Summer 2013.pub - Bipolar Scotland

ON THE LEVEL
Issue 66
IN THIS ISSUE…
Update
p.2
Chief Executive’s Corner
Annual Conference
Pru on Scotland Tonight
Regional Roundup
p.4-5
News from the Support Groups
Fundraising Skydive
Features
p.6-7
p.8-11
p.12-13
p.14-15
p.16-17
p.18-23
p.24-27
Dr Danny Smith—Rapid Cycling
Bipolar
Cairn Trust Q. & A.
The Side Effects of Side Effects
Flu in pregnancy
Lesley’s Diary
Alastair Campbell: I feel for
Stephen Fry
Psychiatrists under fire in
mental health battle
SRN 1-day workshops
Pendulum
Medical Assessments—Advice
from Chris White
What was the truth about the
madness of George III
Holidays—a blog from Charlotte
Walker
Research news from the
Beating Bipolar Research
Network
Your sweet tooth more sensitive
with depression
And Finally ................
2013
Welcome to the summer
edition
of
On
the
Level.............
This issue is a bumper 28 pages mostly
because there has been so much news
around bipolar recently. The Stephen Fry
admission that he had attempted suicide last
year once again brought the spotlight on to
the condition and a couple of articles in this
edition were written as a direct result of the
media attention following on from this.
Our annual conference will take place in
Glasgow on 14th September and following
on from this will be our third Scottish Bipolar
Awareness Week which will run until 20th
September. This is our chance to raise
awareness in Scotland of the condition and
the support that is on offer from Bipolar
Scotland.
We look forward to seeing as many of you as
possible at the conference and to having the
opportunity of catching up with friends old
and new.
First fundraising charity
lunch
Menzies Hotel, Glasgow
Friday 4th October 2013
12.30pm-3pm
Tickets £35
entertainment ● raffle
Contact the office for information and
tickets
Update 1
CHIEF EXECUTIVE’S CORNER
Welcome to our bumper summer issue of On the Level – an
unprecedented 28 pages, and we’ve still had to leave items for next time.
Some summer reading for you when you’re escaping the Scottish rain.
Or take it with you if you’re lucky enough to be heading off on holiday and
send us a photograph of your travels with our magazine. Please also let us know your
thoughts on any of the articles.
There has been a lot going on since the last issue. I think my highlight of the last couple of
months has to be going to the STV studios with Pru Davies to film Scotland Tonight – it was
fascinating to see what happens. I’m just glad I wasn’t being filmed – Pru did a fabulous
job.
What has been going on? Well, we’ve been busy behind the scenes planning for Scottish
Bipolar Awareness Week and beyond. This year we have been granted a parliamentary
reception so we will be showcasing our self management programme to MSPs, clinicians,
funders and others who may be interested in commissioning this training to enable us to
widen the reach of the programme. We will be running some bus advertising again, and will
also be targeting social venues. So look out in September for our posters in a pub toilet
near you!
We are delighted to have two people raising funds for us - Danielle Mavin is doing a skydive
(brave girl), and the sister of Christine Young has raised an amazing sum – over £1500- by
holding a ladies afternoon with an auction in memory of Christine. If you would like to
sponsor Danielle or indeed would like to raise funds yourself please visit our JustGiving
page at http://www.justgiving.com/bipolarscotland.
We have new regular contributions from Cairn Legal Trust – if you have any legal questions
please send them in to the office. If your question is a personal one, then we can direct you
to Nicola and Sophie at Cairn Legal who will be happy to speak to you. If they can’t help,
they will know someone who can.
I am very excited to report that I have just booked our first ever charity fund raising event.
This will be a lunch in the Menzies Hotel, Glasgow on Friday 4th October at 12.30pm. At the
moment this is very much a “stop press”. There will be top class entertainment, lunch and
a glass of bubbly. And a great raffle (if you know anyone who could donate prizes please
ask them)! We’re hoping this will be a huge success – what better than a chance to dress
up and support a good cause at the same time? Tickets will be £35 and available from the
end of July. Do you know a business who would like to take a table which seats 10? Or
some seats at a table? Hopefully interest will be high – I happened to mention it to a friend
the day I booked it and she immediately booked four places, so the interest is there. Let’s
work together and spread the word – it’s a great way to raise awareness, especially if we
can get businesses involved.
Have a great summer – stay dry! I’m heading off on my summer holiday to Majorca this
year, and I’m looking forward to some relaxation time. I was looking forward to the all
inclusive food and drink until I was diagnosed with gall stones recently and have to avoid
most enjoyable foods! By the time of the conference I will have had my gall bladder
removed, so I’ll be able to enjoy the bacon rolls and cream scones with the rest of you!
Alison
2
Update 2
If you haven’t booked a place at this year’s conference yet, you’ll
find a booking form with this edition. Get your form in to the office
as soon as possible as we only have 100 places and more than half
of these have already been booked in response to the flyer we sent
out with our spring issue. If you’ve already booked by phone or email there’s no need to send a booking form. Confirmation of your
booking will be sent out approximately 3 weeks before the date of
the conference along with directions to the venue.
This year there will be a chance for everyone to attend 2 workshops of their choice and
these can be booked on the day of the conference. Registration is from 9.30am onwards
and as the workshop places will be allocated on a first come, first served basis, it’s
advisable to get there as early as possible.
If you’re not sure if you’ve already booked or you want more information on the booking
procedure, phone or e-mail the office and we’ll do our best to help you. All details are as
always on the back page of this issue.
Following Stephen Fry’s disclosure that he had attempted suicide last
year , bipolar disorder was once again thrust into the spotlight. Fry,
who made the award winning documentary The Secret Life of the Manic
Depressive is very open about his struggle with bipolar and has done
much to raise awareness of the condition.
Shortly after this story broke in the media, we were contacted by
Scottish Television who were looking for someone who would be willing
to appear on their Scotland Tonight programme that same night as they
intended to cover the story and to highlight bipolar.
Pru in makeup before
her appearance on
Scotland Tonight
Step forward Pru Davies—our very own media personality. Pru is a
director with Bipolar Scotland and has many years experience of living
with bipolar. She is also a media volunteer with the “see me” anti stigma campaign and has
spoken very eloquently on several occasions about her own personal struggle with the
condition. What a star she was and many people phoned the office to say how impressed
they were with her contribution.
Dr Danny Smith spoke from a clinician’s perspective and gave a comprehensive account of
bipolar disorder and its treatment. Most of you will know Dr Smith from the articles he has
written for On the Level and his current piece on Rapid Cycling Bipolar can be found on
page 6 of this issue. Dr Smith is also one of the speakers at our forthcoming conference in
September.
It’s sad that it takes something like a personal statement from a media celebrity to raise
awareness of mental health problems. As Pru said on Scotland Tonight “people talk about
arthritis, diabetes and even cancer, but mention mental health problems and it’s like—eek,
don’t talk about that!!”
So hats off to everyone who contributed to the programme and especially to Pru for her
bravery and her honesty when talking about her personal struggle with bipolar disorder.
