Tag Archives: IAPT

94. The road to Hull is paved with good intentions.

mona lisa lego

It’s surprising how people you’d think would know better let their electronic stuff get covered in grime.

Although no-one got a Nobel Prize for inventing the microfibre cleaning cloth, one of these, plus a bit of solvent, is the answer.

Luckily Isopropyl alcohol can still be obtained legally in the UK. It’s an excellent way of cleaning computers, smartphones, spectacles etc

Or so I thought, until today, when I handed a pair of broken spectacles to the assistant manager of Specsavers. I mentioned they just fell apart while I was cleaning them. He asked me what I was cleaning them with and I replied, a little proudly, ‘isopropyl alchohol’.
‘That’s what killed them’, he fired back. ‘I’m afraid it’s smack on wrist time’. Specsavers haven’t been to the breaking bad news gently workshop.

Isopropyl alcohol should not be used on certain types of plastic, it turns out. When doctors make mistakes they are called ‘blunders’ in the press. But I’d prefer to call this one just an ‘adverse effect’. No-one is saying those spectacles weren’t clean.

There are probably other friends and relatives remembering that I cleaned their macbooks, wristwatches, phones etc and, come to think of it, they were never quite right ever again.

Isopropyl alcohol might just turn out to be everyone’s perfect scapegoat. ‘The first side of Scary Monsters never sounded quite right after you cleaned it’, people will shout at me. In the years to come the Brexit vote will probably be blamed on accidental exposure to cleaning fluid, rather than the usual ‘death wish’ theory.

To be honest, I cannot really explain my choice of solvent, except that it used to come in a tiny phial, with a cotton bud, for cleaning the heads on cassette tape machines. It seemed somehow so precious. But it was probably why cassettes never sounded very good, not even the ones called ‘metal’.

Like many interventions, from insulin coma therapy to prostate surgery, alcohol cleansing might do more harm than good. I thought that cleaning was improving the world just a little, sublimated baptism perhaps. Instead it was simply vandalism.

Such contributions are part of what I like to call the ‘behaving admirably agenda’, which I see as The Way Forward.

To be honest, I got the idea of behaving admirably from my cousin who lives in Australia. He is fantastically handy at fixing things, so that when he stays with someone, he likes to fix something as a kind of thank you note. For us, he sorted out the little wheels that guide the glass door on the shower. My cousin had taken the best aspects of the Random Acts of Kindness movement, and refined it into ‘specific and targeted acts of kindness’.

Combined with a few other thoughts I was having at the time I came to the conclusion that actions speak louder than words. Partly because Word Inflation has reached record levels. More words are being created and written down than ever before. So that the value of each written word is virtually zero. Take this blog for instance…

There are so many words about that people have taken to rendering them into cloud diagrams, so that words most frequently used get written larger and more often. Our leader, for instance, would just have the words Strong and Stable written over and over again in a very strong and stable font like Roboto Mono.

Our leader can’t even talk a good game. Which brings me to my point, which is that behaving admirably is far more difficult than initially meets the eye.

My idea of behaving admirably, while probably the same as yours, may not be the same as the lady up the road who keeps 14 cats in her bedroom, or the guy in the deerstalker hat who drives his disability scooter at 10mph round Tesco.  

That is perhaps why we have little aphorisms like, ‘the road to hell is paved with good intentions’. And phrases like ‘unintended consequences’. (A lot of aphorisms about this year – maybe the warm winter?)

While it is undoubtedly virtuous to pick up empty beer cans from the street corner and put them in the recycling, and indisputably evil to hang little bags of dog poo from tree branches, in between there are huge grey areas of ethical ambiguity. Many behaviours that are taken to be virtuous at face value, such as mindfulness exercises or prayer, could be seen as horribly self indulgent or even narcissistic, compared say with crown-green bowling or topiary.

One good intention that comes to mind is the current campaign to champion the cause of ‘mental health’. Lots of people have been piling onto the mental health bus recently, from the Royals and Prime Minister downwards, toward the self-congratulatory metropolitans who lead our Royal College.  

If we constructed a ‘word cloud’ from the mental health media coverage this year, what would it look like? The phrases ‘examination stress’ and ‘school mindfulness first aid’ would be in 96 font, whereas the words ‘schizophrenia’ and ‘psychosis’ would be written in size 8 Ubuntu Condensed. And you would need an electron microscope to reveal words like ‘Section’ or ‘ECT’.

Whilst accepting that the mental health discourse is a lot broader than that perceived through the half-moon spectacles of traditional psychiatry (smashed, as they are, by alcohol misuse) it looks as though the notion of severe illness has been drowned out of the conversation. Who would think that mental illness tends to affect older people, that it doesn’t always respond to talking a lot and sometimes disables people for years or decades?  

You could get the impression the government was piling money into mental health services, instead of shutting down all the day facilities, closing wards and sacking community support workers.

The mental health movement is well intentioned but it is all based on words. In particular the notion that the more a person speaks, the more his problems will be solved. Instead of talking, people should try behaving differently, or even admirably. Instead of shouting at your IAPT low intensity worker, why not clean the rubber bits around the washing machine door and the top of the fridge? I have just the solution for you.

