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Day 953

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Discrimination at all levels

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All anaesthetic drugs work in mysterious ways. They mainly work on the brain. One of them is Ketamine. I have used it many times as an anaesthetic and to treat resistant pain. It’s relatively safe even in hands with limited experience. It’s used in all age groups. It’s known to cause ‘Dissociative’ anaesthesia and pain relief. It works through blocking NMDA (Glutamate N-methyl D-aspartate) receptors. Unfortunately, it is known to cause tolerance and dependence. It is also used recreationally.

Recent studies have shown that Ketamine has a significant beneficial effect on patients with treatment-resistant Major Depressive Disorder(MDD). The improvement is often seen within 4 hours of administration. This is the subject of many recent research papers but much more needs to be done.

It is estimated that about 3% of the UK population, nearly 2 million people suffer from depression. A small proportion of them, about 158,000 have depression that resists treatment. Currently, only 101 people are able to access ketamine in Oxford. About 40% showed sustained improvement after taking it.

It is potentially life-changing treatment for those suicidally depressed. Michael Bloomfield from UCL says “Unfortunately, medical research spending for mental illnesses is extremely low compared to other medical conditions. Clearly this needs to change if we are to improve treatments in the future.”

 

 

 

Day 949

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Iatrogenic

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Antipsychiatry – I knew the sentiment but I didn’t know the word.
Dr Bonnie Burstow has helped hundreds of “highly suicidal patients,” as a psychotherapist. She’s come to believe that conventional psychiatric treatment isn’t in their best interests.

For half a century, scholars have been looking closely at Psychiatry as a coercive instrument of oppression. Dr Burstow is a prominent figure in the field of antipsychiatry, which she describes as “a movement of both psychiatric survivors and professionals saying that we need to abolish psychiatry”. She’s the author of “Psychiatry and the Business of Madness” and “The Myth of Mental Illness”.

“Longitudinal studies have shown that people who go off their drugs after a few years do better in the long run than people who stay on them. But guess who does the best of all? The people who were never on them in the first place. So, then the answer is, no one should be on them in the first place. These are not medical substances. They do not address a single chemical imbalance. They, in fact, cause imbalances and not surprisingly they cause all sorts of problems for people who can then never get off them because they now have a disordered brain that is caused by the medical profession. You know I spend a lot of time building up that and showing how it happened. But once you take in that position, it is a very convincing argument for abolition.

Since the 19th century, psychiatry has been defrauding vulnerable people. There was dunking people in cold water. There was rotating people in chairs. There was also opium. There was bleeding. Remember we had bleeding for a long time. There was also genital mutilation, just don’t forget they thought madness was being caused by masturbation.”

The University of Toronto has recently started a scholarship in Antipsychiatry. It is a historical breakthrough and hopefully a precursor to a better society. It signals to the world that this field of inquiry has come of age.

 

Day 940

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The dark thing that sleeps in me

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Thomas Joiner, author of “Lonely at the Top: The high cost of Men’s success” is an avid suicide researcher. He lost his father to suicide.

His career choice is dismissed by some as : “You’re just trying to fix your own psychological problems, just like all mental health professionals.” Having psychological problems is not insulting. They are common, often treatable and nothing to be ashamed of.

Surely, heart and cancer researchers are not perceived in the same light. This is another reflection of the stigma that surrounds suicide.

Stigma is fear combined with disgust, contempt and lack of compassion – all of which flow from ignorance. We need to understand that suicide is not easy, painless, cowardly, selfish, vengeful or rash. It is not caused just by medicines, anorexia, smoking or plastic surgery. It is partly genetic and influenced by mental disorders which in themselves are agonising. That it is preventable (eg. through means restriction like bridge barriers) and treatable (talk about suicide is not cheap and should warrant specialist referral).

Once we get all that in our heads, we need to let it lead our hearts.

“I am terrified of this dark thing that sleeps in me,
All day I feel its feathery turnings,
Its malignity.”
– by Sylvia Plath

Source: ‘Myths about Suicide’ by Thomas Joiner.

Day 937

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Just a rant

Another Thursday. Another musician. Another suicide.

This Facebook post brought up the same old questions. I am not the only one asking them. They are a big problem for many families, individuals and communities. But sadly, the easiest thing to do for a medic at a consultation is to write a prescription rather than invest time and resources in the individual.