3
Regional Roundup
NEWS FROM THE SUPPORT GROUPS
Aberdeen: Last Thursday of the month, 7pm – 9pm, Midstocket Church Community Centre,
35 Midstocket Road, Aberdeen, AB15 5JL. At their May meeting, the group had a talk on
Mindfulness delivered by Dr David McCurty and Dr Graeme Nixon.
Ayr: Third Monday of every month, 7pm – 9pm, Riverside Church, John Street, Ayr, KA8
0BS. The group are in the process of making arrangements for future guest speakers.
Borders: Second Monday of each month, 5.30pm – 7pm. There will be no meeting in July,
so the next meeting will be held on Monday 12 August. Also the group are moving
premises. From August meetings will be held in Suite 2, 6 Island Street, Galashiels, TD1
2JW.
Dumfries: Second Tuesday of the month, 2pm – 4pm at Kaleidoscope, Bankend Road,
Dumfries, DG1 4AL. The group are in the process of arranging speakers for future
meetings.
East Kilbride: Third Tuesday of the month, 7pm – 9pm, Calderwood Hall, Blackbraes Road,
East Kilbride, G74 3JT. The group are in the process of arranging speakers for future
meetings.
East Lothian: Third Monday of the month, 6.30pm – 8.30pm, Tynepark Resource Centre,
Poldrate, Haddington, EH41 4DA.
East Renfrewshire: Fourth Wednesday of the month, 6.30pm – 8pm. Please note that the
East Renfrewshire group are now meeting at a new venue, Orchardhill Parish Church, 12
Church Road, Giffnock, G46 6JR. The group have had a recent talk from Dr Ross White on
Acceptance and Commitment Therapy. For their August meeting, the guest speaker will be
Jacqueline McTaggart, Mental Health Research Nurse, University of Glasgow.
Fife: Second Tuesday of the month, 7pm – 9pm, Express Group, 110 Rosslyn Street,
Kirkcaldy, KY1 3AD. The Fife group also have their own website on
www.fifebipolargroup.org
Glasgow: Second and fourth Monday of the month, 7.30pm – 9.15pm, at the Charlie Reid
Centre, Elmbank Street, Glasgow, G2 4PB. Due to increasing numbers of people attending
the meetings, the group are looking at the possibility of moving to a different meeting
place. If you are thinking of attending any future meetings please refer to the Bipolar
Scotland website (www.bipolarscotland.org.uk), or contact the office (0141 560 2050) to
confirm the address for the meeting.
Inverclyde: Third Thursday of the month, 6.30pm – 8.30pm, Craigend Resource Centre,
McLeod Street, Greenock, PA15 2HD.
Inverness: Contact Cairdeas Cottage on 01463 713928 for information on group meetings.
Lothian: First Thursday of the month, 7pm -9pm, Quaker Meeting House, 7 Victoria
Terrace, Edinburgh, EH1 2JL. Further information on group meetings can be found on the
Lothian group website, www.lothianbipolargroup.org.uk/
4
Regional Roundup
Orkney: A group now meet in Orkney. For further information please contact Fiona Tully on
01856 852110 or e-mail [email protected]
Stirling: Second Wednesday of the month, 7pm – 9pm, Allan Park Hotel, Allan Park,
Stirling, FK8 2QG. The group is open to people who experience bipolar disorder, carers
and friends. At their May meeting the group had a very interesting talk on employability.
West Lothian: A new group will be meeting on 2nd Thursday of the month, 7pm – 9pm,
Bathgate Partnership Centre, South Bridge Street, Bathgate, EH48 1TS. The first meeting
will be held on Thursday 11 July.
For updated information on
www.bipolarscotland.org.uk
self
help
groups
please
check
on
our
website
Scientists have identified a group of patients with a genetic predisposition
to mental illness, opening up for the first time the prospect of personalised
medicine in psychiatry, according to a recent article in the Independent.
Personalised medicine involves identifying groups of patients whose
genes make them susceptible to certain diseases and responsive to
certain drugs.
Researchers from University College, London (UCL) studied 1,000 patients with bipolar
disorder and found 1.7 per cent carried a mutation in an important brain receptor gene
putting them at increased risk of the disease.
The findings suggest the patients with the mutation, called GRM3, could be treated with
existing drugs which are not currently used for bipolar disorder.
Hugh Gurling, a molecular psychiatry professor at UCL, who led the study published in
JAMA Psychiatry, said many different genes were involved in causing bipolar disorder.
These were the first mutations increasing susceptibility to the illness to be identified.
Examining the underlying genetics of the disease enabled psychiatrists to predict who
would respond to different drugs. Two drugs trialled for schizophrenia and anxiety
disorder could be effective in bipolar disorder, Professor Gurling said.
FUNDRAISING SKYDIVE
Danielle Mavin will be doing a skydive on 19 July to raise funds for
Bipolar Scotland. Danielle's mother was diagnosed with bipolar
disorder 5 years ago and Danielle wants to raise funds for Bipolar
Scotland in recognition of the help that we have given to her
mother.
If you would like to make a donation to Danielle's skydive please go to her Just Giving page
at
www.justgiving.com/bipolarscotland and click on Danielle Mavin
5
Features 1
Dr. Danny Smith, Reader in Psychiatry at the University of Glasgow is one
of Bipolar Scotland’s medical advisors and writes regularly for On the
Level. For this edition he has chosen rapid-cycling bipolar disorder as
his topic.
RapidRapid-cycling bipolar disorder
The American politician Donald Rumsfeld once famously (and a little confusingly) said:
“There are known knowns. These are things we know that we know. There are known
unknowns. That is to say, there are things that we know we don't know. But there are also
unknown unknowns. There are things we don't know we don't know.” I thought of this
quote when I started to write this article because I think rapid cycling bipolar disorder is
one of the most unclear and most uncertain areas of mental health diagnosis.
Rapid cycling bipolar disorder is a term within the US-based ‘DSM’ diagnostic system but,
interestingly, is not featured within the World Health Organisation’s ‘ICD’ system, which
most British psychiatrists use. Despite this, it is a term that many British psychiatrists use
within their clinical practice. Strictly speaking, it does not refer to rapid changes in mood
on a day-to-day or an hour-to-hour basis but rather describes the presence of four or more
discrete mood episodes (depression, hypomania and/or mania) occurring during a oneyear period.
Ever since rapid cycling bipolar disorder was first described back in 1974, it has been a
somewhat controversial diagnosis. For example, we have no clear idea about what
proportion of people with bipolar disorder will satisfy the DSM diagnostic criteria at some
point during their lifetime and how stable this diagnosis is over time. Having said this, for
those who do satisfy the criteria, we know that the long-term course of their illness may be
more complicated. Studies have found that rapid cycling bipolar disorder is associated
with longer illness duration, greater illness severity, greater difficulty with social and
occupational functioning, more alcohol use disorders and perhaps a higher risk for suicide
attempts.
