Bippidee (aka a mental) is struggling with body image issues and an eating disorder after gaining weight:

Also I am feeling so [...]]]> As I currently have a cat preventing me from getting at the keyboard, let’s start off this week’s edition of TWIM with a cheery, mood-enhancing lolcat from I Can Has Cheezburger:

Bippidee (aka a mental) is struggling with body image issues and an eating disorder after gaining weight:

Also I am feeling so self conscious at the moment because of my weight that I am finding anything that involves people very difficult, as it feels like everyone is going to be looking at me and judging me, which again is irrational, but I can’t help thinking it. I am constantly so aware of how much bigger I am, that it feels like everyone else must be noticing it too, even people who I walk past in the street and have never met. L said something about people seeing me as slim if they looked at me, and it upset me a bit because I feel like there is absolutely no way that could possibly be true.

Into The System is being dicked around by her crap psychiatrist again (HAVE YOU GOTTEN THAT ADVOCATE YET – YOU NEED THEM):

I saw Dr M again last week. We got through pretty much the whole appointment before I eventually found an opportunity and the courage to ask about my diagnosis. She had to look back through my notes to find it, which is a little scary. You would have thought she’d know what diagnosis she had given me.

It states clearly:

1. Moderate Depressive Episode
2. F 60.8 Other Specific Personality Disorder.

I have issues with the first diagnosis, but didn’t express them because I was so surprised and concerned about the second point. I didn’t know what F60.8 actually said, so I asked her what PD she referred to and she mentioned Narcissistic, which I was surprised about. Of all the PDs I had considered she might give, it was not that one. I told her this and she just said that she “felt the signs were there” and that Dr S agreed with her. I told her what Dr S had said to me; that there were some unhelpful personality traits and that I accepted those, but also that either of us didn’t think any constituted a full personality disorder diagnosis. Dr M then tried to justify her decision by saying it was not the primary diagnosis, but that if she thought it was there it should be documented. Somehow she seems to have decided to open the box after all.

Lorna faced a dilemma at work when putting together a mental-health related display:

I find it difficult when, as a library assistant, I have to choose between a bad book and no book. For instance, I was making a wellbeing display, and I decided to focus on mental health. (I figured I had an insight into this topic. For instance, I threw away some of the official leaflets, on the grounds that if somebody gave me that advice I’d punch them in the face.)

And of course the only book on self-harm was that Steven Levenkron mess. (At least it didn’t have the cover I’ve seen on Amazon, equal parts sexualisation and triggery scars.) On the one hand, I’ve heard terrible things about that book. I think it says a lot that all the good reviews are from well-meaning parents and all the bad reviews are from actual cutters. On the other hand, given how incredibly common self-harm is, I really didn’t want it to be this elephant in the room, the thing that’s so awful it doesn’t even get mentioned on a mental health display.

In the end, I ended up including it, in the hope that people would think “finally someone’s brought it up” but, crucially, not actually read the fucking thing. I also managed to scrounge up a leaflet for a support group that looks relatively inoffensive. But yeah. Awkward and frustrating.

The sunshine diaries reflects on how long she’s been ill:

When I was first referred to CAMHS aged sixteen, I was told that 6 to 8 sessions of CBT would sort me out and they’d send me on my way. Two years later I was still there, draining resources and attending a day service for troubled teens. When I finally left CAMHS, my psychologist told me that he sincerely hoped I wouldn’t, but there was a possibility that I’d have a lifelong career as a psychiatric patient. I didn’t believe him at the time, but unfortunately his prognosis does now seem like a very real possibility.

My family were always so proud of me, I was always the brainy one, the one my brothers were supposed to look up to. Now I’m nothing more than a bad example. It’s depressing to think that I had so many prospects, yet these days I’m reduced to a sort of sub-standard existence where simple things such as getting out of bed before midday or brushing my hair seem like a massive achievement.

It wasn’t meant to be this way.

If it’s any consolation, I spent about 3 years in and out of hospital, and then, gradually, I got better. I’ve had epsiodes in the last few years, but most of the time I am fine. I haven’t always been little Ms functional mentalist.

Astrid talks about the idea of different levels of functioning in autism:

I do not believe in “functioning levels”. I do not identify with a “functioning level” myself, either, except when it is very relevant, such as when acknowledging my verbal privilege. Because granted, I am high-functioning in that respect, and I have no problem acknowledging my abilities and the fact that they provide me advantages over people who do not have (or are not perceived to have) these abilities. That is, however, quite different from identifying with a non-specific, generalized functioning label. I cannot do this. Even I, who meets the criteria for being “high-functioning” in the two most formal definitions – speech and IQ -, do not conform to the general definition of high-functioning autism. Most people don’t. And most people deemed “low-functioning” are not actually low-functioning in all respects, either.

