A good opportunity to answer a complex question. Thread 1/x

https://twitter.com/Rose10843664/status/1842411791672050071

Firstly, "mental illness" is not a comprehensive label, it refers to a wide number of different illnesses of different natures, severity and risk, from severe and enduring psychotic disorders to brief adjustment reactions.

The major issue with the "all mental illness" is an extent of human experience is that it ignores that "adaptation" relies on physiological mechanisms. These mechanisms break. Psychosis may have an adaptive role (in theory) but it is more likely a failure of a process. The question of what defines an illness is of a metaphysical philosophy and pracitical ontology (thats all science can be.) The decision about what we define as intolerable and must treat is majorly ethical, and thus social (unless you feel morality is an apriori construct.)

Lets put this to bed now

1) Trauma is factorial to an extent in all mental illness, causal or as a result or both. The major conscillient explanation is susceptibility to atypical responses.

2) The presence of antecedent trauma is not always the cause of mental illness. 3) Restructing early experiences from a subjective viewpoint can always suggest a traumatic cause. Especially when the observer relies on therapy as their intervention.

We cannot parse any ideology that perceives the killing of innocents as justified in its ambition. Ideologies are often just a way to hide human motivations of greed and power behind lofty concepts of 'right' and 'holiness.' Challenging this is not blasphemy, but humanity. I would say this of any ideology, any religion, any cult, and any politic, all are man-made and reflect decisions made over years by individuals toward their own ends, even if these aspirations are socially tolerable or 'good', they are man-made, man-acted and man-responsible.

My payslip as an ST5 junior doctor (registrar with 7 years NHS experience) w/adjustment for 80% less than full time.

£24.46 p/h basic rate

After all deductions £2850 per month,
£712.50 a week, or £21 hr (this includes accounting for enhanced rate on nights/weekends, additions) £24 is more than average, but so is the work, training, and responsibility. I am asking for a 35% increase in this pay to reflect the amount I would have earned 15 years ago. The work has gotten harder, but the pay reduced in real terms.

TLDR: Midazolam is a commonly used palliative (end-of-life) drug that can help with agitation and anxiety. Its use increasing during covid, where a lot of people sadly lost their lives in a horrible way, is easily explained by its indications of use. No conspiracy here. Dying of covid is a horrible way to go. I have used midazolam with patients at the end of life, dying in all manners of ways. Recognising that switching care to palliation is a hugely valuable, if not easy, decision to make. It makes passing less horrifying for people.

Quick dismissals of antipsychiatry tropes, a thread;

1/x 1) You are pathologising human experience.

Human experience includes things that define illness, and illness is a human experience. There are experiences that deviate from normal physiological or psychological processes within or outside of appropriate contexts.

Because it would be incorrect and this was shown long ago by Freud, Kraepelin, Klein and almost every other respected name across allied mental health disciplines. Revisionism of established illness isn't clever or helpful, its ideological armchair ignorance. Further names that lend to the development of understanding and treatment across all fields that agree on the core perspectives:

Jaspers, Bateman, Winnicott, Bion, Schneider, McWilliams, jung, laing, adler, Nietzsche, kierkegaard.

After six weeks of the most severe depressive relapse I have had, and almost a year of worsening symptoms, I have learned a few lessons that I hope can help others. I will be quite general here:

thread/x 1) Ensuring your basic needs are met is essential to developing both resilience to challenge and a support network for when things get tough This means eat, sleeping, social support, hygiene, and housing.

Narcissism: explanation thread

Trigger warnings: narcissism, symptoms.

This thread explores the concept of narcissism, its role in mental disorders, and addresses misunderstandings around it. This includes stigma.

As always, subjective understanding may differ.

please #rt Before we go forward it is helpful to separate ‘narcissism’ – a set of defences, thoughts, and behaviors, from ‘narcissistic personality disorder’ – a diagnosis based on the enduring and overwhelming effect of this on daily life.

#PTSD: explanation thread.

Trigger Warning: PTSD/trauma/symptoms/discussion of threat/sexual abuse

Omitted: complex PTSD, adjustment reactions, panic disorder, depression.

