imperial College surgeons if they do their jobs well. They get a biscuit.

Good nursie! Nursie beg! Nursie wanna bikkit?

1. Arrange some zopiclone for The Shrink

2. Put together This Week in Mentalists.

Aethelred the Unread is hearing voices.

I find them disconcerting rather than scary or traumatic, and one or two of them (I sometimes hear the voice of my 6-years-dead dad, for example) are quite comforting, in a way. Sometimes I find them wryly amusing, as this time - I think I must have the soul of a chartered accountant in order to hallucinate, not exciting messages of global significance from the Great Sky Spirit, but rather announcements about train delays…

Coloured Mind and Scattered Thoughts is in transition from CAMHS to adult services.

After much discussion they decided not to start the referral process until after results day so they knew which part of the country I would be in and I would get “continuity of care”. The problem is that on Friday I turn eighteen, it means that I am not supposed to be under the outreach team but crisis assessment and treatment team CATT. But me being the special person that I am, it’s not happening because I am staying under CAMHS for another month. The outreach team will receive less funding for me so my sessions are being cut, simple the answer to that is to have more CAMHS clinic sessions. And here we meet problem number two; my main CAMHS worker goes on holiday on Friday until September. I don’t want to see someone new for a month so again we are stuck. Somehow I have gone from too much support, to no support.

The Shrink notices some number-juggling in the Productive Ward scheme funding.

How much is to be spent of this programme? Why, quite a lot. £50 million. Cooo, that’s actually quite a big number, isn’t it? Our Secretary of State, Alan Johnson, said in a press release on the 8th May 2008 that the NHS will be investing £50 million in supporting the roll out of the Productive Ward programme. The letter I’ve had about it is titled, “£50 million to double the time nurses spend on patient care” which is awfully exciting. What can I say, I get excited easily. But really, £50 million national investment to allow nursing colleagues to do more nursing. Fantastic.

One teeny weeny fly in the ointment.

Yet what I read from our SHA is, “. . . we need to demonstrate that £50 million is being invested in implementing the Productive Ward initiative. Schemes may already be in place that count towards the investment target without the requirement to make additional funding of £50 million available.” Goes on to say that some PCTs will need to make available additional funding but that, “Any additional funding required should be made available from existing PCT 2008/09 resources.”

So, no extra cash at all, then

Mandy Lifeboats Ahoy comments on mental health and the arts.

Most Mental Health Trusts in the UK care nothing about the arts but spend a disproprtionate amount of money on a few kept artists and networkers to present themselves as taking the lead.

NHS MH Trusts taking the lead in the arts?

Nothing could be futher from the truth. Many Trusts are simply engaged in cynical self promotional activity with the larger flagship Trusts like the South London and Maudsley (SLAM) and Birmingham and Solihull MH Trusts engaging in outright fraud to present themselves as ‘representative’ and at the cutting edge of mental health arts and user involvment because their foundation Trust status requires them to be more ‘democratic ‘ but of course why bother to be why you can buy loyalty and restrict participation and involvment to a select trusted few?

Seaneen has feminist guilt.

I have Feminist Guilt about mental illness. I feel “wrong” for it. Firstly, women are historically not treated very well if they have a mental illness. In Victorian times, it was “hysteria”, in fact, any “immoral” behaviour was slapped as a deviancy. The same still applies to some degree- I know the toss has been argued here before about the diagnosis of Borderline Personality Disorder by gender, but it is still mostly a Woman’s Illness, namely because the behaviour therein is more aberant for a woman to engage in.

Bipolar women are more generally acceptable than schizophrenic women (but this is true of men, too. Manic depression is a far more socially acceptable illness than schizophrenia, even though they overlap). The image of it has changed, though, as times wore on. Manic depression no longer represents the image of celebrated artists like Sylvia Plath and Virginia Woolf. It has reverted back to image of being a promiscuous, impulsive, irresponsible illness by way of Britney Spears, Amy Winehouse and Kerry Katona.

Mr Man’s Wife has been trying to arrange an emergency appointment.

