Archive for the ‘psychiatry’ Category

At An Impasse

November 20, 2019

I doubt anyone will read this but I want to make a record in case anything happens.  Desperate times call for desperate measures.

First some context. I suffer from a ‘severe and enduring mental illness’ called Schizoaffective Disorder. (I have no time to explain its symptoms here but ppl can google it.) If you don”t mind I will refer to myself in the third person. (It’s easier that way). She was neglected for years by the NHS and then in 2014 her father died and she spent nearly a year slipping in and out of a state of psychosis and extreme changes in mood.

Eventually her GP realised how much she had deteriorated and she was finally admitted to hospital and was at last given the treatment she so desperately needed. An apology was issued (her mother, who lives in another city, had spent the entire year phoning them, informing them of her deteriorating state of mind) and it was acknowledged in writing that ‘(I) do not think this (illness) has been adequately treated at any point in the recent past’. They were also informed that this would never be allowed to happen again.

But now it *is* happening again. In May of this year she was unceremoniously discharged from services, apparently because she had ‘failed to engage in interventions’. (Whatever that means) She was also told that it was a matter of resources, although this has since been denied. She was informed of this in a letter which basically said ’goodbye and good luck’. This decision had been partially made by a new consultant psychiatrist who had seen her a grand total of one time. There was no preparation made for this discharge, no referrals to other agencies that could help, just a letter. She was despatched into the care of her GP with whom she had not had a working relationship for five long years.

These are the facts:

The fact that someone likes being asleep more than they like being awake

The fact that they see their dreams, however horrific, as preferable to being awake

The fact that someone never leaves the house, not even to get food

The fact that someone self neglects to the point of not washing properly for weeks

The fact that medication has reduced efficacy & psychotic symptoms are returning

The fact that this person does not see a real life human being, apart from those who deliver her food, for months at a time.

The fact that she finds it impossible to interact with other members of her own species, even on line

All this time devoid of human companionship when it has been established that this degree of extreme isolation can affect long term cognitive function

The fact that as every day passes her chances of returning to a normal life and interacting productively with society are reduced.

The fact that this person no longer sees any point in life itself

The fact that as each day passes this person is deteriorating further

One would imagine that these ’facts’ would be a cause of grave concern for those who are responsible for this person’s care. But they are not. She telephones the duty team (as she has a right to do under Section 117) and is met with bewilderment (you can’t be that bad if you can eat), indifference, barely disguised contempt and even hostility. She gently suggests that maybe a brief spell in hospital would be sufficient to get her back on an even keel, even a slight increase in anti psychotic medication could help. This is what has happened in the past but she is informed that this ‘is not the the way things work any more’ and that to be hospitalised ‘one of us has to see you’ but they will not see her. And so we are at an impasse. And every day she loses touch with reality even more. She does not know how this will end.

Giving Up

July 13, 2013


I Know An Old Lady

I know an old lady who swallowed a fly,
I don’t know why she swallowed the fly,
Perhaps shell die.

I know an old lady who swallowed a spider,
That wriggled and jiggled and tickled inside her.
She swallowed the spider to catch the fly,
I don’t know why she swallowed the fly,
Perhaps shell die.

I know an old lady who swallowed a bird,
How absurd to swallow a bird!
She swallowed the bird to catch the spider,
That wriggled and jiggled and tickled inside her,
She swallowed the spider to catch the fly,
I don’t know why she swallowed the fly,
Perhaps shell die.

I know an old lady who swallowed a cat,
Imagine that, to swallow a cat!
She swallowed the cat to catch the bird,
She swallowed the bird to catch the spider,
That wriggled and jiggled and tickled inside her,
She swallowed the spider to catch the fly,
I don’t know why she swallowed the fly,
Perhaps shell die.

I know an old lady who swallowed a dog,
My, what a hog, to swallow a dog!
She swallowed the dog to catch the cat,
She swallowed the cat to catch the bird,
She swallowed the bird to catch the spider,
That wriggled and jiggled and tickled inside her,
She swallowed the spider to catch the fly,
I don’t know why she swallowed the fly,
Perhaps shell die.

