Monthly Archives: October 2015

88. Making sense of everything that’s ever happened.

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A service user, just hoping the CQC will make an unannounced visit.

There’s a backlash against drug therapy and a lot of people hate the fact that life expectancy has increased and there are effective treatments for cancer and diabetes. It’s just not natural is it? It’s no work at all just to take a tablet once a day with a glass of chilean merlot. It’s just inherently non-puritanical, especially as medicines don’t taste horrible any more.

Sadly pharmacists and drug companies won’t pretend their products are made out of tree bark or geranium leaves, they won’t put them in medicine bottles, they won’t colour them green – apart from Methadone, which still comes in a retro package – they won’t use the word Potion and they won’t make it taste like socks. Instead they almost celebrate the industrial origins of medicines, so that they are packaged and named like computer parts. Try a course of Celeron, and move up to Radeon if there’s no improvement after 6 weeks.

The market is wide open for a no pain no gain therapy, like the training montages from the Rocky movies, but instead of physical punishment, experts have come up with a therapy that’s more like school detention: History Therapy.

‘Historian and broadcaster Dan Snow and psychologist Richard Bentall get to the root of 21st century melancholy, and propose a cure’, we are promised

They will ask: Does meditating on the lives of our ancestors help us get a better sense of perspective toward our own problems? Can history nourish and console? Is the study of history, in short, a form of therapy?

They are putting History, in a bottle, on your tablet shelf, between Vitamin G and Vitamin I. It’s only £30 to attend the history session, which is less than the price of 100 Prozac tablets. Just remember that history is far more difficult to flush away.

I didn’t say this about Dan Snow and I’m quite scared about repeating it online, but some historians don’t think he’s a proper historian:

‘he routinely refers to himself as a historian when he doesn’t have a PhD or equivalent and therefore has not done the years of original archival research that professional historians have undertaken and then he takes our research and re-hashes it without any credit. And gets his facts wrong but still continues promoting himself as an expert. I think he is a dick and every time I hear the BBC refer to him as a historian I shout “No he fucking isn’t!

(http://gasheadau.blogspot.co.uk/2015/05/a-delightful-discussion-of-self-made.html)

Please, proper historians, try being a psychiatrist, a field where absolutely everyone you meet is an expert.

Anyway, where you stand on Dan is likely going to indicate where you stand on the treatment of Depression.

Is Depression:

  1. A major common medical condition with a high level of morbidity and mortality, that should be treated by experts in the NHS with proven treatments? Or:
  2. A medical metaphor for the stresses of modern living, that should be treated by creative people broadening one’s outlook?

Those of us sensible enough to realise that our bodies are made of molecules still enjoy putting things into them to help them work better and we would use computer parts if we had ports on our bodies, like Jude Law in eXistenz.

For us, if you’re walking away from the GPs without a prescription in your hand, at some deep level you feel that your mission has failed. Now there’s a win / win solution. Regardless of your condition, however big a hypochondriac you might be, you still collect a script. But instead of taking it to Boots and running the gauntlet of their ‘counter intuitive’ queueing system, now you can take it to the library instead and exchange it for some Bibliotherapy, aka books.

The downside of this is that you are at the mercy of your GP in terms of reading material. The other downside for the library is that it becomes a germ exchange and none of the staff use alcohol gel, not externally anyway.

Quite likely your GP, in the last of your eight minutes of consultation time, will rush the all important choice of book and palm you off with The Hunt for Red October. I can just see a bit of confusion ahead, down to the fact that doctors call collecting information from patients ‘taking a history’. e.g:

Patient: I want to take some History

Doctor: That’s my job.

Patient: Can you prescribe me a bit of Dan Snow?

Doctor: No, but we do have some Dan Brown left over.

87. You know I hate to ask, but are friends electric?

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A patent magneto electric machine. USB C adaptor is $40 extra.

In August, I took an Australian visitor to Lincoln Castle for a good slice of History. Everywhere there were flamboyant characters in Victorian outfits and I soon realised Lincoln was hosting a steampunk festival and we were getting more History than just the Magna Carta.

Officially called The Asylum Festival, the event centred on The Lawn hospital, near Lincoln Castle, an early nineteenth century building which, until 1985, served as a mental hospital.