She came back and explained that there “isn’t a real emergency” so Mr Man could come in and see Dr Hillary on Wednesday.

I accept that there are unavoidable circumstances which mean that Dr Hillary can’t be magically brought into work in a puff of smoke, but it’s that phrase “isn’t a real emergency” that bothers me – as if I’m being accused of overreacting again. I suppose she’s right; Mr Man hasn’t chopped his own head off and he hasn’t been running up and down the street naked screaming blue murder (subject to change). But really, those are the kind of emergencies where I would be looking for an immediate assessment to have him admitted into hospital, and it wouldn’t matter which doctor he saw. This situation is an emergency to us because we want to avoid a hospital admission.

Not Another Nursing Student is ignoring the smoking policy.

I went out with the Community Psychiatric Nurse (CPN) today. By and large I enjoyed it, although I do now stink of smoke. Hence the post I started writing. It is my own fault; the patient asked if we minded her smoking - and to be honest it was knocking me a bit sick - but I just couldn’t bring myself to ask her not to smoke when I was a visitor in her house, even knowing I had the holy ‘policies and procedures’ on my side. So I said no, I didn’t mind. Overall, I would rather she felt comfortable talking to us. She was using an empty tin of corned beef hash as an ashtray. I didn’t even know they did corned beef hash in tins. I have learned something today.

As some of you may have guessed by now I am currently reading a book on “Social construction” or social constructivism or constructionism by Ian Hacking called the “Social Construction of What?”. At the risk of boring certain members of the audience even further (audience what audience?). I want to give a resume of Chapter 5 (pp 100 – 125) entitled “Madness: Biological or Constructed” and maybe draw a few conclusions of my own.

There are many controversial diagnosis in psychiatry (Intermittent explosive disorder, ADHD and conduct disorder in children, Sexual addiction and personality disorder in adults) where it is suspected the medical profession is medicalizing certain aspects of behaviour that until recently were considered deviant, naughty, normal or criminal but which are now seen as an illness in need of treatment. There are also cases of diagnoses that have gone the other way (homosexuality and moral imbecility) have all dropped out of current usage and are no longer considered illnesses.

Some mental illnesses are described as transient, they show up at a specific moments in time and place and then mysteriously disappear. Examples include hysteria in 19th century France, Multiple personality disorder in 20th century America and Anorexia which can according to Hacking can be quite local in its history and at the time of writing was particularly virulent in Argentina of all places.

But is there a sense in which mental illness is “constructed” or is it “real” and if mental illness is real what do we mean by real? Hilary Putnam had this to say about reality:

“ (there is a ) Common philosophical error of supposing that reality must refer to a single super thing, instead of looking at the ways we endlessly renegotiate - and are forced to renegotiate – our notions of reality as our language and our life develops”

So is there a sense in which reality is constructed and the dichotomy between what is considered real and constructed a false one in this case? “Socially constructed” and “real” do appear to be at odds with each other. Psychiatry is a part of medicine which views itself as a branch of the natural sciences dealing in “real” things not stuff which has been socially constructed or made up by social workers. Psychiatry sees schizophrenia at its heart as a biochemical/ neurological/ genetic disorder but a minority of critics think that the disorder itself has been socially constructed. Is there a way of reconciling these apparently incompatible views? Hacking thinks there is.

Hacking describes interactive, indifferent and natural classifications or kinds of things. He believes the idea of an indifferent kind of thing can be adapted to resolve the differences between the biological and constructionist camps. Hacking defines an indifferent kind as one that does not interact directly with its environment but is not entirely passive either. Electrons are indifferent to the idea of electrons and do not interact with the concept of what it is to be an electron and so remain unchanged by the concept. Electrons are there fore a natural kind of thing because they have no agency and act as a philosopher would say under description. Likewise the diagnosis of schizophrenia is indifferent to what it means to be a schizophrenic but a schizophrenic on the other hand is conscious of what it is to be schizophrenic and is changed by that diagnosis. Schizophrenics when allied with others who have the same diagnosis (Schizophrenia fellowships and interest groups) are able to influence the diagnosis which in turn changes how the diagnosis is viewed by those so diagnosed. There is in effect an active dialogue between the diagnosis and the diagnosed which evolves over time. A similar dialogue may be occurring between notions of what an electron is thought to be by scientists and how it is thought to behave in the laboratory but this has nothing to do with any independent thought or action carried out by electrons.

