Musings of a phenomenologist

Science, psychiatry and random musings

Archive for the ‘mental health’ Category

Depression, fad or fact?

Posted by soveda on May 18, 2010

I don’t usually read the Daily Mail’s website but my attention was brought to this article by Janet Street Porter:

Depression-Its-just-new-trendy-illness

Which starts:

There’s a big black cloud hanging over parts of the UK, and it’s not going away. Not volcanic ash – but depression. This relatively new ailment appeared on my radar a couple of years ago, when I discovered that more and more women were claiming they suffered from ‘stress’

Ah yes, depression is terribly new – I believe it was first described in… Mesapotamian texts? or the Old Testament? or possibly Ancient Greece. Practically unknown until recent days as you can see.

Why did I get so annoyed with this article?

Is it because, despite the efforts of psychiatrists to reduce stigma (e.g.: Changing Minds) this sort of article appears to promote that stigma? Read the rest of this entry »

Advertisements

Posted in bad media, Medicine, mental health | Tagged: , , , , | 3 Comments »

Is it ethical to lie to patients?

Posted by soveda on October 8, 2009

I ask this question because a number of people have spoken to me about SPECAL care (Specialised early care in alzheimer’s… erm… care- it’s like PIN number). Back in August 2008 there was this article in the Guardian by media psychologist Oliver James. Author of this book: Contented Dementia, which discusses SPECAL and he thinks it is great.

Hang on a mo, have a look at the 4th paragraph:

“There is a desperate need for an alternative form of care. Believe it or not, my mother-in-law has discovered it. I must be the only man in Britain who would like my mother-in-law to look after me if I had dementia. She is called Penny Garner and her method enables family members or professional carers to deliver 24-hour wellbeing to people with dementias. Amazingly, we are still on good terms after spending a year producing a book that now makes her method available to everyone.”

The interesting article he wrote in August 2009 has been commented on by the mental nurse blog which is well worth a read, I have tracked down a copy of the RCN report on SPECAL so I thought I’d blog a bit on the evidence base.

Now read on:

Read the rest of this entry »

Posted in media, Medicine, mental health | Tagged: , , , , , , , | 4 Comments »

Suicide isn’t painless

Posted by soveda on September 4, 2009

Sorry for the punning title, I know Painless was the name of the dentist in M.A.S.H. but I couldn’t resist.
I was just pondering suicide and euthanasia, this was triggered by world suicide prevention day and the lack of coverage in the media.

Now suicide is a bad thing isn’t it?

It’s one of the targets the UK government has for mental health services – to reduce the rate of suicide and undetermined injury by 20% by 2010 (document here)

There are guidelines about reporting suicide (see here), and for good reason. When the media in Hong Kong reported a suicide by a novel and previously unknown method that method increased rapidly (see here).

Suicide is a symptom of mental disorder – however some people who complete suicide have no history of mental disorder.

The national confidential inquiry into suicide and homicide makes for interesting reading (link) The press release states:

The number of people killed by individuals suffering from mental illness in England and Wales increased between 1997 and 2005, figures released today show.  The rise occurred in people who were not under mental health care and was not found in mental health patients.

The annual report by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness also found:

  • a fall in suicide by mental health patients overall and a continued fall in suicide by in-patients
  • suicide following absconding from the ward remains a serious problem
  • however, few serious incidents occurred following absconding from secure units

Of note “patient” means: having had contact with mental health services in the last 12 months.

So it’s clear cut …

Is it possible to wish to end your life without suffering from a mental illness? Now there’s a thorny question, if you asked most psychiatrists I suspect they would tell you that thoughts of suicide and a wish to die were not in and of themselves a sign that someone was mentally ill. Someone would likely be in some degree of distress, either mental or physical, but not necessarily mentally ill. Bit how about those individuals who wish to end their lives on their terms rather than letting a terminal illness make the decision for them (please forgive the anthropomorphising of a process), are they mentally ill?

Some would argue that they are by definition because they wish to end their lives, even if it is a rational decision.

Is that paternalism or realism?

By condoning suicide in those cases are we encouraging people to look at suicide rather than other options in managing disease. especially if you start including mental illness in the diagnoses that are “allowable” in assisted suicide. (BJPsych editorial)

Given that there is to be new guidance on assisted suicide this question will not go away. (BBC report)

For what it’s worth, physician assisted suicide/euthanasia does not sit well with me ethically. I want people to have a god quality of life and I don’t want people to feel pressurised into ending their life because they are a burden. Given the probable high numbers of people who have undiagnosed cognitive impairment/dementia who are vulnerable to this very thought process I think PAS is too risky a proposition.