Please read and #retweet

1/x This thread is an attempt to explain the cause, symptoms and treatment of post-traumatic stress disorder. As always, some understandings are subjective and may not represent everybody’s experience. I do my best here, but disagreement is helpful.

BORDERLINE/EMOTIONALLY UNSTABLE PERSONALITY DISORDER THREAD

I hope to cover and explain this diagnosis using a range of sources and explanations, some of which will have a personal understanding to the terms. If you feel I have missed anything, please add your thoughts.

1/ Definition: The major definitions of EUPD/BPD come from either the Diagnostic Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD.) They overlap considerably, so the DSM's BPD can be closely understood as ICD EUPD.

I guess im not the cool doctor today. Cannabis is not uniformly safe, cool or indeed, as woo-woo instagram people would suggest, alternative medicine. Its a chemical designed to elevate dopamine and the plant is bred to increase potency. Its just as natural as aspirin. It doesnt matter if you smoke it or bake it into something, the THC is still risky and is linked to psychosis amongst other issues. For most people its fine, but for a small subset it can destroy their lives, especially when unregulated.

Cannabis is linked to psychosis, and can bring the onset of schizophrenic illness by many years. High THC potency is a market direction of high risk, and that is a dangerous trend. Thats what we are seeing for years.

https://twitter.com/EveSimmns/status/1543262601517289473

Many of my patients use cannabis, then relapse in illness. Its never as simple as "this directly caused this" or indeed, CBD is fine vs THC is bad, but if you trust your dealer to prioritise your safety over profit, know the risks.

Seems that there is finally a concensus opinion on the small group of anti-psych trolls abusing various professionals. It is not patient advocacy, it is harassment and abuse dressed up as virtue. We stand with harmed patients and those seeking better outcomes, but not for cruelty Tldr

: psych drugs are imperfect, but they are tightly regulated, used within a wider holistic management process and reviewed regularly
: ect saves lives, and there is little data to support hyperbolic claims against it. Still, it is sensibly a last resort.

Truths from #mentalhealth

The voice who says 'I must be right, I must be heard, I must..' comes from a place where one never felt powerful. The drive to power is not always one of greatness. One cannot bury the past in trophies or acclaim.

From a fundamental standpoint, Boris acts not like a suspect, but the judge, jury and executioner.

He is not above the law. In all cases, he sees himself as an exception. It is not for him to be ruled or held back, he has known nothing but his own truth of entitlement. Rules are for his subjects, and the world belongs to him. He sees it only as his servant, and his errors are our failure, not his.

Lets open this up to debate

Lockdowns reduced spread of covid and deaths.

Emma: I disagree
Ben: I agree

https://twitter.com/emmakennytv/status/1482986433442889730

I present to you part 1 of my argument, peer-reviewed science.

bmj.com/content/375/bm…

Train thought;

With regard to psychiatric diagnosis, such aetiological parameters of illness may be so diverse that any categorisation can only be referred to as a working model, enough to indicate a sphere of treatment but ultimately nothing wholly prescriptive or curative... from outside the individual, defined in distance by its relative reductionism.

From a darwinian standpoint we can deduce a subset of approximately homogenous approaches, later defined as psychostasis, defences or, in extremis, psychosis, that by inheritance derive survival..

An examination of anxiety;

Anxiety, as most we experience it, is an unpleasant feeling of pressure related to some potential, threatening event. And yet, when considered on merit, the event is often so unrealistic that the anxiety is considered bizarre, even embarrassing. The original Freudian ideas, which are now extrapolated and refined toward diagnostic categories such as #generalisedanxietydisorder and #phobias, evolved to explain an incongruence between physical and emotional symptoms, and their target or explanation.

The Pearson Paradox: How such fundamental stupidity is rewarded. BECAUSE IT KILLS VULNERABLE PEOPLE YOU MORON. BECAUSE IT IS UNPREDICTABLE AND YOUNG PEOPLE DIE. BECAUSE YOUR CHANCE OF DYING IS HUGELY REDUCED BY HAVING A VACCINE. BECAUSE FFS SOME PEOPLE ACTUALLY CARE ABOUT OTHERS.