The word “kind” was first used in this context by JS Mill and William Whewell and was used to describe the way in which the thing or group being classified interacts with the classification and vice versa. The interaction between kinds and their classifications can be strong or weak in nature and occurs through a looping effect described above in relation to how a diagnosis of schizophrenia changes the individual and is turn changed by the individual. The social sciences (sociology, anthropology, psychology?, Psychiatry?) have for a long time tried to emulate the natural sciences (physics, chemistry, biology, medicine) to identify “true or natural kinds” that is kinds which are fixed and have an objective reality and nowhere is this more clearly demonstrated in Psychiatry than in the research to discover a neuro-chemical basis for schizophrenia.

Indifference does not necessarily imply a fixed and passive response. Schizophrenia may not interact with the idea of schizophrenia but schizophrenics interact with the business of psychiatry and with the psychiatrists who are attempting to treat the condition (or are they treating the individual?). When philosophers talk about natural kinds the indifferent nature of the kind in question is in a technical sense taken for granted, but natural also implies a fixed and passive quality that is not necessarily implied by indifferent. Things classified as natural are not aware of being so classified and do not interact with their classification but schizophrenics do react with their classification or diagnosis so schizophrenia, as it affects the individual, should according to Hacking, be seen as an indifferent rather than as a natural kind.

The targets for the natural sciences are relatively stationary; the targets for psychiatry (literally and figuratively) are, owing to the looping effect, not. The term Schizophrenia was first coined in 1908 by Eugen Bleuler but descriptions of schizophrenia like symptoms are to be found in the Egyprian Ebers Papyrus (BC 2000) and in ancient Greeks and Roman texts which describe symptoms of psychosis but not in a way that would satisfy a modern diagnosis of schizophrenia. However there is a widespread conviction in the psychiatric profession that like America, the condition was always there and waiting to be discovered and will continue to be with us as long as there are people around unluckily enough to be so afflicted. In the constructionist camp disorders like schizophrenia are interactive and essentially man made, in the biological camp they are fixed and timeless. Hacking thinks there is a middle ground by describing mental illnesses like schizophrenia as indifferent.

N.B. Hacking is describing the condition schizophrenia as it affects the individual as an indifferent kind he is not describing those diagnosed with schizophrenia as indifferent to their condition.

Tributes are being paid to nurses after practically the entire profession laughed its self to death following the publication of “Releasing time to care: The Productive Ward” released by the NHS Institute for Innovation and Improvement.

It is believed that most of the countries nurses would have died instantly on reading the publication distributed yeaterday but a few may have survived long enough to raise the alarm late last night.

Small groups of volunteers have been venturing into the nations hospitals since midnight only to find the nursing accommodation full of dead nurses gathered around copies of “Helping the NHS to reach its full potential”. By dawn RAF helicopters were flying over deserted hospitals but it is feared that the entire profession may have suffered a catastrophic abdominal rupture.

Wayne Hayes, a special constable from Northumberland, said:

“We went into one Hospital in Dunbar and found three nurses sitting at the nursing station with huge smiles on their faces still holding copies of “Aims and objectives of releasing time to care” They seemed to be at peace.”

He added:

“In a house near Edinburgh we found an A&E Charge Nurse face down on his living room floor with his trousers and pants round his knees. It seems he may have been showing his bare buttocks to the television when he keeled over. There was a copy of “The Productive ward” DVD in the player.”

Roy Hobbs, a civil engineer from Northampton, said:

“I got a call from my sister, a corony care nurse in Kettering at about 9.50pm. She was already laughing when I answered the phone, but after about 25 minutes of the most vigorous and uncontrollable hilarity, everything suddenly went very quiet.”