The greatest area of uncertainty is how best to treat people who have a rapid cycling
course of bipolar disorder. It used to be thought that anticonvulsant medications such as
carbamazepine were the most effective and that lithium was relatively ineffective but more
recent research suggests that this isn’t the case. In fact, it appears that lithium is just as
effective for rapid cycling bipolar disorder as carbamazepine and sodium valproate
(although the magnitude of the therapeutic effect for all three of these medications is not
as impressive for rapid cycling bipolar disorder as it is for non-rapid cycling bipolar
disorder). Similarly, there has been a view in the past that antidepressants might
significantly destabilize the long-term course of rapid-cycling bipolar disorder but this
assertion is far from clear-cut.
In the future, there is a need for more research on rapid cycling bipolar disorder and
particularly clinical trials aimed at establishing the best treatment approaches. If we think
of rapid cycling as a marker for a more severe sub-type of bipolar disorder, it would be
reasonable to carry out trials of different combinations medications, for example,
comparing lithium plus carbamazepine to lithium versus quetiapine. We also need large
long-term follow-up studies to assess whether antidepressants are safe treatments for
6
Features 2
rapid cycling bipolar disorder, even when given for brief periods.
In conclusion, what we know for sure about rapid cycling bipolar disorder is that
unfortunately there are a still a large number of ‘known unknowns’ (not to mention
‘unknown unknowns’) and that our best option at present is to think carefully about how
best to tailor medication treatments to an individual’s personal circumstances and of
course combine these treatments with lifestyle, social and psychological approaches for
maximum benefit.
Dr Daniel Smith
University of Glasgow.
Glasgow
Welcome to a new feature in your On the Level. Nicola and
Sophie from Cairn Legal have agreed to answer any legal
queries from Bipolar Scotland members. Our first question
concerns Power of Attorney.
Q. When my son’s low, he doesn’t pay his bills. When he’s high he spends money on
expensive things he doesn’t need. I’m really worried the stress is making his illness worse
so I tried to help by going to the bank to explain but they say I have no authority unless I
have Power of Attorney. How do I get this?
A. In general, a Power of Attorney (POA) is used to plan for situations where you might
become unable to make decisions in future due to illness of injury – on a permanent or
temporary basis. People often assume that important decisions about money, care or
medical treatment could be taken by their ‘next of kin’ but they will have no automatic right
to do so unless they’ve been legally appointed. The way to do this is by granting a Power of
Attorney (POA). In my opinion, every adult should have one.
The key thing to note is that you can’t ‘take out’ a POA for someone else. So, your son
would have to sign the POA at a time when he understands the document he is signing.
It’s perhaps easiest to think of a POA being divided in to two parts – the first being
concerned with welfare and the second with finances and property. Let’s assume your son
decides to appoint you as his Attorney. You would only ever be able to use your welfare
powers if and when he lost the capacity to make these decisions. If and when he gets
better again, he would take back control of his own affairs. The financial powers are a bit
different; they can start immediately or only be triggered on incapacity.
You can appoint joint and/or substitute attorneys and the document can be revoked at any
time (as long as you have the capacity to do so).
It’s worth bearing in mind that if you lose capacity and you haven’t granted a POA, you will
have far less control over who may be appointed to manage your affairs.
Sophie Dobson, Cairn Legal, www.cairnlegal.co.uk
If you have a question you’d like Sophie or Nicola to answer send them by post to the BS
office at the usual address (all details on back page of this issue) or ee-mail your question to
[email protected] and mark the heading “Cairn Legal”
7
Features 3
Fiona Watson, whose partner David has an on line film blog
called Shadowplay wrote the following
article about the
representation of mental ill health in films. Fiona, who was
recently diagnosed with bipolar is herself a screen writer and has
kindly allowed us to reproduce her article. Her article first
appeared following the release of the recent film Side Effects.
The Side Effects Of Side Effects
David had asked me in my (in)capacity as a sufferer of mental illness, (specifically mixed
state bipolar disorder) to write something about Side Effects, but it turned into something a
bit bigger. The subject of the presentation of mental health issues in film is vast and is
probably more suited to a dissertation than a blog piece, so please forgive me for the
rather fragmentary, scattershot feel to this piece.
Let’s get something straight first. I like Steven Soderbergh films. I like them very much. I
liked his pandemic opus where Gwyneth Paltrow gets the top of her head sawn off. Who
wouldn’t? I liked his female mixed martial artist actioner starring Gina Carrano, a woman
who can actually do all the amazing things her character’s required to do, including
kicking the crap out of then murderizing the ubiquitous Michael Fassbender. Nice. I’m
chomping on my specially rhinestone-encrusted bit to see his HBO Liberace biopic, Behind
The Candelabra. But oh, Steven Soderbergh, did your swan song from cinema have to be
Side Effects?
I always become infused with excitement and hope when someone makes a film tackling
mental illness. It’s a subject close to my malfunctioning brain and heart. I had my first
depressive episode in 1994. Since then I’ve had recurrent visits from The Black Dog. Many
years can go by when I’m perfectly fine. Then The Dog rears its ugly head, eyes blazing
and seizes me in its slavering jaws, tossing me around like a rag doll. Trust me. I’m well
qualified to talk about this subject but I don’t recommend it as a lifestyle choice.
And so I turn my expert eye on Side Effects. My excitement is always tempered with
concern. Have they got it right? The answer is that for half of this film’s running time, they
do get it right, before (SPOILER ALERT) the thing devolves into Basic Instinct with
psychiatrists and lesbians and lesbian psychiatrists. Now to be fair, it’s not Steven
Soderbergh’s fault he didn’t make the film I wanted to see, a serious study of psychiatric
disorder and its treatment in the modern world. What we have instead is a twisty turny
thriller. Nothing wrong with that and it delivers very well. Rooney Mara, an utterly fabulous
and compelling actress, is great, and her low-key, low affect, unshowy performance is
commendable. She nails the deadening, wading through molasses physicality of
depression perfectly.
But the big surprise is how good Jude Law is. What is particularly impressive about his
psychiatrist character is his ambiguity. Apparently this doesn’t play well with test
audiences. ‘Is he good? Is he bad? Is he both? I can’t handle both!’ Catherine Zeta Jones is
also very effective as the other psychiatrist. As the whole world must know by now, CZJ
has Bipolar II. It’s my belief she never would have revealed her mental health status had it
not been on the verge of being leaked to the press. So she made the announcement herself
in a pre-emptive strike. In fact she recently gave an interview where she pronounced
herself fed up with being the Bipolar Poster Girl du jour, and who can blame her given the
circumstances behind it being made public?
8
Features 4
On the whole, I enjoyed the film but left feeling short-changed. The trouble is — major
spoiler alert — plot twists reveal that nothing that happens in the film happens due to
mental illness, drug side effects, or the pharmaceutical industry. The first half sets us up to
think about these issues, but the second half negates them. The Black Dog is a Red
Herring. And while the film performs its narrative tricks well, if you do think about the story
afterwards, you will probably come to the conclusion that no real person would embark on
a criminal conspiracy of the kind seen in this film.
