54. Looking at parallax, from a slightly different angle.

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Electric horses – the next big thing in personal transportation.

A man talks to a phone-in show on Piccadilly Radio. He says the TV aerials in the next street are of an unusual type and point a different way, not towards the transmitter. Finally he mutters the word, ‘aliens’. The radio host asks him whether he has checked for seed pods under the stairs. The joke is a bit lost on those unfamiliar with ‘Invasion of the Bodysnatchers’. The host finally grows inpatient and cuts off the most interesting guest of the day, before I can get an impression of whether he is psychotic or not.

One of the intriguing questions in public health is how many psychotic people there are hidden away who have no contact with the NHS. Surveys suggest that 1% of people have schizophrenia, which is a much higher number than we see in clinics. Have these surveys over-included a lot of people who, on the face of it, seem deluded, but on closer examination, simply share widely held beliefs about conspiracy?

On a long plane flight this week I read a book by Andy Thomas, called ‘Conspiracies – the facts, the theories, the evidence’. One of many questions that occurred to me, was why had this book suddenly been reduced in price from £6.99 to 99p? It’s hard to believe that Amazon doesn’t form part of the New World Order, the secret power said to be behind many attempts to deceive us. Maybe this book is in itself a diversionary tactic, or a tiny wink of knowingness that Big Brother gives us from time to time.

A surprisingly large number of people believe that Princess Diana was murdered or that the twin towers were brought down by some faction within the USA. In fact a surprising number of people believe both that Diana was murdered and that she is still alive. Chalk that one up to cognitive dissonance theory.

If some or all of these theories turn out to be true, it would definitely change a person’s view of the world, from that of a relatively safe place to a dark, dangerous and threatening one.

The fact that there are so many people who believe in conspiracy, and that certain conspiracies, such as Watergate, turned out to be true, raises a lot of interesting questions for clinicians.

As psychiatrists, we are taught not to get delusions mixed up with religion, politics or superstition. To be called delusional, a belief has to show a clean break in its logical development. Conspiracy theorists work with an alternative chain of logic, rather than a deluded person’s new canvas of meaning. Though many people who are psychotic suffer from persecutory type ideas, it is very rare to confuse a psychotic person with a ‘truth seeker’, as conspiracy theorists are now known, despite some very bizarre truth seeking theories, such as thinking the royal family are lizards.

There is probably very little point in trying to work out why people develop strong beliefs. The answer is ‘all sorts of reasons’. As far as delusional beliefs go, the best answer we have come up with is ‘because of a disease process’. Although delusions are held strongly, most non-delusional belief is held lightly and easily changed in the face of further inquiry. For instance, it is reported that when faced with medical need, many catholics will opt for a termination of pregnancy and that many Jehovah’s witnesses will change their minds in favour of blood transfusion. Most opinion surveys test only the topsoil of belief, and are designed to do so, by whatever vested interest is controlling the survey.

Psychiatrists are not in a hurry to identify beliefs as delusional, and despite what is said about the old Soviet Union etc, it has not been necessary for oppressive regimes to use tame psychiatrists to label dissidents as psychotic. Oppressive regimes are able to lock people up or have them disappear without pretending they are ill.

While psychiatrists don’t seem to be playing much part in locking up dissidents, they may be complicit in some more sophisticated subversions. In particular, psychiatrists play a major role in the drugs pipeline, the one that runs from a chemical works in Hull to your meso-limbic system and mine.

For instance, a steady stream of people come to outpatient clinics ‘wanting the diagnosis’ of bipolar disorder. (See Post 28). The exponential growth in the Bipolar Industry has been well described by David Healy, in his book, Mania: A Short History of Bipolar Disorder. Tellingly, this book has not been reduced by Amazon, so it probably contains some sinister truths we are not supposed to hear.

The key parts of this conspiracy are as follows: No useful new drugs have been developed in mental health for 20 years. Instead, the pharmaceutical industry has chosen to expand the market for drugs already on the market. Hence we saw a complete re-branding of ‘manic depressive disorder’ into ‘bipolar disorder’, massively expanding the diagnostic concept by including so called ‘bipolar II’ and ‘bipolar spectrum disorder’.