It is believed that members of the medical profession, ambulance paramedics and other allied health professions may have been similarly affected.

However in a surprise development the entire leadership of the RCN was discovered alive and apparently conducting business as usual at their head office at 20 Cavendish square in central London. The RCN general secretary Peter Carter is thought to have saved himself by not seeing the joke.

Now there’s a whole heap of debate on coercion and understanding the difference between a patient electing an informed choice as opposed to one who simply doesn’t see themselves as ill. However, I have a niggling question about this state of denial that others may be able to shed considered thought or experience on.

In the case of someone who denies the existence of a mental illness, is it ever found to pervade to the denial of other illnesses, particularly new found medical ones?

I’m not sure I’ve ever come across anything that reports on this phenomena. Lots on why patients won’t take their psych drugs or engage in psychosocial therapy - but nothing that establishes any real construct theory on the nature and extent of this ‘lack of insight’ phenomena.

I raise this primarily in light of a particular case of a man with schizophrenia who has since developed diabetes. He has not adjusted to this new condition well and requires much motivation to follow a decent diet. However, he doesn’t deny he has the condition, engages in glucose testing and takes his medication (tho is passively accepting of all other meds anyhow).

His insight into his shizophrenia is limited (ie - he reports experiences of voices and recognises them as why the doctors say he has schizophrenia  - but does not accept his fixed delusional beliefs as being odd or delusional or how these increase risk associated with his index offence of stalking a woman).

Surely, as he lacks insight, it would be logical to assume he wouldn’t accept his medical diagnosis either?

If this is not so - then why not so?

Any experiences of how patients are accepting of medical diagnoses - whilst denying the presence of mental illness phenomena/significance?

[They] also found that 86% thought being an MP was stressful…

…One in three of them said colleagues’ attitudes and the possibility of a hostile media reaction prevented openness about mental health issues.

Much the same was the case with gay MPs in previous years and while I don’t imagine it’s a huge amount better than it was, there have been some who have been prepared to be open about their sexual orientation. This has been an enormous help in informing the public debate on equality for gay people.

What’s needed is an MP who is prepared to go on the record about his mental health problems, in the same way as former Norwegian PM Kjell Magne Bondevik did when depression forced him to take a very public sick leave ten years ago. An MP who was prepared to do so would be a brave individual indeed, and one can imagine the reaction of the media to such an admission. But think of the good it could do for people with mental health problems.

I guess we have to call it something - and to be honest - I’m using it in belligerence to those who choose to call it by the names of the self-promulgating “sciences” - like psychiatry, neuropsychiatry, neuropsychology, psychology - because this then determines the issue is no longer a person; it is an “ology” or an “iatry” of the “psyche“.

I don’t particularly begrudge each one’s right to inclusion in the search for finding solutions to these debilitating mental health conditions; but I am totally racked off with the sense of pontificating exclusivity each one brings to the dilemma.

I guess I should qualify that last sentence. This example might do it from Fans of Cognitive Neuropsychology on Facebook:

Hate Behaviorism? Feel that Nurture is a whole load of crap? Then join here because here, it is the brain - our genes - that come preprogrammed to respond to our environment. Sure we feel that experience is important, but it is that way that we are programmed by our genes that allow us to respond in the ways that we do. Cognitive Psych explains that we all have these mechanisms that process our sensations and perceptions, and that these programs are the keys to knowing how our brains process our experiences and provide output

So you see - we’re mad because our pre-programmed genes tells us to be mad.

And what’s with the patronising “Sure we feel that experience is important” - I’ll tell you I think the experience is pretty bloody important to those who are having a pre-programmed genetic reaction that causes them to cut their arms, legs and faces to ribbons. But genetically - self-harmers were pre-programmed to do that, apparently, and the fact they were systematically abused is a mere catalyst. All we need to do of course is to find out how we can stop the genetic structure of our brain thinking that self harming is a way to behave and we’ll be right.