There are very few films (in the English language) that tackle the subject of mental illness
head on and with any degree of accuracy. The only film in which I’ve ever seen
psychomotor retardation — where you physically slow down in speech and movement like
a clockwork toy winding down — was Mike Figgis’s Mr Jones which I’ll come back to later.
Nicole Kidman’s turn as Virginia Wolfe in The Hours was laughable. In reality Wolfe would
become so manic she’d dash around the house talking gibberish at high speed,
hallucinating talking birds and her dead mother. When she crashed with depression she
was basically catatonic and took to her bed for weeks on end. All I could see was an actor
moping around in a prosthetic nose. Not good enough. She didn’t even give us the
monotone voice that comes with psychomotor retardation. I haven’t read the book so I
have no idea if there’s a more accurate representation there and it’s the adaptation that’s
at fault. The world is crying out for a full and accurate Wolfe biopic, with all the highs and
lows laid bare.
And speaking of ‘real life’ characters, what about the largely negative critical reaction to
Keira Knightly’s performance as Sabina Speilrein in A Dangerous Method? The emphasis
was solely on The Chin. The Chin was jutting out at a weird angle. The Chin seemed to have
a life of its own, wandering about in a carefree fashion. What would The Chin do next?
Almost everyone agreed that Keira and The Chin were over the top. What those journalists
didn’t know was that Spielrein’s behaviour was one hundred times more weird and
unpredictable than the few hysterical tics Cronenberg had decided upon. Maybe
sometimes it’s necessary to edit the truth.
One recent film that gives us the highs but edits the lows of
bipolar disorder is Silver Linings Playbook. It’s great on mania but
it barely touches on depression. I put it to you that the reason for
this is that no audience wants to pay to see Bradley Cooper and
Jennifer Lawrence sobbing inconsolably and so lacking in energy
they can barely lift a fork. And if there was an audience that would, it would be quite select.
It might be more palatable if Bradley Cooper took his shirt off (more than he does already),
ditto Jennifer Lawrence. In fact you could probably model an entire franchise out of
Jennifer Lawrence crying and having difficulty eating her dinner if she was bereft of outer
wear. But I digress. Watching someone being depressed just isn’t entertaining and that’s
the crux of the problem. The reality of mental illness is horrifying and gruelling, and your
average punter wants to be entertained, not bludgeoned over the head with troublesome
‘facts’.
However, one brilliantly conceived scene, a ‘meet cute’ over the dinner table with the
leads swapping pharmacological anecdotes gets a big seal of approval from me. “Gooble
Gobble. Gooble Gobble. One of us. One of us.” (I wonder what my ‘seal of approval’ would
look like? Perhaps a blister pack with a smiley over each compartment.) Later on, Bradley
and Jennifer go to a diner and we have another marvellous scene where she tells him all
9
Features 5
continued from previous page
about her “slut wife” status. In psychiatric parlance, Jen had become ‘hypersexual’ in the
aftermath of her husband’s death. This is a (little discussed) symptom of bipolar disorder.
In the past she would have been labelled as a nymphomaniac. A subject matter that
enormously subtle, uncontroversial film maker Lars Von Trier will be tackling in his next
feature. Hopefully, Lars will be making another appearance later in this article. He will be
arriving by camper van because of his fear of flying so he could show up at any moment. Or
not at all.
Remember back in the mists of three paragraphs ago when I mentioned I’d be back with
something more to say about Mr Jones? Well here I am. And here he is. In all his buff,
manic, silver foxy, highly compromised glory. If ever a film felt like it had been cut to
ribbons to appease queasy producers it’s this one. According to rumour, the producers
of Mr Jones said, “I know this could cut the running time a bit, but
could he be a Manic rather than a Manic Depressive?” All of this
must have been rather depressing for Mr Figgis, because he
does manage to squeeze in the aforementioned psychomotor
retardation – Gere wanders pitifully and very, very slowly
through the city, unable to even wash. He finds himself in a
building which looks like a Music Academy. This building exists in
the past (at least that’s my reading of it) and each room is an echo from decades before.
The sounds become cacophonous. Everything becomes more chaotic. This is a very skillful
evocation of the confusion, sensitivity to noise and horrible nostalgia of manic depression.
Somehow he makes it back to his apartment where Lena Olin and her hair are waiting for
him. He ends up slumped on a stool in a shower, naked and grubby, while an annoyingly
cheerful psychiatric nurse sings at him (“C’mon let’s make a round!”) and hoses him down.
Depression on its own just doesn’t put bums on seats. Richard Gere charging into an
orchestra recital and taking over the conducting DOES. Well a few bums anyway. Mr
Jones was not a great box office success. Realistic depictions of psychiatric suffering just
don’t create revenue. A shame since this is probably Gere’s finest performance to date.
If you want to experience that kind of thing you probably have to look outside of English
language cinema. Or get yourself sectioned. Oh look here comes Lars! He’s just parked
the camper van! “Hi Lars! How’s it hangin’?!” I have yet to see Lars’ Melancholia. Von Trier
and his leading lady Kirsten Dunst have both made their statuses as depressives public.
For someone who’ll happily confess to feeling sympathetic towards Nazis, Von Trier is
surprisingly tight-lipped about the details of his depression and anxiety. What kind of
treatment regime is he on? Does he even have one? Charlotte Gainsbourg has a very
convincing panic attack in Antichrist, which I felt he must have coached her through in
some detail. Perhaps we have to look to Lars for an unexpurgated cinematic
representation of depression, when he’s finished dabbling in hardcore depictions of the
life of a ‘Nymphomaniac,’ a descriptor which no longer exists in the DSM.
Because even in the arthouse sector, mental illness isn’t seen as box office unless you edit
the reality down to something more appealing.
Remember Bipolar Scotland in your will and help our work live on. Future
generations will be eternally grateful.
Apply for our leaflet “Leaving A Legacy”
10
Features 6
Flu in pregnancy 'may raise bipolar risk for baby'
Flu during pregnancy may increase the risk of the unborn child
developing bipolar disorder later in life, research suggests.
The article which appeared on the BBC’s website goes on to say. A study
of 814 expectant women, published in JAMA Psychiatry, showed that
infection made bipolar four times more likely.
The overall risk remained low, but it echoes similar findings linking flu and schizophrenia.
Experts said the risks were small and women should not worry.
Researchers at the Columbia University Medical Center identified a link between the
condition, often diagnosed during late teens and twenties, and experiences in the womb.
In their study looking at people born in the early 1960s, bipolar disorder was nearly four
times as common in people whose mothers caught flu during pregnancy.
The condition affects about one in 100 people. The lead researcher, Prof Alan Brown,
estimated that influenza infection during pregnancy could lead to a 3-4% chance of bipolar
disorder in the resulting children.
However, in the vast majority of cases of bipolar disorder there would no history of flu.
So in the list of things pregnant women have to worry about, how high should it rank?
"I wouldn't say high," Prof Alan Brown told the BBC."The chances are still quite small. I
don't think it should raise alarms for mothers."