I know an old lady who swallowed a goat,
Just opened her throat and swallowed a goat!
She swallowed the goat to catch the dog,
She swallowed the dog to catch the cat,
She swallowed the cat to catch the bird,
She swallowed the bird to catch the spider,
That wriggled and jiggled and tickled inside her,
She swallowed the spider to catch the fly,
I don’t know why she swallowed the fly,
Perhaps shell die..

I know an old lady who swallowed a cow,
I wonder how she swallowed a cow?!
She swallowed the cow to catch the goat,
She swallowed the goat to catch the dog,
She swallowed the dog to catch the cat,
She swallowed the cat to catch the bird,
She swallowed the bird to catch the spider,
That wriggled and jiggled and tickled inside her,
She swallowed the spider to catch the fly,
I don’t know why she swallowed the fly,
Perhaps shell die.

I know an old lady who swallowed a horse,
She’s dead, of course!!

NB: Across the Big Pond they say I guess she’ll die.

During the Christmas holidays I did something – one of the most heart-stoppingly, mind-blowingly stupid things I have ever done and, believe me, there’s a lot of competition. I decided to do what so-called Junkies and other assorted addicts (of both legal and illegal sort) call ‘going cold turkey’. My own drug of choice isn’t a ‘drug of choice’ at all. It was prescribed for me when I was an inpatient in the local psychiatric hospital by an attractive older lady who called herself a ‘doctor’. She was highly plausible. She looked like a doctor, acted like a doctor, wrote prescriptions like a doctor. The only things she lacked were a stethoscope and a white coat. The absence of these things should have given me a clue. Well, all that proves is that I am no Miss Marple.

Some of you may be aware that my ‘diagnonsense’ (hat tip to ‘Girl Interrupted’, both book and film) is schizoaffective disorder (a word that is a fully paid up member of the English language. I know this because my usually efficient spell-checker did not attempt to correct it.) My diagnosis has not changed over the years and given the unfortunate experiences of many (for example Seaneen from The Secret Life of a Manic Depressive) I consider myself fortunate. It dates back to the year of our Lord: nineteen hundred and ninety four. Throughout the nineties (aside from the odd brief spells in hospital) I was well and truly ‘pushing the envelope’ as our good friends across The Big Pond would say. I was taking just one type of medication: a relatively low potent ‘typical neurotic’ called Melleril. I give away my age when I tell you that on my second admission to hospital I was prescribed the drug Chlorpromazine (known by their trade names in the US as ‘Thorazine’ and in the UK as ‘Largactil’), the oldest neuroleptic on the planet. (Details of its long and, some would say: ignoble, history can be found here).

Then one day (circa 1998) it was revealed that Melleril was capable of causing sudden cardiac arrest (it has something in common with life then). I remember being vaguely amused at the GP’s receptionist’s panicked tones on my answering machine: “This is an urgent matter. It requires your immediate attention. It is imperative that you contact the surgery straightaway.’ (Don’t you just adore italics?) Given that I had been on this particular medication for almost half a decade without incident, frankly I was prepared to take my chances. To my mind their concern, grateful though I was for it, was a little excessive. Still, it had been taken off the market so I had no choice in the matter so I strolled on down to my GP’s surgery and was prescribed an alternative low potency antipsychotic. Unfortunately they got the dose wrong and forgot to prescribe Procyclidine, a drug designed to combat the side effects of neuroleptics which include…(It’s like the old lady who swallowed the fly but more on that later.) The result was that I had what medics call ‘a bad reaction’

(understatement of the millennium) and lost control of my own body.

Later, it transpired that I had been experiencing ‘dystonia’, a neurological disorder that causes twisting and repetitive ‘motor-side-effects’ and ‘spasmodic’ (don’t be childish, now) ‘Torticollis’ which causes the head to pull down towards the neck or back. I felt as though my limbs were being wrenched part, as though I were a puppet caught up in a war of two rival puppeteers who seemed determined to pull me in two. (the elderly get this frequently but because they are elderly no one, including, it would seem, the majority of the medical profession really gives a toss.) On top of this I was also encountering ‘’Oromandibular Dystonia’ which involves mouth and tongue spasms. In short, my own body had become my adversary.