Differently Sane is feeling stable (cool!):

I’m also apparently quite stable, in fact I’m the most stable I’ve been in about 4 (according to some folks) years.

Those two sentences are connected.  Far, far more connected than I could possible ever describe.

I am stable because internally I am being pulled in both directions at the same time, but not in the usual ‘mixed episode’ kind of way (or at least in any way I’ve ever experienced it before).

I am sleeping about 10 hours a night (although I wake several times).

In the mornings my thoughts are racing.

By the evening they’ve run away.

But I am stable.  I feel stable.

Is this what normal people experience?

I get it the other way round, sluggish in the morning, thoughts racing a bit in the evening, but yeah, that’s not so much normal as your hypomania being under control enough not to be a problem. Just don’t get into internet arguments when you’re racing, that’s my recommendation.

The Shrink is not mental but has an interesting article about what he spends his time doing (if I wrote an account of my time, I’d have to include a lot more “gossiping at the water cooler” and “facebook time” than he does):

What do Consultant Psychiatrists do? Really! How does a Consultant Psychiatrist fill their working week? The short answer is patient contact and meetings. The longer answer is the detail to this.

Other than ward round and clinics, most Consultants have few fixed clinical sessions. Even a full day of both only eats up 2 days of a week. For most Consultants, they’ve half the week free to do whatever.

For me, although I’ve a full sector that’s a higher patient population than the Royal College of Psychiatry guidance for one Consultant Psychiatrist, and there’s no Staff Grade and no ST4-ST7 specialist registrar or any senior medical support at all, I tend to average one in-patient at any one time so my in-patient work takes literally just about 2 hours a week. My out-patient clinic is one morning for 3 hours, once a week. That’s 5 hours a week. What do I do with the rest of my time?

Quite a lot – my formal timetable (my Job Plan) goes on over 6 pages.

I also note from the start of his entry that he’s familiar with the oeuvre of Messrs Monty Python.

Madsadgirl is having a shitty time of it:

Depression is crowding in on me again. Having spent nearly a week in hospital and surviving the weekend at home I hoped that the slight improvement in my mood was an indicator that things were starting to get better. But I was wrong.

Last night it was about 3am before I got to sleep, which on the heels of only a couple of hours sleep on Monday night, meant that I woke this morning feeling dreadful. Not only am I tired but I am feeling much lower than either Monday or yesterday. It is that awful vicious circle again; feeling low so I can’t sleep, not being able to sleep so I feel low.

The feeling of worthlessness is overpowering. I want to do so much but have neither the energy nor inclination to do anything. It is impossible to focus on anything for more than a few minutes, and for someone who was known for her focus and determination that is difficult to take.

Mags1234 is getting a new psychiatrist:

So today was the big day my psychiatrist is leaving. Not just leaving the NHS but leaving the country. It is sad, i’ve been lucky in that i have had the same psych for about 2 1/2 years now and we had a good relationship. He most definately knows me well,  he can tell how i am doing just by looking at me. He told me today that my face doesn’t tell the real story i put on a mask and it is hard to tell what is going on behind it, but my body language speaks volumes and my hair apparently. I don’t think that is covered in the dsv or whatever it is called and i don’t think it is an academic finding it’s just one of those things that he has noticed about me. When i am down my hair is normally scrapped back into a tight ponytale my roots show where i haven’t bothered to dye them and generally i look a mess and all of my years and more.

Abysmal Musings was also not impressed with the execrable Why Did you Kill my Dad?

I am contacting you to ask if I can publicise a study myself and a number of researchers are conducting through your website: a web [...]]]> As well as the bipolar disorder research project mentioned by DeeDee Ramona, there’s also another one run by the University of Lancaster. They’ve sent me the following e-mail about it:

I am contacting you to ask if I can publicise a study myself and a number
of researchers are conducting through your website: a web based self
management intervention for people experiencing Bipolar Disorder. We are
looking for participants to help develop and test the intervention.

This study has the potential to improve the lives of many people with
Bipolar Disorder. We know that many people want access to psychological
therapy and that it works well. However, many people never get this kind of
support due to therapist availability. This project aims to improve access
to psychological therapy through a free to access and web based interface.