He said seasonal flu vaccination, which is advised for pregnant women in many countries,
would reduce the chances of catching flu.
Similar studies have shown a link between flu and schizophrenia
How flu could affect the foetal brain has not been completely explained.
Influenza is not thought to directly affect the foetus, but the mother's immune response to
the virus could affect development.
Dr Fiona Gaughran, lead consultant psychiatrist at South London and Maudsley NHS
Foundation Trust, said: "This highly regarded group of researchers has reported similar
links between schizophrenia and various maternal infections.
"If future work confirms the link reported here, policymakers may need to consider
implications for flu prevention pre-pregnancy, but mothers need not be worried.
"The overall risk of offspring developing bipolar disorder is low, even if one did get flu in
pregnancy."
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Lesley’s diary
Recently I enjoyed a wee jaunt away to celebrate my mum's birthday. I
won't tell you her age as that wouldn't be fair—let's just say it was an
important one which deserved a trip to the Chelsea Flower Show. We both
had a great time but I think I was a bit annoying during the journey as I
suffer from an imaginary condition where I suddenly need the loo as soon
as I realise I won't have access to one for a while. I don't know if it's an
age thing or just a me thing but it's a serious thing. Those of you who have
been on a long coach journey will understand when I say I would rather pee behind a bush
at a lay-by in the middle of a storm in full view of a coach of foreign tourists than use the
chemical toilet on the bus. Especially by day three. Not a chance!
I got up at 5am on day one to get ready for what ended up being a 12 hour journey. I
thought I would have no coffee or drinks therefore avoiding having to get up and publicly
bounce up the aisle to the chemical loo with everyone knowing what I
was about to do. No. This was not going to happen. We arrived at the
pick up point got on the bus and found our seats. Once I was nicely
settled and pulling away I suddenly needed the loo. I knew it would
happen—it always does. I shuffled about in my seat complaining and
moaning as always saying I couldn't last the 3 hours to the first stop.
Oh it was awful. What a drama. My mum is very tolerant.
Three hours later we were at the first motorway service station and I would have ran to the
loo but it was more of a skip and a hop for fearing an accident occurring if I was to move at
any great speed. Now here is the weird thing. Once I am over the initial drama of no toilet
and have finally paid a visit to one my imaginary condition immediately goes away. Once I
am on the road I am OK. It's just the idea of knowing for weeks that I would be subjected to
the possibility of having to use the stinky chemical toilet that's the problem. Once I am
over the initial drama I change completely and become more like a camel. As
soon I had paid a penny it was straight to Costa and not for a fluffy milky
cappuccino, no, I went for a bucket of Americano. Instant diuretic. I loved it
and I knocked it back. Then I bought a diet coke for about £25 to have on the
bus.
I was cured. I didn't even think about the loo. Every stop we made required a
yet another bucket of Americano sometimes taking one on the bus and
spending a huge chunk of my life savings on diet coke. I think some people thought I had a
rucksack under my jacket but I didn't—it was just one of my camel humps. I was fine the
whole way and I smugly watched some poor unfortunate people as they bounced up the
aisle to the dreaded chemical loo.
We had a lovely time at the Chelsea Flower Show, but all too soon it was the
last day. The return journey. I had no orange juice and no coffee in the
morning and no fried breakfast in case it made me thirsty. I got on the bus
feeling thirsty and dehydrated but there was no way I was drinking and as
soon as the bus pulled away I was shuffling about and moaning about being
bursting for the loo. I went through the whole thing again. And I will do again
and again and again. I am sure it's just a me thing and there is probably no
cure for it.
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I have some news. After being unemployed for 18 months I have finally been offered a job
with my local council. I will be working in a day centre for older people. It was a
long slog to get there I had five interviews with them then I think they thought
they better offer me something to make me go away. Some of my interviews
were so bad I still can't believe I had the cheek to show my face again. The
problem was that with so many interviews with the same organisation the same
faces were showing up on the panel and it's hard to sell yourself to someone
who has already rejected you previously.
I was so nervous and out of practice that at one point in an interview I really
wanted to say “Let's just call it a day now and you can have an extra tea
break and I can go home and watch Bargain Hunt”. It really was that bad.
You know the celebrities on Dancing on Ice when they've just done their ice
skating routine and they can't talk for a while because their lips are stuck on
top of their teeth from smiling so much. Well that happened to me. And I
hadn't even been smiling I had on my serious and important face but I was
still finding it hard to speak. I felt the need to apologise so I did. They offered me some
water but my hands were shaking so much that when I put it to my mouth some water
splashed onto my face.
Then I had a dilemma. Did I wipe it away and draw attention to something they possibly
hadn't even noticed or did I carry and try to be nonchalant like it wasn't there. I opted to
carry on but I was so aware of it and I felt like the interview panel were
staring in disbelief at the person who, in my minds eye, was sitting with a
bucket of water poured over her with hair plastered round her face.
It was really starting to annoy me but I felt that I had now left it too long to
wipe it away because if they had noticed it they would wonder why I had left it
there so long. It was terrible. All my energy and concentration went into trying overcome
this incredible desire to touch my face instead of saying why I was perfect for the job.
Eventually I could stand it no more and I wiped it off but by then it was too late it was all
over. A Dear John was to follow. Another one to add to the collection.
But I finally got there and after five attempts I am looking forward to
getting started and working again and trying to be a pillar of the
community and doing my bit for society. I will let you know how it goes in
my next diary. Hopefully I'll be able to get through a working day still able
to speak properly without my lips stuck to my teeth. I'll let you
know.
Lesley
A new way of helping people with serious mental health problems has been welcomed by a
healthcare watchdog.
"Intensive home treatment teams" take the experts to the patient's own home, avoiding a
hospital visit even for some patients who are suicidal.
The Mental Welfare Commission said that, despite initial safety concerns, the scheme is
proving a success.
To hear the report by BBC Scotland's health correspondent Eleanor Bradford go to http://
www.bbc.co.uk/news/uk-scotland-23084517
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The following article appeared in the Independent on 7th June 2013 following
Stephen Fry’s announcement that he had attempted suicide last year.
Alistair Campbell: I feel for Stephen Fry. Nobody
would wish depression on their worst enemy
Having depression is part of who I am, and it always will be
I felt really bad when I met Eric Clapton at a Test match at Lord’s a couple of years ago.
Not bad as in depressed; in fact, I was rather happy. But bad in that since 3 March 1996, I
have always associated Eric Clapton with deep depression, and a desire to match up dead
feelings inside with an external reality – aka a suicidal thought.
It wasn’t his fault. He was his usual brilliant self, delighting thousands in a packed Albert
Hall. It wasn’t my fault either. I was just depressed. Seven out of 10 depressed. I grade my
depressions. Eight and a half is can’t-get-out-of-bed bad. Nine is can’t open my eyes,
dress, shave, brush my teeth. At seven out of 10, with Clapton getting the rest of the crowd
going, I could not hide how low I felt. Conversation was impossible. Other people’s
enjoyment and laughter drove me down. Any attempt to draw me in served only to push me
further away. I recorded in my diary that halfway through I said I was going for a pee, and
went off on my own, hanging around outside. I was “just disengaged, dead inside, and
desperate to get home. It was a real ‘life is a bitch and then you die’ moment”.
