Proud to be mad

More quotes:

790,000 BC, give or take a few years – Discovery of fire. Anyone crazy enough to take a burning tree into their cave and find a practical application had to have been dealing with bipolar. So, you nonbipolars out there, listen up: We give you the gift of civilization, and how do you thank us? That’s right. You marginalize us. (By the way, sorry we couldn’t get fire to you sooner.

John McManamy with a rather flippant look at Mental Illness Awareness Week. Americans reading this blog, go hug a nutter!

Killer Peanut saves the day!

I just chanced upon a website called Killer Peanut. Here you can generate, for free, personalised “alert cards” regarding your allergies in an array of different languages.

Whenever I’ve been travelling abroad, I’ve hunted out someone who can speak the language to do the translation for me, but this does the job perfectly. Not only do you get a little emergency card to put in your wallet, they also give you translations to explain your medication at Customs, find a chemist selling antihistamines, treatment instructions in the case of a reaction, and a guide to give to restaurants.

Now I just need somewhere to go abroad so I can try it out…

The pain – when will it end?

I’m almost bored of ranting about the lack of adequate pain management in primary care. I say almost, but the slightest provocation in real life will probably set me off (as it did today… and regarding euthanasia, abortion, etc….), however I’m really quite fed up writing about it.

But that’s ok, because (another) Nick has taken up the torch. So go over there, and get your daily dose of rant. Insulting primary care doctors due to their mismanagement of chronic pain? Just my cup of tea…

It’s the answer that’s the problem, stupid

Alison at Genius Gone Wrong has penned an insightful and very personal post about the link between mental health and debt.

For countless people with mental health problems debt is often a common problem, whether it’s just a case of day to day struggling to cope with simple daily finances or more serious debts from spending on credit and not being able to pay the money back. The situation gets worse and gradually as time goes on you find yourself scared to answer the telephone or open the post and as the time progresses you continue often to bury your head in the sand in the hope the problem will just magically disappear.

Been there, done that. I’ve struggled with managing my finances for as long as I can remember. I’m bad with money at the best of times (“I want it, so I’ll have it”), but this worsens at either end of the mental health spectrum. While hypomanic, buying things seems like a great idea – spending money to make money. This occasionally pays off (my import schemes of WeatherWriters and Firewheels), but in the majority just leaves me with a pile of crap that I had a fantastic idea about, but now have no motivation or use for.

Worse still, and what seems to be the opposite to Alison, is the depression that can seemingly only be cured by buying “stuff”. Everything from food to CDs to toys to the random, like tents and cars, calls out to you, claiming that it can sort you out and return you to the height of happiness. Of course, this never works, you just accumulate yet another pile of crap that you have no motivation of use for, and of course, a massive debt.

After several years of that, and an expensive degree looming on the horizon, I decided enough is enough, and started sorting my finances out. Recording absolutely everything I spend money on has really made me appreciate just how much money I waste, not just on the big things (which I’ve slowly been CBTing myself to stop impulse buying), but especially the snacking on chocolate and coke that still doesn’t manage to make me happier. And this is a good thing, because seeing daily how much money I (don’t) have, really is putting the brakes on my spending.

However, my point is this. Why did I decide to do it now? Just as I’m heading into a mild depression that is making me want to buy stuff. So I’m taking bets. Depression or budgetting – which one will win out?

Nervous tick

I can tell that I’m getting stressed at the moment. Not just outwardly stressed, but subconciously. How? I’m plucking my beard.

Much like a parrot, when I get down or under pressure, I start plucking. Though there are several differences: parrots are far more intelligent, better looking and easier to understand than me, and unlike them I luckily have an almost limitless supply of things to pluck, with my rediculously fast growing beard.