The outcome was a massive increase in the numbers of people with miscellaneous temperamental problems being given so called ‘mood stabilisers’, either atypical anti-psychotics or anticonvulsants, both being items from Boots’ ‘fat and sleepy’ aisle.

It took a lot of time and money to do this, and large numbers of psychiatrists collaborated in the process. There is a strange relationship between certain academics and clinicians and the drug companies and by strange relationship I mean free lunch – in Belgium.

In fuddy-duddy Britain, there is now endless conflict between psychiatrists and wannabe bipolar patients, but the signs are that the psychiatrists are surrendering. The customer is always right, especially if he is persistent, sharp-elbowed and well-googled.

We saw the same pattern in children’s mental health services. Once upon a time it was extremely rare to be diagnosed with Hyperactivity in the UK. A child had to be hyperactive all the time, not just between 4pm and KFC time. Even then, the use of psycho-stimulants like Ritalin was rare, and couched in cautionary warnings, like ‘use only as part of a carefully controlled therapy package, including social and family interventions’. Today’s community paediatricians basically fly crop dusting planes over the countryside, spraying Ritalin wherever they see a school.

Does someone have an agenda that includes more and more people taking mind altering drugs? It’s hard to imagine that a proper dictator would like to see cohorts of drunk women staggering round York on Friday nights, or lines of people queuing up for methadone outside Boots every morning. But then its hard to work out why the existing drug laws are not enforced, or why more and more heroin came out of Afghanistan despite the war in that country, or why our ward has a filing cabinet full of confiscated ‘legal highs’. Is it feasible that legal highs cannot be controlled by legislation, when there is legislation that makes Tesco throw away half its food, and legislation that stops me from connecting a gas fire?

Would a genuinely repressive regime be happy for millions of its citizens to take antidepressants, in some misguided hope that they would become more docile or cheerful in times of adversity? Marx is quoted as saying religion is the opiate of the masses, but perhaps the word he actually used was Ritalin.

The culture of propaganda has a lot to do with the rise of conspiracy theory. In the public sector we are routinely spun false statistics and like to pretend we are providing an excellent service. In mental health Trusts we want to pretend we are offering psychotherapy, when really we are offering only a nice chat, checklists and tablets. Its a kind of cover up, but we’re not in Jason Bourne territory. It’s obviously a lot cheaper to fiddle the statistics than to provide real therapists or policemen.

My colleagues are probably sitting tight, waiting for the Bipolar II epidemic to subside. Just like the Ritalin kids, the new wave ‘bipolar twos’ will soon be be stuffing their tablets behind the radiator. At the moment some people view a diagnosis of bipolar disorder as a get-out-jail-free card, in case of a minor indiscretion. These will get devalued if more people use them, instead of throwing doubles or paying £50 . Even now, fewer celebrities are coming forward purporting to have Bipolar II, and they are probably going back to having narcissism instead.

The conspiracy between Big Pharma and eminent psychiatrists will find a new condition supposedly amenable to antipsychotic drugs, such as food intolerance, or somatic symptom disorder. Then the experts and drug reps will be back in their Audis again at another round of conferences.

Sadly, most conspiracies don’t involve lizards or the CIA. Nor even do they involve a secret Mister Big, played by Morgan Freeman . They are just about drumming up trade. How boring is that? The new world order is just business as usual.

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32. Picking and Mixing with the Mules.

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It’s not cool and it’s not clever.

Aren’t we funny about taking tablets? Some people just refuse to admit they are biological machines run by small computers made of gloop. We are quite happy to have additives in petrol, but not in food, unless you call butter, sugar and salt additives, which you would if they were called by their chemical names.

Nevertheless, when Pain is the issue, most people are fairly quick to give up grinning and bearing it. Suddenly alien molecules are allowed into the body. And in the case of opiates, not just allowed in, but given the full red carpet treatment.