I lay down on my bed still writhing. I figured that I could sleep for just a while the side effects of this daemon drug would have worn off upon waking. Even metaphorical puppet masters drop their guard eventually. But it was not to be. Five minutes passed. then ten and finally the quarter hour. At this point I realized that my condition was not improving. It was getting worse. I would have to get help.

I wasn’t sure whether my condition was ‘999-worthy’ so I decided to take the fifteen minute walk to my GP’s surgery. I barely made it across the grass. An elderly ex soldier came walking towards me. He could see that there was clearly something wrong. He said later that I looked like I had experienced a stroke. And he should know because as well as being a war veteran he is also an ex paramedic. He took me by the arm and led me into his ground floor flat. There he insisted on calling an ambulance.

Ten minutes later an ambulance pulled up outside. The driver and the paramedic disembarked. My ‘Good Samaritan’ neighbour rose to let them in. The driver hovered hear the living room door while his colleague sat beside me on the sofa clutching his clipboard and pen. He seemed strangely hostile. At the time I attributed this to my imagination but later my neighbour said that he had picked up on it too. He was certainly supercilious.

My tongue had swollen in my mouth by then and my jaw felt as though it had locked but I did my best to accurately answer the ten minutes worth of questions he was compelled to ask me. I told him that the antidote to ‘my condition’ was Procyclidine. He had never heard of it. But then he had never heard of the drug that caused it either.

Eventually I was bundled into the ambulance, strapped in and driven to the local general hospital. The paramedic climbed in after me and sat beside me. He maintained his air of sneering hostility. Later Nobby told me that he had asked if he could accompany me on my journey to Addenbrookes. Our friendly paramedic said that this would not be possible citing ‘health and safety’ and ‘insurance issues’. Nobby described his attitude as ‘dismissive’, uninterested in the dear old chap’s own experiences as a paramedic (or ‘ambulance man as he was called in those much less enlightened times).  His driver, however, was spellbound.  Just before he climbed into the vehicle and drove off he said something to Nobby that cast recent events in an entirely different light.  Referring to the paramedic he said “Take no notice of him.  He’s only been on the job five minutes and already he thinks he knows everything.’  It would seem that Nobby and I had walked in on a ‘domestic’.

(To Be Continued)

Talking of Collective Guilt

May 17, 2013

Peter Hitchens has some rather interesting things to say about psychiatry.

He has taken the debate to a whole new level.  Thus far the mainstream media have focused on the pharmaceutical industry.  But they merely produce, they do not prescribe.  This task is in the hands of psychiatrists.  There is an understandable reluctance to criticize doctors.  We have elevated them to the status of minor deities who, even when they do wrong, are acting as a result of the purest of intentions but this does not accord with contemporary and historical reality.  The reason people wind up on pedestals is because other people put them there.

Picture 28

Picture 19


A Public Service Announcement

May 12, 2013

Or: Another Dog That Failed to Bark


And Do the Dumbest Docs Become Psychiatrists?

March 25, 2013

Perhaps ‘The Lancet’ should publish a paper on that:

Screen shot 2013-03-25 at 14.59.15

Medical Student 1: You know, they really should abolish psychiatry.  It’s an embarrassment to the medical profession.

Medical Student 2: But then what would all the dumb docs do?

Medical Student 1: (shrugs) They could always become lawyers.

Addendum: I am rereading a rather interesting little book entitled: Instructions for American Servicemen in Britain 1942 reproduced from the original typescript, War Department, Washington D.C.


The blurb on the back cover reads:

‘…The British don’t know how to make a good cup of coffee.  You don’t know how to make a good cup of tea.  It’s a even swap…”

“…When you see a girl in khaki or air-force blue with a bit of ribbon on her tunic–remember she didn’t get it for knitting more socks than anyone else in Ipswich…”

“…It is always impolite to criticise your hosts; it is militarily stupid to criticise your allies.”

I love primary sources.