We have been funded by Mersey Care NHS trust to carry out this project for
3 years. The project has received full ethical clearance from the Division
of Health Research Ethics Committee at Lancaster University.

More information on the study can be found on our website:

I’ll start by re-posting The Shrinks slaphead OT suggestions from [...]]]> In the comments thread The Shrink is demanding a Slapheads: Occupational Therapists post. I’ll broaden it slightly into Slapheads: Professions Allied to Medicine so we can also include physiotherapists, radiographers, clinical psychologists, pharmacists etc. A post on Slapheads: Social Workers will also come soon.

I’ll start by re-posting The Shrinks slaphead OT suggestions from the comments thread:

Purist Polly who thinks any doctor or nurse is oppressive and forcing a construct of medical paradigms on what’s just understandable behaviours arising from distressing experiences, so just needs attention to managing function instead of all that diagnostic and supportive and interventional nonsense CPNs and folk do. She tutts and hisses when doctors or nurses are mentioned, is bitter that there are more doctors and nurses in the NHS than OTs and constantly has to paint OT as the best thing ever since oxygen whilst putting down “orthodox outdated working models,” like doctors and nurses seeing patients instead of OTs.

Basket-weaving Brenda who think the solution to any problem is to occupy oneself. Busy hands make for a busy mind. Can’t be out of sorts then, can we? So let’s all weave some more baskets.

Hippie Hugh who reckons the best way to solve distress is to sit down in a circle (ideally in the wondrous bounty of Nature’s bossom, but a carpet will do, at a push) and reflect ‘pon how we’re all inherently part of nature, which is a well oiled machine withe everything in balance and harmony, so for us to be part of this and ticking along we just need to re-connect with our place in that. Hug a tree, meditate and you’ll be cured in no time.

Psycho Saul who thinks peoples’ function is about being part of the shared consciousness, man. A bit like Hippie Hugh, he thinks that you just need to stop focussing on details and worries and specific issues and instead let your mind go an’ be a part of the Big Picture. This is achieved through pop psychology, his own bias and the 3 day course on some CBT modules that seemed interesting to him in 1998. This empowers him to now dabble is psychological interventions, rummaging around in peoples heads, to help them be at one with the cosmic consciousness. Because only then will peace and tranquility be theirs.

Thanks to The Shrink for those.

I’ll add:

Technological Tanya (radiographer): Covets her fMRI/CT/EEG machines with a passion that borders on sexual. Can speak in binary code. Is absolutely horrified at the prospect of a patient coming near her precious, precioussss machines, particularly if the patient is anyone confused enough to look like they might possibly bump against them.

Gatekeeper Gary (pharmacist): Guards his little pharmacy hatch like it’s the entrance to Fort Knox. Gets snotty with you if you rush down asking for a stat dose of a medication at quarter to five. For this we can only apologise that our patients’ clinical needs don’t work 9 to 5 hours.

Lost Sample Lenny (biomedical scientist): Uses the blood and urine samples you’ve sent him as chess pieces, poker chips, anything except actually analysing the damn things. Will keep you waiting for two weeks for a result and then, when you ring up to ask where on earth it’s got to, will tell you, “Oh yes. The sample leaked in transit, so we didn’t process it. No, it didn’t occur to us to tell you that two weeks ago.”

See if you can spot the differences…

First, let’s look at the Inquiry, which says things like [...]]]> Lake Cocytus has an excellent post about the Mid-Staffordshire hospitals scandal. I couldn’t help noticing a slight difference in emphasis between the closing submission of the Mid Staffordshire Inquiry and the way it was reported by the BBC.

See if you can spot the differences…

First, let’s look at the Inquiry, which says things like this:

It appears that some staff from whom we heard were often demotivated, undervalued and working in an understaffed and stressful environment

and this:

We heard of understaffing both in nurses and doctors, lack of effective leadership, lack of basic equipment, absence of triage or any effective alternative and pressure to meet the four-hour A&E target.

or this:

In the emergency assessment unit, we heard of lack of nursing staff; nurses left in tears because of their inability to provide basic care; inappropriate use of the unit to avoid a breach of the four-hour A&E target

plus this:

The staff who worked on these wards all agreed that there was a shortage of nursing staff. A consultant explained that there was a lack of continuity of care and failures to record basic observations. We heard these wards were significantly short of nurses, especially at nights and weekends.

How about this?

Some staff expressed the view that there were insufficient nurses before the reorganisation and that there were fewer after.