It’s a strange habit. I think it came about from when I used to pick at my hands – as a kid I had really bad eczema, and still get flareups of stress related dermitis, especially in my hands. I used to scratch and pick at that, until I had it pointed out that I was doing it to extremes, and it really wasn’t a good idea for my hands to look quite that red. Since then I’ve put some real concious effort into controlling it, as well as generally managing any flareups so they never reach a pickable state, and rarely catch myself doing it now. But instead of this, my subconcious “must pick at something” has moved onto my facial shrubbery.

As habits go, there are worse, more destructive ways to deal with stress. And it does serve as a useful indicator to me of when perhaps I should calm down a bit, unplug and try and figure out why I’m so stressed, especially when it gets to the stage where I’ve picked a bald patch in my face – that’s when I know something’s seriously going wonky, such as during the writeup of my master’s thesis when I developed a hairless circle a couple of centimetres across on the chin (on the plus side, it made me shave regularly).

Now I’ve said this, you’ll be looking out for my giveaway beard picking. My crewmate has spotted it a couple of times when I’ve been trying to keep things secret, but didn’t know what to make of it – you do now! But I was wondering, anyone else have anything similar? That little sign your subconcious gives you that it’s time to back off and chill out a bit?

Update: Apparently (hat tip to Anickdaler) this is a proper  psych issue  called trichotillomania, or “trich” (everything gets a name nowadays!). Similarly, the hands jobby is dermatillomania. Some people just do it, in others they can be caused by stress and depression, and it does occur comorbid with bipolar disorder - see here and here for more serious discussion. Awesome – I might be able to add self-harming and/or OCD to my list of mentalist attributes…

More “stop taking your meds” from the media

Dr Joanna Moncrieff from UCL writes for the BBC today on the horrors of psychiatric medication. This is starting to be a recurring theme.

If you’ve seen a doctor about emotional problems some time over the past 20 years, you may have been told that you had a chemical imbalance, and that you needed tablets to correct it… In my view it remains more plausible that they “work” by producing drug-induced states which suppress or mask emotional problems (Dr Moncrieff, BBC News)

Ok, so that’s her view. So in the case of depression, SSRIs don’t work because they increase levels of the neurotransmitter serotonin, they just make you feel different. Surely thats the aim? And can’t one cause the other? But wait, serotonin has no link to depression!

Scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed

Really? As a doctor, I’d have thought  she’d have been able to do something as simple as use Google Scholar? In fact, let me google that for you…

My core problem with this argument is the idea that a pyschoactive drug causes a change in mood as if by magic. Sure, something like an SSRI could cause a change in mood. It’s designed to be psychoactive, by being designed to increase serotonin levels in the synapses of the brain, hence changing mood. It’s like she’s ignoring the inbetween step of all pyschoactive drugs, that they have to do something to have the effect they do on the brain. There’s a link between low serotonin levels and depression. SSRIs are designed to increase serotonin levels. There’s a link between SSRIs and a decrease in depression. Employ Occam’s Razor and what conclusion do you reach?

However, I wouldn’t be all this ranty about the article if it wasn’t for what follows…

At the moment people are being encouraged to believe that taking a pill will make them feel better by reversing some defective brain process… If, on the other hand, we gave people a clearer picture, drug treatment might not always be so appealing. If you told people that we have no idea what is going on in their brain, but that they could take a drug that would make them feel different and might help to suppress their thoughts and feelings, then many people might choose to avoid taking drugs if they could

Again, this seems to me to be missing a fundamental step in the argument. It is known, to an extent, what’s going on in the brain. Something is going wrong. Chances are, it has something to do with crazy levels of particular neurotransmitters, given this is what makes the brain function. In the case of depression, plenty of evidence (see no evil?) is there to suggest that this could be linked to low levels serotonin, or norepinephrine. Hence, giving you a drug that may increase these levels will surely have a chance of making you better. The patient knows that the drug is going to make them “feel different” – that’s why they went to the doctor in the first place!

And talk of giving people a clearer picture? Pot, kettle… The article is in no way clear! It’s a very one sided take on the matter, with no suplimentary evidence provided. She’s an “expert”, so we, the public, should listen to what she says and take it as gospel. The article gives the impression that we’re not supposed to think, just do as we’re told. Way to buy into the media control over the public… and way to sell your book, for that matter.