I’ve been speculating a lot about pain this week, thanks to my foolish attempt to test the limits of the sacral disc mechanism. (Is that quite a good name for a progressive rock band?) God was clearly having an off day when he drew this part on the celestial white- board. Perhaps he was going through an ‘organic’ phase, knowing deep down he should be using neoprene and titanium for load bearing surfaces, and proper grommets instead of cartilage.

We can’t change our spinal parts, but we can get painkillers from Wilko.

It’s interesting what pharmaceutical products you can find in a hardware store. All the inconsistencies of the so called war on drugs present themselves along aisles 5 and 6.You can buy two packets of aspirin or paracetamol, but no more, in case you take an overdose. The rule does not seem to apply to Ibuprofen though, and certainly not to other tablets which are not painkillers.Just across the shop you can buy any amount of Evo – Stik, Meths or nail varnish remover, not to mention turpentine. Possessing and inhaling solvents is not illegal and never has been.

Similarly not illegal, some of our patients take what are called ‘legal highs’. The current favourite seems to be ‘Clockwork Orange’ which I am told costs £10.95 a sachet and can be added to tobacco.Most people who tried it seem to have become violently sick, much like the effects of tobacco itself, only exaggerated.I looked at the wording on the packet- poor quality graphic design by the way – which says not to consume it at all, it is a ‘research chemical’. This obviously appeals to a sizable minority of drug users who like to experiment, usually without getting permission from the ethical committee and seldom sticking to robust methodology

.I think I can trust most of our patients not to take it, but what concerned me most was that many of them did not know Clockwork Orange was a book and a film. That’s why we need psychiatrists from my age group, so we can explain the cultural background properly, including how Stanley Kubrick had the film taken off the market for a long period for fear of copy cat violence. Probably the drug will go the same way. Maybe one day it will turn out to be a useful remedy for migraine or piles and stage a comeback

.Meanwhile, for only 36p, thirty times less than Clockwork Orange, you can get 16 Ibuprofen tablets. They are foil wrapped, mint coated and come in a nice carton with tasteful graphic design and a better instruction leaflet than you get with a Sony TV. I’m tempted to photograph the packet lovingly and put it on ebay. Would that make me a drug dealer?

Supposing opiate painkillers like Tramadol or Morphine were on sale in Wilko for a similar modest price – what would happen? Would everyone become an opiate addict within a few weeks? To some extent this is the question that needs to be answered by those who seek to legalise drugs.

One of Thomas Szasz’s better works was: ‘Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts and Pushers’. One of his arguments was that certain cultures had learned to deal with opiates and used them medicinally and recreationally while still holding down jobs and families.This has probably not happened yet in Rotherham, so we could expect a learning curve if Wilko suddenly turned into a Head Shop. And by learning curve I mean spates of car accidents, marital breakdowns and people getting fired.

What would happen to the NHS if Opiates were freely available? Would we even need the NHS at all if we could get Tramadol from Poundshop, instead of behind Poundshop? Which section would Wilko have to delete to make room for extra tablets? Already it’s quite a nuisance that the gardening section disappears in September to make room for an aisle of Christmas tat.

We could easily lose the pick and mix selection. Light-bulb moment! What about a pick and mix section for drugs? Like we have in the NHS. You read it here first

.All drugs are just molecules, whatever the effects they might have on the human body. Some are poisonous, some are illegal, some are helpful, some are  more or less inert. Some are called over the counter, some are called prescription, some are called controlled. Some are called research chemicals and some are called plant food. Some are just called glue. If the molecule gets a hold over us, it’s a power we have bestowed on it.

There is a kind of market for drugs, artificial to an extent, and distorted by the way compounds are treated by the authorities and tradition, but the likely premier league would consist of the old favourites – opiates like heroin and psycho-stimulants like cocaine.

As far as Depression goes, all these are off limits, being gigantic holes to fall down.Life is a battle against adversity and these substances – unlike Chateauneuf du Pape and Theakston’s Old Peculiar –  are classed as chemical weapons.If Wilko seriously try putting these on sale they can expect a surgical strike from the US air force, or at least a visit from Kofi Annan.

I think he’s more of a Waitrose man to be honest.