Treachery, Treason and Self Enrichment

December 23, 2012

Only the Üntermenschen Take Psychotropic Drugs. The Übermenschen Get ECT.


Is that so? People of all ages tend to be pretty compliant when they are unconscious.

Some people expect personal loyalty from others. Crazy, huh?

Shoot the Foot Soldiers But Leave Those Generals Alone. Kind of cowardly, if you ask me.

We Are Doomed

December 6, 2012

Is it the fault of politics?


The legal profession, as some latter day witchfinders would have us believe?

Sorry, nope


Probably: ‘Psychiatry is probably the single most destructive force that has affected American Society within the last fifty years,” Dr Thomas Szasz, Lifetime Fellow, American Psychiatric Association (APA).


Oppressed by the Underclass

October 24, 2010

You don’t have to be an amnesiac to read The Spectator but it helps. Or so it seems for one of its former columnists, the medical correspondent Theodore Dalrymple has been writing the same thing over and over again for the last two decades. I have almost completed the task of reading his entire oeuvre and despite my reservations I had quite a good time doing it. For Dalrymple is witty and frequently cruel and his prose is little short of sublime. And it’s dressed up as satire so what the hell?

I’ve always thought psychiatrists were a peculiar breed and Dalrymple is more peculiar than most. I’ve never encountered a psychiatrist who despises his patients as much as he does. His ‘Dispatches From the Front Line of the NHS were first published in The Spectator in the early ’90s and were reproduced in book form: two slim volumes entitled If Symptoms Persist and If Symptoms Still Persist.

Although he worked in separate institutions, each designed to serve very different sections of society: a psychiatric hospital and a prison he fails to acknowledge this and often conflates the two. In neither collection of biographical vignettes does he refer to a single case of bona fide mental illness. Illnesses that often necessitate admissions to psychiatric hospitals such as bipolar affective disorder or schizophrenia are notable for their absence. He also avoids making explicit his own medical specialisms: he was a consultant psychiatrist in the hospital and a general practitioner in the prison.

So what is his agenda? It is tempting to dismiss him as a ruthless, relentless, one-man right wing propaganda merchant. Yet the man himself, in recordings made for the internet, comes across as charming, kindly and avuncular. His soft voice and gentle manner lead one to believe that he’d make quite a good confidante. So you confide in him and the next day he is sharing your deepest, darkest secrets with the entire readership of The Spectator.

His patients are portrayed as cardboard cut-outs, devoid of any redeeming features. With a nod and a wink Dalrymple is telling his readership ‘They’re not like you and I. They’re not as human as you and I. In fact, they’re barely human.’  He was that tour guide in Bedlam.

There is a war going on, if Dalrymple is to be believed, between doctor and patient. He takes great delight in denying his patients medication. He also takes pleasure in forcing medications upon them, (‘I got my revenge. I had her injected in the buttock’- If Symptoms Still Persist). And if, despite his ministrations, the patients failed to recover then it was their fault, not his. It couldn’t possibly be that Dalrymple was an ineffectual doctor.

According to Dalrymple all of his patients are members of the so-called ‘underclass’. Are these people poor because they are mentally ill or mentally ill because they are poor? It is a question Dalrymple declines to address. And anyway 99.9% of his patients are malingerers. (Does that not sound statistically unlikely?)

I feel compelled to ask if the good doctor was born with a jaundiced eye. I get the feeling he probably was. Are sour old cynics (like me) born or are they made? And why do such people choose psychiatry as their medical specialism and then express astonishment when their patients turn out to be mentally ill? His former patients have my deepest sympathy.

The Good Doctor (no 999)

October 20, 2010

Resentment is the monster that lives within me. My favourite former psychiatrist, Dr Anthony Daniels/ Theodore Darymple has written an essay on the subject. I can only concur with its premise which is that resentment is corrosive and destructive and, in the long term, pretty damned useless. It is insidious though and once it has you in its jaws it will not willingly release you. You have to fight your way out. I’m hoping that my own resentment has plateaud and will soon subside. For to sustain resentment you have to keep feeding it fresh meat. I am nourishing it. It is eating me up and, if I don’t kill it, it will kill me.