“Just reading about Chris Cornell and how according to his wife he took too much of his prescribed medication, out of it, because he was on his medication. Whether it was a suicide or “accidental death” I am outraged at the system. I didn’t really know Chris Cornell’s music until recently, but I lost my dear friend, another talented musician, to a similar situation recently. And before that I lost my mom, who became psychotic when given anti-depressants and took the whole bottle a few days after she had started taking them. I am so frustrated by a medical establishment that refuses to treat the whole disease and the whole person, and so tired of people I love dying from the very medication that is supposed to prevent it. If you work in (mental) health, please consider the risk when prescribing medications. Years ago, I myself was prescribed ativan and other medications and became addicted and had to take myself off everything completely without the support of a doctor because they thought I needed medication, while in reality the medication was making me suicidal.

Medication without therapy from my perspective is no different than drinking or smoking or taking drugs. I see the system changing as the trauma-informed approach enters the mainstream but in Nova Scotia, so many mental health problems that need deep spiritual healing are treated with drugs. Drugs that sometimes exacerbate the problem, or create a whole new problem, without leaving the person spiritually and emotionally sober enough to make sound decisions that could save lives.

I look forward to the day when the mental hospitals and outpatient aftercare support radical healing on a whole-person level-the kind of work that the International Association for Human Values and Body Talkers are doing-treating the whole person and providing them with actual physical stress and trauma relief tools.

Just a rant. I’m done. Love to all. Please no more state/big pharma-sponsored suicides…”

Eleven years ago, purely by chance, I learnt a breathing-based meditation technique called ‘Sudarshan Kriya’. It has kept me strong through deeply traumatic life-events. Our breath is a subtle but powerful bridge to knowing the ‘self’. It has precious secrets hidden in it. It energises and detoxifies. It keeps us alive. If we are willing to learn, it teaches us the art of living.

 

Day 926

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AYA-5

Finally something wholistic. Is it?

Ayahuasca is a foul tasting, nauseating brown Amazonian psychoactive brew.

The name comes from the Quechua language where aya means soul, ancestors or dead persons and wasca (huasca) means vine or rope. One interpretation of the name is “vine of the soul” and another is “rope of death”. Of late more arguments are being made in favour of the former than the latter.

This Shamanic concoction has been the core of many religious, magical, curative, initiation, and other tribal rituals for millennia in the indigenous and mestizo populations of South America. They respect the brew as a sacrament and value it as a powerful medicine for physical and mental problems, social issues and spiritual crises. It is traditional medicine and cultural psychiatry.

During the last two decades Ayahuasca has become increasingly known to both scientists and laymen. Its popularity is spreading all over the Western world. People seeking improved insight, personal growth; emotional healing and contact with a sacred nature, deities, spirits and natural energies have given rise to the phenomenon of ‘drug tourism’.

In the correct therapeutic/ritualistic setting, with proper preparation of the user and subsequent integration of the experience, Ayahuasca has proven effective in the treatment of substance dependence and depression. The therapeutic effects of Ayahuasca are best understood from a bio-psycho-socio-spiritual model.

The first Randomised Clinical trial, led by Draulio Barros de Araujo at the Federal University of Rio Grande do Norte in Natal, Brazil has been published.  2 similar groups of 14 and 15 patients with resistant depression were randomised to receiving either placebo or the active drug. They filled out standard questionnaires the day before receiving their dose and 2 and 7 days later.
64% of patients who took Ayahuasca felt the severity of their depression fall to half. This was true for only a quarter of those who took placebo. The inference drawn is that Ayahuasca is better than placebo at least for the short term. More studies are required to see if the effects are sustained over longer periods.

Roughly 350 million people experience depression globally. Between one-third and half of  them do not respond well to medications. In addition to psychedelics such as Ketamine and Psilocybin, Ayahuasca is being investigated further as potential treatment for resistant major depression.

Ref:
Articles:
1. Therapeutic Potentials of Ayahuasca https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773875/
2. Rapid Antidepressant effects of Ayahuasca: http://biorxiv.org/content/early/2017/01/27/103531

Presentation by Draulio Barros de Araujo: https://vimeo.com/143399447

Day 925

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Vulnerability. Not weakness.

Stories are data with a soul. Researcher and storyteller Brene’ Brown has taken the time to take a deep hard look at shame and vulnerability.