Or then again; it could be because of any one, or indeed any combination of these studies of the mind:

Aphasiology
Biological psychology
Cognitive Science
Evolutionary neuroscience
Generative grammar
Machine Learning
Metaplasticity
Neural Networks
Neural engineering
Neuroanatomy
Neurobiology
Neurochemistry
Neuroeconomics
Neuroergonomics
Neuroendocrinology
Neuroesthetics
Neuroethics
Neuroethology
Neurogenetics
Neurogenomics
Neuroheuristic
Neuroimaging
Neurolinguistics
Neuromarketing
Neuropharmacology
Neurophenomenology
Neurophilosophy
Neurophysics
Neurophysiology
Neuroproteomics
Neuroprosthetics
Neuropsychiatry
Neuropsychology
Neuropsychopharmacology
Neurotheology (also Biotheology)
Psychiatry
Psychoneuroimmunology
Psychopharmacology
Psychobiology

(lots of neuro - which may be further defined by adding “cognitive” in front of each one for a more defined specialty of studying how the brain processes the thought - genetically; philosophically; linguistically.. etc)

(Oh.. and Behavioural before the neuro if it’s the study of how that neuro~thingy makes us behave)

(cognitive behavioural would of course be…. err… that we think then we behave… with some neuro thingy inbetween)

Not forgetting of course, theories in:

• Cognitive bias
• Cognitive linguistics
• Computational neuroscience
• Decision theory
• Decision field theory
• Educational psychology
• Heterophenomenology
• Human Cognome
• Embodied cognitive science
• Embodied cognition
• Enactivism
• Linguistics
• Neural Darwinism
• Neural network
• Neuropsychology
• Neuroscience
• Notation bias
• Simulated consciousness
• Situated cognition
• Society of Mind theory
• SP theory
• Concept Mining
• Thought

What gets me about all this science is how little science there is.

For example: fMRI can now tell us how the brain, for want of a better description, lights up like a Christmas Tree fairy lights during certain processes. Unfortunately, they can’t tell us what those lights all mean and whether they are a cause of ensuing behaviour or effect of experience. So what they do is note something happens then say “In schizophrenia lights 5 & 6 blink differently to non-schizophrenia”. They have no idea of the significance of this.

Woo

Hoo

Now I’m all about curing all diseases and illnesses (because we’re selling the health service to Branson anyhow so I would rather we didn’t need one - then we can all complain about dying of “nothing”)

Psychopharmacology/Psychiatry Interest Group:

TO ALL THE DOUBTERS AND THE ANTIPSYCHIATRISTS:
WHY IS THERE NO BIOLOGICAL TEST FOR MENTAL ILLNESSES? HERE’S WHY.
Classical illnesses such as tumours and brain infection can cause psychiatric symptoms. The diagnosis can be relatively easy to make- do a brain scan, do a blood test. But what is going on in the brain at the molecular level can be hard to interpret. Brain function also depends upon more subtle biology – specifically the pattern of neuronal connections and the robustness of neurotransmitter activity, and that problems there can also result in mental disorders.

Finally, it is worth noting that the same situation exists for many non-controversial biological diseases. For example, there are many studies showing early biological correlations of Alzheimer’s disease. But none of these tests are used clinically. Instead, the diagnosis is made by history, signs, and symptoms, and by ruling out other causes – exactly how ADHD and schizophrenia are diagnosed. There are also numerous neurotransmitters which interact in a highly complex manner to produce behaviour in the individual. The way these neurotransmitters interact is coded for by many genes. One subset of genes will produce many different complex behaviours. We do not yet know all that is going on in the brain at this level, we do not have the resources fully as yet but then this is why neuroscience is working hard to find answers to these complex problems. So, rather than mocking psychiatry as a discipline, you should educate yourselves more about this fascinating organ, which we call,the human brain.

Hmm.. so we aren’t genetically programmed to be paranoid? We have a faulty anatomical or chemical balance. No reference as to how things got to be so imbalanced. Well, of course not. They’re not even sure what is out of balance - which is a cause and which is a consequence.