In this case, and in general, it’s easy to argue that steampunk is filling not just a building but also a cultural void at the Lawn vacated by psychiatry, at least in terms of celebrating the Gothic.

According to wikipedia, Steampunk refers to a subgenre of science fiction and sometimes fantasy that incorporates technology and aesthetic designs inspired by 19th-century steam-powered machinery.

Contrast with Psychiatry, which refers to a subgenre of medicine and sometimes fantasy that incorporates technology and aesthetic designs inspired by 19th century electrical-powered machinery.

Another attempted definition of Steampunk is ‘modern technology—iPads, computers, robotics, air travel—powered by steam and set in the 1800’s’.

Again, contrast with psychiatry, which is all about old ideas (mental energy, chemical deficiencies, mindfulness etc) set in a concrete building on a business park modelled on George Smiley’s HQ.

The point is, Steampunk celebrates the art of anachronism, whereas psychiatry regards it with a mixture of hatred and denial.

The Lawn was opened in 1819, which was before the reign of Queen Victoria, but most of the British Asylum hospitals were built during the Victorian period. Many of them were gothic in style, making them a suitable venue for wearing top hats and tinted goggles, riding round on penny farthings and racing steam robots.

Nowadays, psychiatry is shy about its Victorian heritage. The contribution of Freud and his colleagues is celebrated only in terms of a sprinkling of multiple choice questions. Freud’s early work would now be called Neuroscience and we know that he was intrigued by nerve tissue and would have taken a much more Electric road, if only he’d had access to multipacks of AAA batteries or a USB charger.

Freud knew that the brain was electrically powered – indeed this discovery went back to the end of the eighteenth century. He attributed symptoms like hysterical paralysis to mental energy short-circuiting down the wrong pathways.

Since the Victorian era of psychiatric treatment, electricity popped up as a treatment option at frequent intervals. Nowadays there are many people working on various kinds of electrical brain stimulation, such as deep brain stimulation, transcranial direct current brain stimulation (tDCS), magnetic stimulation and the original and genuine product, ECT.

This is not, you understand, the official penchant of British psychiatry, which by convention pretends to emphasise social and psychological approaches. You’re supposed to listen actively for at least five minutes before getting the talk round to tablets and quite a bit longer before mentioning the E word. That’s just a convention. I wouldn’t call it hypocritical, more, let’s say ‘dual mode’.

People say they want to be listened to more than anything else, but that stance also can be a little dual-modish. Quite a number of patients are in search of physical treatments of one kind or another and want to seek medical advice before buying batteries and sponges from B and Q.

Talking yes, counselling certainly, making a few changes to your life, I guess so, but hey, just tossing an idea out there, how about electricity?

Sadly, the custodians of ECT, psychiatrists and their colleagues in mental health trusts, have completely failed to market their product at all. The number of people prescribed ECT has declined dramatically over the years. Depending on where you stand on this argument, either it is being enormously under-utilised or you can’t believe it’s still going on at all.

Because the NHS mainly seeks to discourage people turning up to use its services, nothing much has been done to promote electrical treatments. The premises used are a bit drab and though they are strictly regulated, the ambience is a bit like the blood – doning centre, being a strange mixture of homeliness and apprehension.

After ‘One Flew over the Cuckoo’s Nest’ was made and shown to generations of students, the Royal College decided that ECT could never be made to look cool ever again.

Regulators like NICE narrowed down the number of indications and the treatment itself changed a lot subsequent to most of the controlled trials that were conducted.  A different anesthetic is used, the energy level has been reduced, the ECT box is not made of mahogany any more and some units don’t even provide free toast after treatment. Arguably, the toast issue has been the most damaging.Whereas 6 to 8 treatments used to be standard in the toast era, now it’s often 12.

I doubt if ECT will be hived off to the private sector, but it wouldn’t totally surprise me to see new departments of electro-therapy in different settings, like sports medicine clinics or the corner of Debenhams.

Unlike ECT, tDCS has acquired a better vibe, being used by the Air Force to keep people concentrating and allegedly by students to improve their performance in games and exams. Perhaps more psychiatrists should be looking at it, but they won’t hurry because they are still struggling with their electrical baggage.

Steampunks would be delighted with a treatment like tDCS that was invented in 1798, but psychiatrists haven’t yet learned to love and embrace the anachronisms of modern life.