She believes that ‘connection’ is neurobiologically why we are here.

Shame is fear of disconnection or not feeling like you are worthy of connection. For example, not good enough, not pretty enough, not strong enough, not rich enough and so on. All experiences of excruciating vulnerability.

After 6 years of researching ‘Shame’ she took a closer at a sub-group of individuals with ‘Worthiness’, people with a strong sense of love and belonging who believe they are worthy of love and belonging. She called them  ‘Wholehearted’. This group had a few remarkable  traits:

  1. Courage – to be imperfect
  2. Compassion – ability to be kind to themselves and others
  3. Connection – ability to give up the idea of perfection

They fully embraced their vulnerability. They believed that vulnerability makes them beautiful. They were willing to reach out their hand first, to invest in a relationship that may or may not work out. It was not comfortable but they did it anyway.
Vulnerability is also the birthplace of tenderness, belonging, love and joy.

What makes us vulnerable?
The simplest things like asking for help, waiting for the doc to call back, initiating sex, loosing a job, asking someone out on a date and many more.

Why do we struggle with vulnerability?
The uncertainty is too uncomfortable. So we numb it.

At present, we are most highly addicted, medicated and obese populace ever.
We can’t selectively numb feelings.
When we numb vulnerability we also numb joy and connection.

The ways in which we deal with our discomfort with vulnerability are:

  1. We make everything uncertain, certain, eg- religion.
  2. We Blame- a way to discharge pain and discomfort.
  3. We Perfect – most dangerously our children.
  4. We pretend – like what we are doing doesn’t have an effect on people.

We need to let ourselves be seen.
To love with our whole hearts even if we are unsure.
To practice Gratitude despite the uncertainty because our vulnerability means we are alive.
Lean into joy and believe – I am enough.
That enables us to be kinder and gentler to the people around us and to ourselves.

Ref:

Book :
Daring Greatly by Dr Brene Browm
TED talk by Dr Brene Brown on Power of Vulnerability:

Day 906

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Last September I started writing a case study on patient safety for an academic paper. For every sentence, it required evidence. Unfortunately, the level of evidence for some of the material is not high because of the nature of the subject. Secondly, research in mental illness is poorly funded in the UK.

I am reminded of a young friend who is looking for a job but she can’t find one as they require her to have experience which she cannot gain unless she has a job. A classic chicken and egg situation.

So, the deadline has been extended time and again and finally we are going to have another attempt at submitting it before the end of this month. The lowest level of evidence to be found is Level 5 – ‘Case series or studies with no control’.

Here is one that I am going to use to support my statement: “Almost everyone who is suicidal is ambivalent. They don’t necessarily want to die. They just want the pain to end.” Hopefully it will be accepted. 

Kevin Hines is one of less than 1% of people to survive a jump from the Golden Gate bridge in a suicidal attempt. He is now a mental health advocate and works actively towards suicide prevention.

“The millisecond my hands left that rail, I thought, ‘what have I just done? I don’t want to die, God please save me’, and then I hit the water,” he said.
“You fall four seconds, you hit the water and get vacuum sucked down 70 or 80 ft – when I opened my eyes I was alive. “All I desperately wanted to do was survive – suicide experts call this being ‘shocked into reality’.”

Ref:

Kevin Hines:
http://www.bbc.co.uk/news/uk-northern-ireland-29995470

Youtube clip:
https://www.youtube.com/watch?v=WcSUs9iZv-g

Website: http://www.kevinhinesstory.com/bio/

Day 890

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UNIVERSITIES MISS CHANCE TO IDENTIFY DEPRESSED STUDENTS
– A study from Chicago, by Marla Paul in Jan 2011.

This study surveyed 1,622 college students. One out of every four or five students who visits a university health center for a routine cold or sore throat turns out to be depressed, but most centers miss the opportunity to identify these students because they don’t screen for depression, according to new Northwestern Medicine research.

About 2 to 3 percent of these depressed students have had suicidal thoughts or are considering suicide, the study found.

“Depression screening is easy to do, we know it works, and it can save lives,” said Michael Fleming, professor of family and community medicine at Northwestern University Feinberg School of Medicine. “It should be done for every student who walks into a health center.”

The consequences of not finding and treating these students can be can be serious and even deadly. “These kids might drop out of school because they are so sad or hurt or kill themselves by drinking too much or taking drugs,” Fleming said.