Shameless melancholic moanings

Don’t know why, but I’m on a real downer today. Could be the waking up early, could be the panic of budgeting for next year, or could just be my normal “boom-to-bust” mood cycle on the way down. Probably a combination of all the above to be fair, been heading down for a fair while and the extra misery inducing aspects are usually enough to make me all moody and pouty.

I’ve no motivation to do anything: Work is happening because I’m on top of myself enough to make it so, but the drive to do all the other exciting plans I had has evaporated. Blog posts remain unwritten. Letters to save my ass financially next year are unsent. The funky new website header I designed is unmade. It’s a shame, as my last week is up there in the Best Weeks Ever hall of fame, I hadn’t felt so alive and amazing in a long time.

Mood disorders suck.

Mildly (by which I mean not at all) interesting genetics news

The BBC News are reporting that “scientists” have uncovered a genetic basis for schizophrenia. Ish.

Scientists have identified thousands of tiny genetic variations which together could account for more than a third of the inherited risk of schizophrenia (BBC News)

So there is a genetic basis to schizophrenia, a strongly heritable condition. Whoda thunk it? But wait, there’s more!

A similar pattern was found in people with bipolar disorder – indicating a previously unrecognised overlap between the two conditions…. “If some of the same genetic risks underlie schizophrenia and bipolar disorder, perhaps these disorders originate from some common vulnerability in brain development.”

So the two are pretty similar in terms of diagnostics and brain behaviour, and so are rather unsuprsingly genetically similar too? Again, quelle suprise!

To be fair, I’m being deliberately anti this article, just because it is almost entirely real content free. Here’s the Real Thing, but unfortunately most people won’t be able to get at it, so I’ll stick with taking the piss out of the sugar coated, genetics for morons BBC version. However, poking fun at bad science reporting aside, this research is pretty interesting (for a limited value of interesting), as although it was guessed that the two illnesses were a) similar and b) at least partially genetic in cause, it’s nice to actually have some solid evidence towards this, and fingers crossed it may help figure out better treatment and management of the two.

More excitingly (again, using the word slightly out of context), is the location of the genes involved.

All three studies highlight genes found on Chromosome 6 in area known as the Major Histocompatibility Complex, which plays a role in the immune system, and in controlling when other genes are switched on and off.

Now my very basic (I didn’t even do A-level biology, remember) knowledge of genetics suggests that there is something more complicated going on that what I’m about to say, but I’ll go with it anyways: Could this have something to do with my allergies (or vice versa)? Immune disorder andmental health issue that is, apparently, at least caused by an immune problem… Any geneticists out there fancy helping out here?

On a side note, while searching for pictures to illustrate this diatribe, I found this – PET scans of someone with type II bipolar switching from depression to hypomania:

Pretty brain scan things

Nothing really to say about them, they’re just pretty. I want one.

How to disappear completely?

I have a dilemma with regards to blogging. I’ve always been proud of myself for blogging under my real name about things that may well get (and in fact have got) me into “trouble”: behaviour that some, especially prospective employers, may deem unpleasant; problems with organisations I’m part of; and in particular trying to be blunt about medical issues and how they effect me.

Unfortunately, as readership of this blog has grown, so has the number of people I love and care about reading it. And this is making me reluctant to post such frank descriptions of the effects of bipolar disorder on me, for fear of upsetting and offending those who I come into contact with every day, and in a way also biasing the view people will have of me on my attempts to enter a medical career.

Now I still want to blog about mental health. It’s excellent cathartic therapy for me. And I also feel that I’m making some form of difference, that by being honest about the effects on my relationships, jobs and education someone else may be able to get something from my experiences and mistakes. But my worries are stopping me doing this to such an extent as I’d like to.