“If mood state x exists when neurochemical y is present then making y present will make mood x happen”. Crap. That’s hypothesising like saying “when I pull this string forward the cart will follow. So if I push the cart forward the string will remain in front”.

Even in our beloved psychiatry there exists a quandary on the principle of how some chemicals fire off and on. People behave differently according to different chemicals, so ok… let’s fiddle about with the brain chemicals. No one tablet provides the same outcome in everyone.

I see psychopharmacology as kind of, if you remember, when you put your arms through someone elses arms while standing behind them and try to make a chocolate cake while having all the ingredients and equipment for every other sort of cake and a meat pie and some 3-in-1 oil available in front of you - but they were blindfold and you are relying on someone who doesn’t know what any of the items in front of them are and trying to tell you what to grab.

So I’ve had enough.

Those of you who sit and pontificate your theories on causes and cures are annoying to those of us actually doing them.

In PE I learnt if bits of your body get broken - that bit doesn’t work right.

In computers level 1 I learnt GIGO: Garbage in - Garbage out.

And in chemistry I learnt - if you put enough shit together you can make a real mess.

Of course, I wasn’t la creme de la creme enough to enter into Doc Crippen’s elite training academy, but I learnt enough to know simple basics principles -

If people have a shit life; they feel like shit.

If you stop treating them like shit; they don’t forget - but it helps to stop them feeling so shitty.

And I can’t think of a single time I’ve come across someone with mental health issues - neurotic or psychotic - where they haven’t got a significant reason for being so: acute stress; drugs; emotionally traumatic events; infection; brain injury; etc.

If someone keeps hitting me on the forearm with a piece of 3×2 I will very likely get hurt. I might even show a bruise, or a fracture or even some external bleeding. I don’t need nor do I want someone to be telling me at what tension my arm actually broke; or to be able to explain to me why the blood is pumping out of my gaping wound. I need a support applying to hold the break; some pressure to stem the bleeding; some analgesia to provide pain relief and someone to help tie my shoes til I get use of both arms back.

Why do we care so much about how these things happen in the brain when we obviously care so little about how to simply make our society a less hurtful place?

An epitaph for the eighties? “There is no such thing as society”

“I think we’ve been through a period where too many people have been given to understand that if they have a problem, it’s the government’s job to cope with it.’I have a problem, I’ll get a grant.’ ‘I’m homeless, the government must house me.’ They’re casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It’s our duty to look after ourselves and then, also to look after our neighbour. People have got the entitlements too much in mind, without the obligations. There’s no such thing as entitlement, unless someone has first met an obligation.”

Prime minister Margaret Thatcher, talking to Women’s Own magazine, October 31 1987

What did Prime Minister Thatcher mean when she famously declared in 1987 that there was no such thing as society? What I think she meant was that society, as it was in the 70’s and early 80’s, was (and remains) a social construct and that she, Maggie Thatcher, was in the process of deconstructing it. But to replace it with what and what exactly was it that was being deconstructed?

Before answering that question we need to ask what we mean by “construction”. Clearly construction has two meanings. We can talk about the process of constructing or building a thing, place or entity or we can talk about the finished product that has been constructed. Hence I can say that the construction of Chatsworth house began in 1687 and ended in 1970 which is to say the process of building Chatsworth took a little over 280 years. Or I can say that the construction that is Chatsworth is a large country house situated in Derbyshire 3 ½ miles north east of Bakewell has been owned by the Dukes of Devonshire since 1694, which is to describe what it is, where it is located and who owns it.

In a similar way we can talk about gender and ethnicity being constructed either as a process or as an end product but what is the difference between the construction that is Chatworth and the construction that is an ethnic minority. Well clearly an ethnic minority while not an individual has a collective consciousness in a way that the bricks and mortar that go to make up Chatsworth house does not. An ethnic minority may not even be aware that it is an ethnic minority until this fact is made known to them but once identified as such the knowledge that “they” are an ethnic minority will change how that group views itself and in turn behaves and is its self described.