That was the moment I thought of when I heard Stephen Fry’s observation that sometimes
he can be laughing and joking as he presents QI and inside he is thinking: “I wish I was
f**king dead.”
I wished I was dead when Eric Clapton did “Layla”. Again, no offence Eric, and I felt
especially bad that it was his concert that was driving me down, he having suffered what I
imagine to be the greatest loss of all, that of a child. But when the depressive downward
spiral hits, there is nothing you can do to stop it, and everything you try just seems to make
it worse.
I knew I shouldn’t have gone, but I also knew that would disappoint friends who had invited
us, and I was already disappointing my partner Fiona who could tell I was mid-plunge. She
thought maybe going out would help. I knew that it wouldn’t, and the moment we left the
house, I longed for the evening to be over. I am often asked by families of depressives if
there is anything they should do to help. Be there for them when it starts, I say. Be there for
them when it is over. Don’t make them do things they don’t want to in between. Don’t tell
them to pull themselves together. Do suggest they get proper professional help. I ignored
that one for many years.
Fiona and I have a rhythm with my depressions now. I tell her it has struck. It helps to tells
someone. She asks what triggered it. I say I don’t know. She suggests I go and see the man
I go to see when I get depressed. I go. Sometimes I take medication – which I hate taking,
but it does help – sometimes I tough it out. Always, I know it won’t be the last time. It is part
of who I am.
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“Real struggle to get out of bed,” I recorded of the morning after the Clapton concert. As
he, his wife and I sat watching the cricket, I thought about telling him about that awful
night, but decided against. I find it hard to describe depression when, as now, I am not
depressed. It is the mental health equivalent of childbirth. You have to forget, or else you
wouldn’t be able to face it again.
I have faced it many times, though for years I drowned it out in drink, and perhaps at other
times crowded it out with work. You hope it helps that you can say to yourself: “You have
been through this before, you can do it again.” But when the moment comes, when you
know that depressive cloud is moving in, and you cannot stave it off, and it is going to enter
your head, your chest, your guts, your legs, your toes, your bones, your teeth and every
fibre of mind and body, it is like the first time all over again. Dead and alive at the same
time.
Stephen Fry said that perhaps if he had children, it might make him less suicidal when in
the depths of a depression. He is probably right. I can’t remember how much I thought of
my children when Clapton was performing, but I know I will have done. They are adults
now, and I know that when they were young it was an unfair burden to place on them, but
they were the only ones whose company could sometimes lift me when I was down.
Yet, of course, some parents do kill themselves. I remember several years ago, a leading
politician telling me a friend had taken his own life, and the politician had harsh words for
this act of “cowardice and cruelty”.
We ended up having a row. “Who are you to say “Depression is the mental health
he was a coward?” Back came the answer. “He
had a good job, a nice house, great wife, two
equivalent of childbirth. You
lovely sons – what did he have to be depressed
have to forget, or else you
about?” We hear it less than we used to, but
hear it we do. Stephen Fry is often called a
wouldn’t be able to face it
national treasure. He is clever, witty, hugely
successful, massively popular. So “what does
again.”
he have to be depressed about?” Nothing. He
just is.
Alistair Campbell
It is to change the attitudes of those who think
“what does Stephen Fry have to be depressed
about?” that the Time to Change campaign
exists. We are a long way from the goal of parity of understanding and treatment of
physical and mental health. You would never say: “What does he have to be cancerous
about, diabetic about, asthmatic about?” That bloody Stephen Fry, always going on about
his rheumatoid arthritis, his club foot, his bronchitis, his Crohn’s disease.
Nobody ever gets blamed for getting physical illness – even when those illnesses do result
from lifestyle choices – so why on earth do we still talk about depression like it is the fault,
and the lifestyle choice, of the depressive? Believe me, nobody who has had it would
choose it for themselves, nor wish it on their worst enemy.
Alistair Campbell is a Time to Change ambassador. He is the author of two books on
mental health, ‘The Happy Depressive’ and ‘All in the Mind’.
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Psychiatrists under fire in mental health battle
The British Psychological Society recently launched an
attack on their rival profession psychiatrists, casting doubt on
biomedical model of mental illness
British psychologists said that current psychiatric diagnoses such as bipolar disorder are
useless. There is no scientific evidence that psychiatric diagnoses such as
schizophrenia and bipolar disorder are valid or useful, according to the leading body
representing Britain's clinical psychologists.
In a groundbreaking move that has already prompted a fierce backlash from psychiatrists,
the British Psychological Society's division of clinical psychology (DCP) recently issued a
statement declaring that, given the lack of evidence, it is time for a "paradigm shift" in how
the issues of mental health are understood. The statement effectively casts doubt on
psychiatry's predominantly biomedical model of mental distress – the idea that people are
suffering from illnesses that are treatable by doctors using drugs. The DCP said its
decision to speak out "reflects fundamental concerns about the development, personal
impact and core assumptions of the (diagnosis) systems", used by psychiatry.
Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the DCP's
statement, said it was unhelpful to see mental health issues as illnesses with biological
causes.
"On the contrary, there is now overwhelming evidence that people break down as a result
of a complex mix of social and psychological circumstances – bereavement and loss,
poverty and discrimination, trauma and abuse," Johnstone said. The provocative
statement by the DCP was timed to come out shortly before the release of DSM-5, the fifth
edition of the American Psychiatry Association's Diagnostic and Statistical Manual of
Mental Disorders.
The manual has been attacked for expanding the range of mental health issues that are
classified as disorders. For example, the fifth edition of the book, the first for two decades,
will classify manifestations of grief, temper tantrums and worrying about physical ill-health
as the mental illnesses of major depressive disorder, disruptive mood dysregulation
disorder and somatic symptom disorder, respectively.
Some of the manual's omissions are just as controversial as the manual's inclusions. The
term "Asperger's disorder" will not appear in the new manual, and instead its symptoms
will come under the newly added "autism spectrum disorder".
The DSM is used in a number of countries to varying degrees. Britain uses an alternative
manual, the International Classification of Diseases(ICD) published by the World Health
Organisation, but the DSM is still hugely influential – and controversial.
The writer Oliver James, who trained as a clinical psychologist, welcomed the DCP's
decision to speak out against psychiatric diagnosis and stressed the need to move away
from a biomedical model of mental distress to one that examined societal and personal
factors.
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Writing in the Observer, James declared: "We need fundamental changes in how our
society is organised to give parents the best chance of meeting the needs of children and
to prevent the amount of adult adversity."
But Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair
of psychological medicine at King's College London, said it was wrong to suggest
psychiatry was focused only on the biological causes of mental distress. He defends the
need to create classification systems for mental disorder.