“Things continually happen to students – a low grade or problems with a boyfriend or girlfriend — that can trigger depression,” Fleming said. “If you don’t take the opportunity to screen at every visit, you are going to miss these kids.”

The frequency of depression and suicidal thoughts among campus health clinic users was nearly twice as high as rates reported in general college samples.

Depressed students need treatment, which may include counseling and medication. These students are more likely to drink, smoke and be involved in intimate partner violence, the study found.

With new technology, screening students is simple. While waiting for an appointment at the health center, the student could answer seven simple questions – a depression screening tool that that could be immediately entered into his electronic health record. “They can answer those seven questions in a minute,” Fleming said. Universities typically separate mental health treatment from primary care treatment. If a student comes to a campus health center and complains about depression, he is referred to a counseling center.

“If we screen, we can try to find every student that is depressed.”

Historical perceptions and biases against preventive screenings are that kids who need treatment the most don’t go to campus health centers, and they won’t tell the truth about their depression.

That’s wrong. “Students will tell you the truth,” Fleming said. “If they are sad and depressed, they will tell you that. And, kids who are drinking too much or who are suicidal do go to the campus health centers.”

 

Day 888

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Dying from Inequality – Samaritans commissioned eight leading social scientists to review and extend the existing body of knowledge on socioeconomic disadvantage, ie. being poor, addressing three key questions:

  • Why is there a connection between socioeconomic disadvantage and suicidal behaviour?
  • What is it about socioeconomic disadvantage that increases the risk of suicidal behaviour?
  • What can be done about it?

A few excerpts:

Neighbourhoods that are the most deprived have worse health than those that are less deprived and this association follows a gradient: for each increase in deprivation, there is a decrease in health. Additional support for those living in deprived areas is needed to reduce geographical inequalities in health and the risk of suicidal behaviour.

Economic uncertainty, unemployment, a decline in income relative to local wages, unmanageable debt, the threat or fear of home repossessions, job insecurity and business downsizing may all increase the risk of suicidal behaviour, especially for individuals who experience socioeconomic disadvantage.

Unmanageable debt is an important risk factor for suicidal behaviour. Financial advice and support for those at risk of having unmanageable debt can help reduce the risk of mental health problems and suicidal behaviour.

Suicidal behaviour and mental health problems, such as mild-to-moderate anxiety and depression, could be reduced through labour market policy design, such as higher spending on active labour market programmes and unemployment benefits.

People living with socioeconomic disadvantage and inequalities are more likely to experience negative events during their life, such as job loss, financial difficulties, poor housing, and relationship breakdown. This can lead to negative emotions and increase the likelihood of suicidal behaviour.

Ref:

Dying from Inequality: http://www.samaritans.org/sites/default/files/kcfinder/files/Samaritans%20Dying%20from%20inequality%20report%20-%20summary.pdf

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Day 850

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Findings of National Confidential Inquiry into suicides and homicides by people with Mental Illness – 20 year review published in 2016 :

Key elements of safer care in Mental health services

  1. Safer wards: Removal of ligature points /Reduced absconding / Skilled in-patient observation
  2. Early follow-up on discharge from hospital to community
  3. No ‘out of area’ admissions for acutely ill patients
  4. 24 hour crisis resolution/home treatment teams
  5. Community outreach teams to support patients who may lose contact with conventional services
  6. Specialised services for alcohol and drug misuse and “dual diagnosis”
  7. Multidisciplinary review of patient suicides, with input from family
  8. Implementing NICE guidance on depression and self-harm
  9. Personalised risk management, without routine checklists
  10. Low turnover of non-medical staff

Key elements of safer care in the wider health system:

  1. Psychosocial assessment of self-harm patients
  2. Safer prescribing of opiates and antidepressants
  3. Diagnosis and treatment of mental health problems especially depression in primary care
  4. Additional measures for men with mental ill-health, including services online and in non-clinical settings

There is strong evidence for all of the above.

5 items from the first list (MH Services) were missing for Saagar.
4 were not applicable. One, I am not sure of(rate of staff turnover).

All 4 items on the second list were missing for Saagar. The ‘wider’ health system did him more harm than good.

Can we turn this evidence into action before hundreds more die? Please.

Reference: http://research.bmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/reports/2016-report.pdf