So does it make sense to talk about the construction of Chatsworth house in the same way as we talk of the construction that is an ethnic minority or does Chatsworth simply exist? Well on one level yes Chatsworth was built, it exists and one day it will cease to be, it is a thing and no amount of philosophy will change that, wind and rain will eventually wear it away but how we view Chatsworth will not affect its appearance. But is Chatsworth more that just a country house built in Derbyshire 3 ½ miles away from Bakewell owned by the Duke of Devonshire? To the 12th Duke of Devonshire and the many people who live and work there I suspect it is. It is home to the Duke, it is where he was raised where he has lived as an adult and where his children were born. To the people who work there it is where they and possibly generations of their family have worked and where they belong. It is this sense of construction that can be deconstructed and then reconstructed anew without altering the fabric of the house.

And it is this sense of society that I suspect that Maggie Thatcher imagined she could (and arguably did) deconstruct in the early 1980’s. Clearly if all we meant by society was a group of humans coming together to live in close proximity and mutual dependency then “society” has always and probably always will be with us. But society is about more than a group of people living together it is about social morays, ethics, customs, attitudes and prejudices and it was this aspect of society that Thatcher wanted to change.

But why say society does not exist, why not say society must be changed or altered in some way? Here I think we need to look at the agenda that social constructionists often have. By describing society as a social construct that did not in fact exist, Maggie was taking a revolutionary approach towards deconstructing society in much the same way that Feminists have sought to deconstruct gender and Carl Marks attempted to deconstruct capitalism. In this she made the following assumptions about society

1. Society in its present form is taken for granted and would appear to be inevitable but in fact is not. (Historically people have short memories and forget that the welfare state, which arguably was what Thatcher really wanted to deconstruct, had only been around since 1948)
2. Society does not need to be as it is at present
3. Society as it is currently constructed is a bad thing
4. We would be better off if society were to be changed (or in the case of a revolutionary like Thatcher or Lenin completely done away with and replaced with something new).

But society did not cease to be because Margaret Thatcher said it did not exist and the welfare state which I beleive was the true target of her reforms is still very much with us, but society in this country has very definitely changed since the 1980’s. We have gone from an industrial and manufacturing economy to a service economy, from an economy based on physical labour to what is called the “knowledge economy”. There have been winners (the SE and London) and losers (mining, manufacturing and ship building communities) The growth in recent years of the social problems that we see today (unemployment drug use, teenage pregnancy, crime) summed up as “social exclusion” are mainly a result of the wholesale destruction of this countries manufacturing base in the 1980’s and it’s replacement with little more than call centres and flipping burgers . Ironically the social disadvantage that the loss of this countries manufacturing base has produced in the Midlands, the north east of England and Scotland has meant that the welfare state, which Thatcher so detested, is probably more entrenched now than it ever was.

As you may or may not be aware, I am in my final year as a student and will be a qualified Mental Nurse by the end of September.  I’m quite surprised at how the time seems to have gone quickly, although there have been plenty of times I wished it could have gone even faster. Particularly the due dates for course work, which always seemed to be such a long time away, with plenty of time to put off doing any work, and then it’s the last night and I’m up all night typing away, trying not to panic. (I don’t recommend this approach to current and future students)

I digress…..

At university (or if you prefer, the school of nursing) we have been taught, and are regularly reminded, about the importance of reflection, taking the time to think about your actions and thoughts, trying to understand them and learning from it for the future. I have to say, writing essays on reflection is really, really crap, but I do understand the importance of this and regularly practice it.

On reflecting on reflection, I think I have always been a bit reflective and self aware. I think I am the kind of person that at the end of the day, goes over what I’ve said and done. I used to really worry about it and the effect it had on other people.  Particularly the day after a few too many bacardis (that’s another story). Therefore it didn’t take much work for me to be a competent reflector when I started my nursing course.

As for self awareness…….