"A classification system is like a map," Wessely explains. "And just as any map is only
provisional, ready to be changed as the landscape changes, so does classification.”
courtesy of The Observer, Sunday 12th May 2013
This September SRN are running a series of free 1-day workshops, across Scotland, to
develop recovery oriented services. They are particularly interested in engaging with
service users and carers.
Participants, including mental health practitioners, will have the chance to discuss and
learn from each other around the subject of mental health recovery and what best practice
looks like.
Location and dates for the workshops are as follows:
Glasgow:
Aberdeen:
Dundee:
Inverness:
Edinburgh:
2nd and 18th September 2013
4th September 2013
9th September 2013
11th September 2013
16th September 2013
All venues at the above locations are still to be confirmed
Full information about the workshops and the application process can be found at:
http://bit.ly/1brixbk
Pendulum
The new look Pendulum is now available from Bipolar UK and everyone
who requested a copy by e-mail should have this by now. A few members
still want to receive a paper copy of Pendulum and the cost for 4 editions
is £12. For those who have already subscribed to a paper copy and have
paid their £12, please note that this will entitle them to receive the summer
edition (pictured), the autumn and winter editions for this year and the
spring edition for next year. Unfortunately, there was no spring issue for
2013. If you have any queries, please get in touch with the office. All details are as usual
on the back page of this issue.
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Features 13
Medical Assessments
by Chris White
Medical assessments and entitlement to benefit are arguably the most
contentious aspect of the benefit system. Criticism over the fairness of
DWP medical assessment and the role of Atos in medical assessments
is at an all-time high. However, whatever thoughts and opinions you
have, the reality is that if you are claiming benefits because you are not able to work, or
because you have a disability, then you will be expected to go through these medical
assessments.
Whether your assessment is in relation to Employment Support Allowance (ESA); Disability
Living Allowance (DLA); or the new Personal Independence Payments (PIP) the claim will
go through several stages. Firstly, a self-assessment form will need to be completed.
Secondly, there is likely to be a medical assessment interview. Finally, the DWP will make
a decision. If you disagree with the decision you will need to go to appeal and in all
likelihood have to attend a tribunal. Try not to be scared by this, a high percentage of
people go on to win their appeal.
What you want is for the right benefit decision, hopefully sooner rather than after a long
and stressful appeals process. It is important to build a strong case, simply stating that
you have a diagnosis of Bipolar, or any other condition and cannot work; or that you need
help is not good grounds for successfully claiming benefits. Many people with bipolar do
work, and do not have significant care needs. You need to think about how your condition
affects you and why it means you cannot work, or you need support to look after yourself.
When you receive a benefit form it needs to be completed and returned. Forms are not
easy, it might be useful to get help with the form from someone who knows you, but the
person with most insight is usually yourself.
It is important to give yourself time to
complete the forms properly and put some thought into what you want to say before
starting the forms. Don’t put it off or avoid completing the forms, and ask for support from
someone if you need it.
It will help if you consider the following points, and how you include the information on the
forms:•
What benefit is the form about? The form will either be about why you are not able to
work (ESA) or because you have care and mobility needs (DLA or PIP). If the form is
about not being able to work, read through the questions and then consider what is it
about your health condition that means you are unable to work. Similarly, if it is about
your care needs, think about what actual care you need and why that is important.
•
Who gives you support? Include all the support you receive on the form, even if you
need to put in extra pages. The form will generally ask about your G.P; have space to
include a hospital specialist; and space to provide details about anyone else who
provides care or support, possibly a CPN. However, you might receive more support
than this and want to include a support worker, psychologist, or a family member who
provides care and support. Ensure that you provide details about all of this support.
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•
The form will ask about hospital admissions in the last two years and about hospital
outpatient appointments. However, you might not have been in hospital in the last two
years, but have had six admissions in the last 10 years, or it may be that in the last 2
years referral to a Crisis Team or Intensive Home Support Team has helped you stay
out of hospital. If you attend a community mental health team, see a psychiatrist or
another professional, you might not consider this as hospital out-patient
appointments, but, they are out-patient services and important to include on the form.
•
How, What, Why. Consider, how you receive support? What support do you need?
Why is that important? What might happen if you did not have that support?
Self-assessment forms ask a series of more general questions about you and your needs.
Sometimes questions can feel as though they are asking about your physical health, but
think about what they mean in mental health terms and try to give examples in your
answer.
•
A question asking about can you get into or out of bed might sound very physical, but
lots of people experiencing a mental health problem can have problems getting into or
out of bed. “At night I struggle to get into bed, I cannot settle and every noise outside
frightens me, I end up calling my friend in the middle of the night who then spends an
hour trying to help reassure me that everything is okay, last week they had to come
over and spend the night with me because things were that bad”.
•
Think about what happens outside, if you have panic attacks out of doors try and
explain what actually happens. “When I need to go out I feel panicky, I try to put it off.
When I do have to go out I arrange to meet someone or have them go out with me.
Last week, I went out by myself, but got so scared I got lost and forgot where I was
meeting my mum. I ended up just sitting on a park bench crying because I felt
useless”
•
Forms ask about your communications needs, which might not sound as though it
applies to you, but think about how you communicate or hide your feelings. “I can’t
communicate with people and tell them what is going on, I withdraw and bottle things
up, and sometimes things get so bad the only way I can tell people how much I hurt is
by deliberately cutting my arms. When I do cut myself I feel stupid and then try cover
up the fact I did it”.
Putting so much detail into a form can be upsetting, but it does give an accurate picture of
you. If possible, enclose a statement from your doctor or support worker supporting what
you have said. Before posting the form take a copy.
copy
If you do have to attend a medical assessment, read through your copy of the
questionnaire and have someone go along with you. You want the medical assessor to
give an accurate report to the DWP, but this is not always the case and people frequently
feel that the decision is wrong.
If you find yourself in this position try not to feel as though the work you put into the claim
was all for nothing, it is more likely that the DWP made the wrong decision rather than
anything you said. You will however need to appeal the decision and may need to attend a
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continued from previous page
tribunal. At this stage you should definitely get some support. Your local authority advice
time or local CAB will be able to provide representation. Make an appointment as soon as
possible and give them copies of everything you have sent to, and received from, the DWP.
Remember,
Remember a high proportion of tribunals are successful. If you do feel that the decision
made by the DWP is affecting your mental health, tell someone about it so they can give
you the extra support you may need.
Chris White
What was the truth about the madness of George
III?
Modern medicine may help us to discover the real reasons behind
King George III's erratic behaviour, writes historian Lucy Worsley.
George III is well known in children's history books for being the "mad king who lost
America".
In recent years, though, it has become fashionable among historians to put his "madness"
down to the physical, genetic blood disorder called porphyria. Its symptoms include aches
and pains, as well as blue urine.
The theory formed the basis of a long-running play by Alan Bennett, The Madness of
George III, which was later adapted for film starring Nigel Hawthorne in the title role.
However, a new research project based at St George's Hospital, Tooting, has concluded
that George III did actually suffer from mental illness after all.
