Somewhat Bitter

Dear Nurse O’Connor,

 

I am writing to you because you are my only point of contact. Please forgive the rambling, fragmentary nature of this missive.  As you know I have significant cognitive impairment and this is reflected in my communication style.

I would be grateful if you could pass it on to the relevant authorities and I will no longer attempt to contact you.  You have made your opinion of me quite plain.

 

Yesterday I received an in-home visit from Dr Simon Mitchell (consultant psychiatrist) and Ms Natalie Bo (some kind of social worker).  From the outset their contempt for me was palpable.  I would not expect any health care professional to like every patient they encounter.  My problem is when they make these feelings obvious and they permit this to affect their ability to act in a professional manner. Their attitude perplexed me because I have had very limited contact with them; a *single meeting* with Dr Mitchell (in which he apparently decided I required no more assistance from the CMHT); and a couple of brief telephone conversations with Ms Bo.

 

I was then informed that I was not a priority (even though people with severe and enduring illnesses are absolutely a self-declared priority.) and that my contact with your service would be reduced to seeing   Dr Mitchell every six months, which is extraordinary given the nature of both my illness and the medication I am obliged to take.  I might as well then be getting my medication from a vending machine.  It would probably have a better bedside manner.  In the past, I have had psychiatrists who have approached their patients in a more holistic manner, presumably because they recognise that no mental illnesses occur in a vacuum, detached completely from their social contexts.

Dr Mitchell clearly has a vastly different approach.

 

It was implied that I am somehow unworthy of treatment, that I was a waste of resources.  Need I remind you that I was taking up a whole two hours a month of your time.  Hardly breaking the bank. The manner in which this was delivered was hurtful, devoid of compassion or empathy.  When the meeting drew to a close I was obviously distraught but the pair left the flat with no attempt to address this. And even if it is a matter of resources then why am I specifically being singled out?

 

I would also like to know what process your team went through to arrive at this decision.  You informed me that you and Dr Mitchell arrived at this conclusion in a meeting but he denied all knowledge of this.

 

I was also told that I would henceforth be in the sole care of my GP. I pointed out that I have no working relationship with my GP’s surgery because I have been under the care of your team for until your abrupt & whimsical decision to abandon me at the beginning of the summer.  I have had no regular contact with my GP for five years.  And besides, they are not specialists, and many have limited experience with my complex needs.  This did not elicit a remotely satisfactory response.

 

I get the distinct impression that their treatment of me is being influenced by the personal grudge you seem to have against me.  I am being unjustly treated as a result.  This is not acceptable. Please be aware that  I fully intend to make a complaint and follow it through to its conclusion.

 

Yours Sincerely,

 

Insert Real Name

At An Impasse

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.

Old Novel

A Day on an Eating Disorders Unit:

First page of an old novel

(Warning it’s pretty terrible but nonetheless…)

Images of the Edible

She was dreaming of food.

It was all that Gemma could dream about.  It filled up most of the space in her head. Sleeping and waking, her mind was stuffed with images of the edible.  Chips- hot and salty.  Apples- cool and crisp, straight from the fridge.  Corn flakes, covered in sugar and immersed in milk.

At every mealtime Gemma heard the footsteps of her fellow patients pounding past her door, heading for the dining room.  They seemed to live for food.  The dining room was one room Gemma was determined never to enter again.

They brought her a tray laden with food three times a day.  Breakfast.  Dinner.  Supper.  Every day.  The food they brought her always remained uneaten.  She didn’t even bother to remove the covers to see what culinary delights they had brought her.  The aroma was enough.

She wanted it.  But she could not have it.  It was desirable but forbidden.  It was poison.  Sugar-coated cyanide.

Instead she was sustained by memories of epic binges.

Three times a day, every day, the nurses came to remove the tray with barely suppressed sighs of disappointment and looks that said, ‘Eat.  It’s not so hard.  Just pick up a fork.  Spear a broccoli floret and raise it to your lips.  Then chew and Swallow.  Simple.’

But they didn’t know Gemma.  They didn’t know that if she were to start eating again she would never stop.  She felt like she could consume the entire world.  She pictured herself as some obese God, grabbing planets and stuffing them into her mouth, their juices running down her chin. She felt as though she could have munched her way through the entire universe.  But she still would not have been satisfied. Her appetite was insatiable.

Aktion T4

Giving Up

I Know An Old Lady

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

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

http://www.timmyabell.com/music/lyrics/ol/oldlady.htm

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)

Oh, the Irony!

From Dr. Peter Breggin’s Psychiatric Drug Withdrawal .

A Letter to the Lesser Hitchens Brother

Mr. Hitchens,

While elements of your case against anti-depressants may be valid, you are undermining your case by blaming them for just about every terrible thing that happens anywhere on the planet. LIke Scientology and its video on You Tube ‘PSYCHIATRY: THE INDUSTRY OF DEATH’ although even they make some valid points.

I noticed that you mentioned the Hannah Bonser case a few months back in the context of anti-psychotics. (‘She was also prescribed ‘antipsychotic’ drugs, and who knows what effect they may have had?’) If you have read Theodore Dalrymple’s ‘If Symptoms Persist’ he writes about a young woman in the manic phase of her disorder who had (and these are the good doctor’s words, not mine.) ‘taken to hearing voices’ and gloating over the fact that he orders his ‘underlings’ (aka: nurses) to forcibly medicate her ‘in the buttocks’.

I fear for the future of journalism when mere fact checking is interpreted as an ad hominem attack.

In response to this.

…

Talking of Collective Guilt

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.

 

A Public Service Announcement

Or: Another Dog That Failed to Bark

A Potentially Seismic Move

http://mindhacks.com/2013/05/03/national-institute-of-mental-health-abandoning-the-dsm/