Then there’s this:

As recently as January of 2009, some nurses set out their concerns in a letter, referring amongst other things to unmanageable workloads and an environment which is neither safe for patients or staff.

Spotting the theme yet? See also this:

In most cases it appears that the failure to provide proper care was caused by a lack of staff. Many witnesses noted that there were too few nurses and that those that were there were doing their best in difficult circumstances.

And this:

The Inquiry may feel that some staff at the hospital are entitled to feel aggrieved at any suggestion that no one tried to raise concern about conditions at the hospital. The Inquiry has heard evidence that some staff certainly did. We heard of incident reports being completed but to no effect. We have heard of concerns being raised with managers but falling on deaf ears. We have heard of three whistleblowers. We have heard of a consultant who raised a number of concerns in writing.

And, as a final example, this:

Overall, with limited exceptions, the Inquiry may be left with the impression that staff on the wards sought to do their best in difficult circumstances, often short of adequate numbers or of suitably qualified staff, demoralised and under pressure. Those at the top of the organisation did not heed warnings and appreciate the reality of the ward environment or the effect of their decisions on that environment.

You get the picture. So, how did the BBC report it?

Hospital patients were left “sobbing and humiliated” by uncaring staff, an investigation into one of the worst NHS scandals in history has found.

Oh, for fuck’s sake.

I [...]]]> My turn to delve into the delights of world of blogs. As part of my continuing attempt to be awesomely Cool for Cats ™ I intend to make little Tweet like comments describing the minutiae of my life as I compile That Was The Week That Was This Week In Mentalists. (TWTWTWTWIM).

I am listening to Hazey Jane II by Nick Drake.

This song contains the lyrics;

Answers at the bottom please. Right now to the Blogs of Wrath! Ho!

Because cellar_door will not blow her own trumpet over here please can everyone go round and congratulate her on  happy dance inducing event.

To help drive more traffic people to Mo’s site I hereby link to his latest rambling post with most excellent (cool eh?) accompanying images.

Aethelreadtheunread talks about The Sex Thing. I dream of the day I look in the ICD-10 and find blapping or even teabagging listed as a symptom of something. Not for any serious reasons, just for the giggles.

So far we have covered exams, wallowing in bed like a hippo and sex. Good start.

I am now listening to Other Side of the World by KT Tunstall. Because I can.

Astrid takes a look at some of the changes in the DSM-V. Looking at Possibly Unwanted Implications of the Pathologization of Sex Crimes.

Bluesilk gives us Da Rules of Depression!!

Now I am pratting about on my seat shouting Woo Hoo!

Crashing into the mental system shares her experiences of DBT. Something I know effectively nothing about; though as my current student pointed out today Nursing is something I effectively know nothing about. I hate how he said it after I completed his book.

When I initially read it I fixed the minor spelling mistake. Then I thought the phrase ‘I did bear my soul‘ sounded a little like a phrase from a Nick Drake song. This has now left me contemplative. Time for a change on the mp3 player.

Have just discovered I have not put my Leonard Cohen on my mp3 player. Lotus Eaters it is.

Eccedentesiast has problems with sanity verification.

All of us here at Mental Nurse really hope the Nutter alarm does not go off before August.

Or after August for that matter.

Or during …

Fighting Monsters shares some problems with client choice.

Go read this at Lake Cocytus.

That was the only line I read. But I liked it. I liked it a lot.

Hlaf way through my list of blogs to read I am off to bed. Am listening to Cowtown by They Might be Giants.

Hlaf?

I am now sitting here the next morning in my jammie listening to the central heating shake itself apart.

Jessa has a yellow tendril. Her Yellow Tendril has built a protective shell.

Lola is taking a break from the Internet for a while. All of us here at Mental Nurse wish her well a lokk forward to her return.

Prozacville gave use this. Which has quite cheered me this morning.

Reynolds has dealings with a man with knives.

This time he’d called 999 and told the calltaker that he had cut both of his wrists and as it involved a knife the police were sent with us again.

We arrived to find the front door open and on entering found our patient sitting on a sofa, smoking a spliff and with remarkably unscathed wrists. No telltale scars from deliberate self harm in the past either.

A knife was sitting on the table next to him so I moved it to another table further away…

…Which had another two knives on it.

And there were knives in the bookcase.

Right. I am done. Time to let this baby fly free.

Oh.

Wild card.

80 Extreme Advertisements That Will Challenge Your Mind

Nasty.

Happy reading.