Right now, the question is this: Do I turn Dysphoric Mania into an “about me, minus the unsavoury parts” and adventure into medical school blog, and move the ranting of a lunatic off somewhere else like The Icarus Project where I can moan away to my heart’s content? Or do I keep my mentalist ravings here, and hope to hell it doesn’t upset people? Perhaps maybe there’s a middle ground?

Both options have their merits – moving would allow me to feel much more free to let go, and hence be better writing therapy for me. But then I would lose the altruistic aspect of wanting to help others, which is something I feel I could really do, especially embarking in medicine and having to overcome the mental health stigmas there. Plus I like the feeling of actually knowing a bit about bloggers, their names and personalities, so I guess that people must appreciate that bond with me and my writings.

So I’m opening this up – what do you think I should do then?

Anyone else want to smack Andrew Scull?

The Times is really going down the pan. The standard of journalism has been slipping since before I left for university, and the switch from broadsheet to tabloid format just highlighted their slip from a serious newspaper into the relms of their sister publication, The Sun, and the numerous free papers that one can pick up on a ten minute stroll through London.

So I read the article in the Times Literary Supplement on “The Madness of Big Pharma” with little expectation of fair, balanced, well informed writing. But even with that mental steeling msyelf, I was still enraged.

Under the pretence of reviewing the book Mania, written by renounded pyschiatric whistle-blower David Healy (who is actually a bit of a knob, but that’s a completely seperate rant), Andrew Scull goes on that old rant of how mental illness, in particular “manic-depressive psychosis” (which he then explains is the common term for bipolar disorder disorder – someone really needs to tell the mental health community we’ve been going with the wrong name all along), is actually just a form of weakness, and if we’d all man up and chuck away the meds – which aren’t actually working, of course – then the world would be a brighter place for everyone.

I’m so angry, I’m having trouble writing in a sensible and coherent manner without resorting to name calling (you dick, Andrew) and SCREAMING IN ALL CAPS about how for some reason a literary journalist is qualified to discuss mental illness in such a frank and demeaning way. Luckily, a guest post is up over at Mental Nurse which does much better at it:

It’s a hatchet job, from the arts and entertainment section of the Times – specifically, the Literary Supplement – of the diagnosis of manic depression, done by being quite selective about what is actually mentioned about the book in question…

I love “a disease (if such it be)”. Because of course, here we get to the nub of the matter. I’m not really ill, it’s not really a disease, I’m just either a poor wee victim of the evils of big pharma, or alternatively, a malingerer who needs a kick in the arse, or again someome who has caused themselves problems in their life and needs some therapy so I can talk about how I feeeeeeel…

Why is it so damned important to people at the Times that I happen to take medication for my disorder? Why do we see article after article in the media, on one pretext or another, that promotes the view that mental illness is not real, that mental illness is not as severe or not as big a deal as sufferers say it is, or that taking medication for it is evil, or a crutch, or an excuse for not wanting to “confront” one’s issues because therapy is so much work etc etc etc? (DeeDee Ramona)

Go over there. Read it. Comment on it. Repost it. Because the more people that actually get how mental illness works, how it effects sufferers and those around us, and how similar it actually is to “real” illnesses like asthma and diabetes, the less likely we are to get articles like the above published and the more likely it becomes that treatment will be taken seriously and become more and more effective.

But returning to my diatribe, in conclusion I’m sorry Mr Scull that I’m making your world so distasteful by my support for big pharma, but I quite like my Lamictal and being a fully functioning member of society. I can prove it works, both by independant medical studies (PubMed can help you here, but surely you already know this as a medical journalist. Oh, wait…) and my own personal experience (stable with the drugs, unstable when I stop seems good enough for me) so whether you like it or not I’m going to keep treating my chronic mental illness in the same way you’d treat any other chronic physical illness.

Oh, and finally? Laura Anderson of Charlottesville, US: BPD is short for borderline personality disorder, a completely seperate illness with completely seperate methods of treatment. Though I should expect that kind of ill-informed behaviour from Have Your Sayers by now…