On a recent placement, I found myself having to perform a basic/essential/core clinical skill. One that isn’t often called upon in my area. I was unable to do it. My reflection in action (are you enjoying the terms here?!) told me I was an idiot and I instantly felt like a failure. Believe it or not, I don’t often feel like this. I regularly question my own competence and try to improve on my practice, but there is a difference to feeling like I can’t do the job at all.  These skills are easily measured, although many other aspects of being a mental nurse aren’t quite so straight forward

How can a mental nurse measure their performance? Ask the patient to fill in a questionnaire:

Q1. Do you think the nurse managed to build a therapeutic relationship with you?

Q2. Did the nurse listen to what you had to say and help you come to the best decision for yourself?

Q3. Did the nurse complete the relevant paperwork in relation to your care in a timely fashion?

Q4. Did the nurse avoid you at all costs, ensure you took your medication and discharged you as soon as the consultant would allow it?

Do you count the number of success stories? The people who aren’t re-admitted within the next 5 years as you cured them (not likely).

It’s not a very quantifiable job.

In the same day I was a failure as a final year student, I managed to perform other actions and tasks with no problem, perhaps even successfully. I was left wondering if I really was any good and and if this was just a hiccup.

Is it because I am near the end of my training that I suddenly feel I am being constantly assessed by every nurse in the ward? Is it because I am under relentless and constant scrutiny and always have been but haven’t been as aware? Or am I just being sensitive since I failed at one task?

I have had good feedback from the nurses on the wards I have been on placement with (mostly) and occasionally a patient or two, but I have constantly wondered if I am managing to fool them because I really am a bit rubbish. Is that then unfair on the trained and experienced nurse to question their own judgement of me? Or am I actually going to be competent upon qualifying? I know that I won’t be good, that’ll take experience, practice and time, but I can at least be competent and safe in practice.

Self awareness and reflection are good things, yes, but not too much. A person could end up constantly criticising themself and thinking of other things they should have/could have done/said. There is a healthy balance here.

As a side note, my clinical skill was later relearned and used correctly with a bit of practice.

I’m away to lose my head as I wonder if I should have published this post…..

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

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

Minister Ben Bradshaw said to reporters shortly afterwards:

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

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

Dr Jodi Lindsay later added,

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

Lord Dazi then took up the tale,

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

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

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

(shamelessly plagiarised from the Daily Mash again)

They’ve given us a very positive review, praising the “wide range of ideas and approaches” discussed, and the fact that “professionals can have very different views from each other, as can those who experience mental health difficulties themselves.”

That’s certainly true. Can I say how much I regularly look forward to the Weekly Oldschoolbaby/Beakie Argument?

Anyway, since One in Four have been so nice about us, I think I should give a review of their magazine in return. So here it is:

It’s a glossy, quarterly magazine that describes its focus as “Lifestyle, health, mental wellbeing”. Kind of a Cosmopolitan for people who take Quetiapine. It’s intended for distribution for free in GP surgeries, libraries, counselling services etc, or individual copies can be ordered online for £2.50 here.

This issue includes an interview with the former Prime Minister of Norway, relating his decision to go public while still in office about his struggles with depression. There’s also an article by our cyber-homie Seaneen, on the subject of “What’s the difference between being unhappy and being unwell?” She warns of the perils of labelling straightforward emotional distress with medical terms, and discusses some of the benefits and risks of self-diagnosis using the internet. Another one of our e-buddies, Mr Man’s Wife describes the highs and lows of being married to a person with schizophrenia, and stresses the importance of mutual support and understanding within the family.

There’s also articles on getting into and staying in employment, on talking therapies, and on mental health issues in the Army. Plus news, book reviews, and a regular section on mythbusting, which this issue tackles the perception of personality disorders as “untreatable”.

Admittedly I’m somewhat biased since they gave us a good review and they’ve got two of our mates writing for them, but I’d definitely recommend this publication. It’s well-designed, readable and informed.

To order an individual copy for £2.50 go here. To order bulk copies for distribution in GP surgeries, CMHT offices etc, download the subscription form.