Words are just clouding the picture, like the view you get through contact lenses cleaned with alcohol and cotton buds.

Sorry about that.

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72. Falling back on homes under the hammer.

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Hull Trains are quite influenced by the Terminator series.

 

On the breakfast news there is almost always a mental health item. There are two types of mental health news reports: the short one and the long one. On the short one, the presenter merely reads out two statements, one from a survey and one from the health service.

First statement: a survey conducted by a charity reveals that there are no services for the mentally ill north of Milton Keynes and that depressed people in the north are simply rounded up and dropped down coal mines.

Second statement: more people are being treated than ever before due to increased investment in acronyms like IPT and IAPT.

You wait for a moment of analysis or commentary, a denial from someone in the coal industry perhaps, or an acronym buff, but in a blink, its over to the Midi dress. Should it really end at the thickest part of the lower leg?

The longer version of the mental health report is just the short one followed by an interview with a ‘service user’. Typically, the service user seems suspiciously mentally well, despite their long period of suffering and eventual escape from the coal mine. It took years of waiting, but eventually they reached the top of the Mindfulness Therapy waiting list, after which they were cured in a jiffy and made ready for TV.

This week, we just had the short version: One in six people attempted suicide while on the waiting list for psychotherapy, which is more than a year on average. NHS England says that there are more mental health services than ever before and even now new acronyms for services are being coined at their new DOA. (gettit?)

It is such a relief when the news stops and Fred Dibnah’s World of Steam, Steel and Stone finally begins, even though every episode is the same. Then there is a program where people buy a small house at an auction, paint it magnolia and rent it out. After that two people try and decide whether to emigrate to Australia, nearly go and then don’t quite go. Following on, a lovable cockney sorts out some dodgy builders in the style of Jack Regan from The Sweeney. Daytime television can seem massively interesting, but only under certain circumstances.

Normally these programs leave the viewer underwhelmed, but that all changes if you get ill. Once you are debilitated and a little delirious, daytime television takes on a whole different dimension. The level of stimulation the human system requires, or can even tolerate, is greatly reduced in cases of biological malfunction.

The key to successful television seems to be following a formula. Even though we’ve seen it a thousand times, we still love a plot that ticks along like a Swiss clock. To a very alert person, formula means repetition and repetition means boredom. To a stressed or unwell person, formula means familiarity and familiarity means comfort. Entertainment has a long history of formulaic productions, from Punch and Judy through James Bond to Strictly Taxidermy. Every time we are presented with a repeatable pattern, the part of the mind that ticks boxes is comforted.

I once asked an older colleague how people used to treat serious mental illnesses before the invention of antipsychotics. His reply was ‘Institutionalisation’. At the time I took this to be an attempt at irony, especially as institutionalisation had come to be regarded as oppression. Now, I realise he was giving a serious answer. Reducing stimulation and imposing regularity were ways of calming people. Perhaps it is just a coincidence that large asylums closed just as daytime TV began. Or perhaps, television just happened to hit the right level of stimulation to suit chronically ill people. One person’s stultification is another persons action thriller. On the acute ward, I noticed that really ill people hardly watched TV, not even football, but could just about manage old Top Gear repeats on Dave.

Disruption of biological rhythms is almost the hallmark of Depression and the first thing that psychiatrists ask you about. Sleep pattern, diurnal mood variation, bowel habit etc. Disruption of biological rhythms is also the hallmark of twenty-first century society, now that shops and the internet are open all hours, pubs never close and you can watch Dr Who whenever you want. I’m not saying the two are causally related, any more than fridge ownership is causally related to crime statistics (other than ice pick murders).

But possibly Stress is being met with De-Stress, in the form of Repeatable Pattern Seeking Behaviour or RPSB, as it will never be called again (too similar to the RSPB, who are a very powerful lobby). Accordingly I may have to forgive people who own pets or buy lottery tickets as simply stressed people in search of fixed schedules. Perhaps they just have nothing to do – besides panic – between Street Patrol UK and Cash in the Attic.

If you just don’t ‘get’ the Fast and Furious series, now you can understand why the same bits are in every film. Humans like patterns. Much of our brain is a scanning device and every cell has a system of time clocks.

Which is why, even before they had CAT scans, Interferon or Clozapine, Regional Health Authorities had their own carpet designers. One design was blamed for people hallucinating. Another type caused terrible friction wounds to frail people. Our own hospital replaced carpets with ‘abattoir-chic’ red lino. Cue carpet jokes: Where to sweep things now?

Like TV programs, carpet that can look fine – just a bit hectic – when you are fully conscious and alert, may look like a pit of vipers to a delirious person. Wetherspoon’s know this only too well.

Last time I was really sick, I remember thinking The Weakest Link was a brilliant program. But after taking a Zantac it suddenly lost all its appeal. It goes to show, if you are sick, you need to titrate your choice of programming carefully against your drug therapy.

Like hospital carpet design, there probably needs to be special programming for sick people. Or just accept that most television is aimed at people with impairment and should be run by Occupational Therapists. It already has?  DIY SOS, Blue Peter, Celebrity Master Chef, Come dine with me, Extreme Fishing…

TV is the new OT and we even have one on the ward.