“… failure to recognise that correctly identifying the problem does not make it magically go away …”

It is just this kind of thing that really annoys nurses you know! You take something we have lovingly created, slaved over, researched thoroughly *cough* cast [...]]]> Thanks Lorna for summarising my earlier post into a pithy one liner.

“… failure to recognise that correctly identifying the problem does not make it magically go away …”

It is just this kind of thing that really annoys nurses you know! You take something we have lovingly created, slaved over, researched thoroughly *cough* cast your eyes over it then summarise and improve (improvarise?) in one fell swoop.

Now I intend to waffle a bit more about intelligence, some of my pet hates, bizzarophobias, delusions I have held and maybe put in a picture of a cat doing something amusing at the end.

With me?

Intelligence. Intelligence like any other trait is not a constant. Nor does intelligence defeat mental illness, even if someone is so intelligent they can give me an unarguable (to me) proof of why they are not unwell.

We tend to treat intelligence as if it is something we apply to every aspect of our daily life and that it trumps every thing else. Despite us all knowing Spock is a fictional character. As an example take a hypothetical patient Mrs Foxglove, every time Mrs P stops taking her medications she gets depressed again, she ends up in hospital … round and round the cycle goes. Mrs P agrees this is the pattern and the mood plummeting is totally a result of the medication stoppage.

A slaphead nurse, or a tired nurse,or just plain thoughtless can easily look at this kind of thing and get it all terribly wrong. Here is a hypothetical thought process.

Nurse think:

• 1) Mrs F. is quite intelligent.
• 2) Mrs F. knows she becomes unwell when she stops her antidepressants.
• 3) Mrs F. has stopped taking her meds and been admitted.
• 4) I observe that Mrs F is due a DLA review.
• 5) Mrs deliberately chose to become non compliant, get admitted to an acute admissions ward and go through hell just to get her benefits reviewed favourably.

Before you think I have gone all soft. Mrs F may well be a Slaphead: Patient of the worst scrounging sort. But there are so many other things wrong with the above process, which I have seen in action, I leave it as is for you to fume over. There are people out there who think this kind of thinking, in absence of context, is the high quality logic.

Intelligence and many types of stupidity can co exist in the same person. Douglas Adams invented something in one of his books (DGHDM?) called the Monk. Which was a machine capable of believing several mutually contradictory things at the same time. Just like people, of course.

I can already hear the grinding of teeth and people thinking to themselves that their beliefs are logically self consistent and make sense and are based on logic and reason.

I have friends out there in the real world who are rather intelligent. We a talking serious proper degree qualified people working in a science based industry doing extremely clever things. Honest I go round a a cup of tea and a plain biscuit and within minutes I find my head spinning with the cleverness of their talk. They read well, they discuss current affair intelligently, they live their lives prudently and with exemplary common sense. I hate them.

Not really.

As mentioned before I am a signed up God Bother and I do God bothering things. I know many other people who are as thick as mince. Many of these people have a belief that the world was created in six literal days and everything in it was created in some approximation of the form it exists now. Morons, really. I can handle this, I have tried discussing it them and generally find them almost incapable of stringing two thoughts together. Morons with moronic beliefs I can accept.

On a slightly related note I once worked with a chap who disbelieved in dinosaurs because they looked so ridiculous. I quite liked that. Same chap also believed anything he read in any paper because they would not print it if it was not true.

Hold on. Let me recover from my bout of hysterical laughter.

Anyway you can see the punchline.

My super intelligent chums turned out to be strong believers in Creationism. They have terribly long and convoluted arguments that I find so difficult to follow that I find myself unable to argue. Which apparently counts as a win for the opposing side. This makes it very difficult when I go to visit as I find myself fighting the red mist of frothing spittle specked argument.

But my point.

Ummm.

Point.

Nurse need to understand, by analysis of the world around them, that people are complex, do not generally react like Pavlovian Dogs and inside every clever person there is a moron trying to get out.

There was a comment by dizzyjess in the previous post:

My main gripe with the BPD diagnosis is that whether given correctly or not, it has the potential to become a self-fulfilling prophecy due to the way that health professionals tend to view people who’ve had the label applied to them.

The self fulfilling prophecy really holds for any of the fundamental attribution errors that nurses make. As pointed out here;

We see what we expect to see, which is informed by what we want to see. Although you’d think we see what we see, our processing filters out what is likely to be extraneous detail …

Please remember nursing staff are probably the biggest creators of the consensual reality on an inpatient ward.

I like that. I will make that the title for the hopefully last post in this sequence. I have totally lost the plot on this post.