Now that was the most unfocussed and self contradictory I’ve been in a while but hey, I’m human too.

Posted in mental health | Tagged: , , , | 1 Comment »

I’m starting to think they do it on purpose

Posted by soveda on May 8, 2009

Here we go again, the BBC website has some more marvellous reporting of research. This time the article is : Trial drugs “reverse” Alzheimer’s
O rly…

Read the rest of this entry »

Posted in bad media, Medicine, mental health | Tagged: , , , | Leave a Comment »

The least worst option

Posted by soveda on February 20, 2009

This post was triggered by a comment about bpsd (behavioural problems and symptoms in dementia) made by The Shrink author of the Lake Cocytus blog (follow the link and read it is a great insight into life as a consultant psychiatrist). Much of what The Shrink writes echoes with me as I have had eerily similar experiences in my practice.

I made a decision when I started blogging to focus on evidence and legislation rather than clinical cases when I started and I’m not going to change that when others do the clinical blogging better than me. Having said that one of the biggest (if not the biggest) challenges presenting to the psychiatrist working with dementia and brain injury is that of so called “behavioural disturbance” and “wanderi

Edit: the rest of post appears to have disappeared into the ether, I will reinstate it if I find my musings elsewhere!

Posted in Medicine, mental health | Tagged: , , , , , , | Leave a Comment »

Are you sure you really want to do that?

Posted by soveda on November 25, 2008

Or: Do we have the right to make bad decisions for ourselves?

Yes I’m going to start talking about the Mental Capacity Act 2005.

It’s a great piece of legislation, not really it is and here is why:

Read the rest of this entry »

Posted in mental health | Tagged: , , , | Leave a Comment »

Is madness all in the mind?

Posted by soveda on November 18, 2008

I’ve been banging on about mental illness and stigma on this blog for a few posts and I’m sure it it getting very dull for people but I’ll go on and on anyway.

I was just pondering the rationalle behind the programe “Horizon: How mad are you”. I read on the BBC website that is was all about showing people that you can’t see who has a mental illness just by looking at them. Now I have no problem with that concept, I just have a sneaking suspicion that there are better ways of doing that than a glorified reality TV gameshow.

Cards on the table, I tried to watch the programme but I just couldn’t get past the awful Big Brother style opening and portentous music. So I can’t comment on the programme itself, I heard “all in the mind” today where they interviewed one of the “expert panel” and he implied that he was not as happy with the content of the programme as he could have been.

So is this sort of programme educational or exploitative?

(I understand that the individuals with a mental health diagnosis were for the most part in remission/fully treated at the time of the programme, surely this means that they were not “mad at the time?)

For a more measured post have a read of JDCs blog, and while you’re there read all the other posts, there is quite some thinking going on.

Posted in mental health | Tagged: , | 2 Comments »

It’s just part of getting old isn’t it?

Posted by soveda on October 28, 2008

Memory loss that is, but here is a scary word for you:

DEMENTIA

Are you scared yet? I am and this is why: Stigma

But what is dementia and why are we frightened, why am I talking about this now. Well, there have been a few news stories recently about treatments and I was interested in looking at why they were reported in the way they were.

First some background,  Read the rest of this entry »

Posted in bad media, mental health | Tagged: , , , | Leave a Comment »

Psychiatrists are agents of social control… aren’t they?

Posted by soveda on September 23, 2008

On the 3rd of November the 2007 amendments to the 1983 Mental Health Act will come into force.

Why should I care? I hear people cry, well I’ll tell you at tedious length! Read the rest of this entry »

Posted in mental health | Tagged: , , , , | 1 Comment »

A pill to help the world

Posted by soveda on September 16, 2008

Now I’m not sure quite what to make of this, I was listening to the radio on the way heard and caught the start of a story about a fish oil trial in prisons. I didn’t listen but thought I would when I got home,I forgot but I was reminded of it by Norbury on the Bad Science forum.

Just like Norbury I had a sinking feeling mainly because of the Durham fish oil non trial.

But this seems a bit different. Read the rest of this entry »

Posted in bad science, mental health, Uncategorized | Tagged: , , , , , | 2 Comments »