Speaking of Doctor Dalrymple: this article (hat tip to his ‘groupies’ here) reminds me of why reading his output frequently leaves me incandescent with rage. ’Narcissist’ is one of the good doctor’s favourite insults but this time he should direct it at himself, for is there anything more ‘narcissistic’ than writing about the heroism of the Chilean miners, making it fit into your latest little pet peeve (sense versus sensibility) and then twisting it round so that it becomes about you and your own putative heroism? And, naturally, he never misses a chance to malign his native country: ‘Of course, I was talking of the British as they once were, not as they now are—world-champion snivelers’. Well, one less ‘sniveller’, Doctor Dalrymple, now you’re temporarily absent from the country. One accusation you could never level at Dalrymple is that he is afflicted with an excess of patriotism.

Found in the Bowels of the BMJ

September 28, 2010

Finally, I have discovered someone else who is not star struck by Theordore Dalrymple/Anthony Daniels:

If Symptoms Persist

Theodore Dalrymple Andre Deutsch, pounds sterling8.99, pp 150 ISBN 0 233 98898 X

Writing under a pseudonym in his weekly column in the Spectator, Theodore Dalrymple presents a picture of a lawless world. Dr Dalrymple works at a hospital, and he makes regular prison visits. His life is threatened, and within the space of a week his car is broken into for the third time in a year, his secretary’s mother is attacked, and one of his patients is robbed and beaten in two separate incidents. Responsibility for this anarchy is placed squarely on both the courts and the police, who are either stupid, lazy, or interested only in clearing their cells.

Inhabiting Dalrymple’s world are an edentulous people, unable to read (with the exception of benefits pamphlets) and sometimes called Jason, who use words like “yoof” (for youth). His patients carry knives, and they tell stories of robberies, burglaries, and vandalism. Their tattoos determine their relationship with the world and proclaim a message which is either unambiguous (“Fuck Off”; “Made in England”; a swastika) or subtle (the Old Borstalians’ blue spot on the cheek). They are a whingeing breed “maintained if not created by the welfare state and whose every word is uttered with the dying fall of complaint.” Even in prison the standard British burglar, malevolent and self righteous, lives the life of Riley, endlessly replaying the violent parts of videos.

The environment matches its inhabitants. A community centre’s garden is barren because its clients urinate on the plants. Residence in a tower block is possible only if tenants are calmed with Valium. Housing officers and social workers are the targets for attack and manipulation. One man requested a transfer to a three bedroomed flat because his existing accommodation was too small for himself and his 40 ferrets.

Felons blame either drink or drugs. Young women, blessed with many nippers (sic)—who are mostly cared for by someone else—and deserted by their violent cohabitees, become pregnant in an attempt either to force their men to return or to have another person to give them love. Overdoses and threats of self harm have an added value, causing bad debts to be cancelled and those who have been disconnected from services to be reconnected.

A selection of Dalrymple’s articles is now available in a book, and the whole could be read as an exercise in satire, with invective and wit being used to dramatise the vice inherent in contemporary urban society. Some hint as to whether or not Dalrymple is a psychiatrist can be deduced from the following. (Of a patient frequently the victim of burglary): “It was fortunate…that she was too poor to have valuable possessions”; (speaking of giving evidence in court): “It gives me great pleasure to cook the goose of some of my more obnoxious patients”; (of a man tormented by hallucinations whose origins he believed lay in an intestinal worm): “No doubt advances in parasitology will soon result in a compact disc worm.” A last example is worth a thousand words, and in it he mocks in trenchant tabloidese: “Single mother victim of bag snatcher outside social security.”

Coming from a doctor’s pen it all has a certain shock value. But there is something sinister about a physician presenting in this way people to whom he has a duty of care. It is both exploitative and unremitting in its harshness. It is a perfect paranoid position: reason surrounded by feckless scrounging, short-termism, and greed. But is it not all a fabrication that panders to those who have the responsibility to change things from being what they are but choose not to do so? And do his patients know what he thinks of them?—PAUL BOWDEN, consultant forensic psychiatrist, Maudsley Hospital, London

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