Using the evidence of thousands of George III's own handwritten letters, Dr Peter Garrard
and Dr Vassiliki Rentoumi have been analysing his use of language. They have discovered
that during his episodes of illness, his sentences were much longer than when he was well.
A sentence containing 400 words and eight verbs was not unusual. George III, when ill,
often repeated himself, and at the same time his vocabulary became much more complex,
creative and colourful.
These are features that can be seen today in the writing and speech of patients
experiencing the manic phase of psychiatric illnesses such as bipolar disorder.
Mania, or harmful euphoria, is at one end of a spectrum of mood disorders, with sadness,
or depression, at the other. George's being in a manic state would also match
contemporary descriptions of his illness by witnesses.
They spoke of his "incessant loquacity" and his habit of talking until the foam ran out of his
mouth. Sometimes he suffered from convulsions, and his pages had to sit on him to keep
him safe on the floor.
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The researchers have even thrown doubt on one of the key planks in the case for
porphyria, the blue urine. George III's medical records show that the king was given
medicine based on gentian. This plant, with its deep blue flowers, is still used today as a
mild tonic, but may turn the urine blue. So maybe it wasn't the king's "madness" that
caused his most famous symptom. It could have simply been his medicine.
George III's recurring bouts of illness caused him to withdraw from daily business to
recuperate out of the public eye at secluded Kew Palace, near Richmond.
Each time he withdrew to Kew, this triggered a crisis - who was to make decisions in his
absence?
His son, the Prince of Wales, with whom George III had a terrible relationship, wanted to be
appointed regent, and to act as the king in everything but name. But the future George IV
was very much associated with the political opposition, and the government was
determined to keep him out.
Strikingly, although the crisis caused a good deal of arguing, it was in fact resolved quite
easily. This was partly because the king just got better (despite the bizarre and sometimes
inhumane treatments given to him by the royal doctors) and partly because he was, by this
stage in British history, a constitutional king.
When the Hanoverians had been invited over from Germany in 1714 to take the throne after
the failure of the Stuart line, they came at the invitation of Parliament. Parliament therefore
held the whip hand over them, and the powers of the monarchy declined.
But despite his illness, George III was a dedicated and diligent king, and won the respect
of his politicians. In fact, when his illness drove him off the political scene, they realised
how much they needed his calming effect on their squabbles.
It is counter-intuitive to suggest it, but royal health issues can actually strengthen the
monarchy, not least by creating sympathy and affection for an afflicted individual.
Garrard also points out how the explanations or diagnoses that we come up with for
patients in the past reflect our own current attitudes to sickness and health. One of the
reasons that the porphyria argument caught on is because it seemed to remove the
supposed stigma of mental health issues from the Royal Family.
And yet, as Garrard notes, porphyria opened up a different set of problems, because as an
hereditable illness, George IV, and indeed other members of the Royal Family, became
candidates for diagnosis too.
The research project still continues, but Garrard is already confident of one thing. "The
porphyria theory is completely dead in the water. This was a psychiatric illness."
But it certainly did not stop George III from being a successful king. In a prosperous,
industrialising Britain, it was growing more important for a monarch to reign rather than
rule, providing background stability rather than aggressive leadership.
With his 60-year reign, George III certainly provided continuity, and I believe that his short
episodes of illness tend unfairly to diminish our views of him.
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Holidays are supposed to be a time for relaxation, but not for
Charlotte Walker, a mother and blogger with bipolar disorder.
She values the opportunity to spend time with her children, but
fears that a change from her routine may mess up the mental
stability she works hard to achieve.
My children live with me only at weekends; our time together is precious. My 15-year-old
son and my daughter, who is 13, make the two-hour journey to my home in London after
school each Friday and are gone, almost before I know it, by Sunday afternoon.
It's not common after a marital split for the dad to be the primary carer, but there's a good
reason why I, the mum, am the weekend parent in my children's lives - it's called bipolar
disorder.
After agonising whether it was worse to move my children to be with their father more than
me, or to risk them being affected by my instability on bad days, I concluded that
weekends would work best for us all.
I particularly look forward to bank holiday weekends because I get three days with my
kids, not the usual two. Traditionally we set out, armed with cagoules and optimism, for a
budget break on the coast.
Being by the sea has always given me a boost, and it's great seeing them drop their
electronic devices and jaded teen act in favour of eating fish and chips out of paper or
building a fortress in the sand.
Sometimes bipolar can feel a little like living on a beach, permanently, with waves of
unbearable emotion and panic washing over me. I'm unable to work or parent effectively
for months or even years at a time - then the tide goes out and I feel "normal" for a while,
able to function again.
I was symptom-free for eight great years of my children's lives. But in 2011 the tide swept
back in and I'm only now just getting my head above water, if you'll excuse me using the
holiday metaphor again.
There is no cure for bipolar, but there are ways of managing it.
Once diagnosed, you're bombarded with advice about establishing a routine to help
stabilise your moods. Psychiatrists, therapists, self-help books - everyone recommends
good "sleep hygiene", regular exercise, structured social activities and, above all, taking
your medication daily and on time.
The annoying thing is, the experts are right.
To keep a lid on things, my doctor prescribes a mood stabiliser and an antipsychotic, daily.
They ensure I get to sleep and do a great job of slowing my racing mind down - but at a
price.
Take them too early in the evening and I'll struggle to stay awake for dinner. Take them too
late, and you might not see me again until lunchtime. And I always need at least 10 solid
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hours in bed, otherwise I'll find it hard to care about anything beyond getting back under
the duvet.
Through trial and error, I've gradually got my daily routine down to a fine art and it's been
the key to my stability. "Have you taken your meds, Mum?" is a familiar refrain in my family
because they know how important it is to keep on track.
And then something like a bank holiday comes along and, with it, expectations, and an
urge to go somewhere that will make the whole family happy.
My current partner and I still take the children somewhere they can mess about in rock
pools, though the trips are not as idyllic as holidays past.
Sadly, it seems, a change is no longer as good as a rest.
Travel, getting up for hotel breakfasts, or setting out early on day trips can all disrupt my
medication and sleep. I have phone reminders set to prompt me to take my antipsychotics
at 7.30pm but if I find myself out and about with no drinks on hand, I take them when and
where I can, knowing that I'll sleep in for hours after everyone else the next morning.
My lithium has to be taken just before bed and with food, sometimes leading to hectic
drives round quiet seaside towns looking for a shop that might still be open, and selling
chocolate.
I try very hard not to let my children know how much I struggle. They're pretty clued up
about bipolar, but they're still just kids and I'm still their mum. I don't want them to spend
their weekend worrying about me, so I try to just go with the family flow.
I slope along on cliff-top walks watching everyone get further and further ahead. I pay for
entry to the local museum, but once inside I scan the room, more interested in finding
somewhere to sit than in what's in the glass cases. And I plod my way through dunes,
wondering if anyone would notice if I burrowed my way into the sand and took a nap.
"Come on, Mum!" my daughter might call over her shoulder.
I've always believed my decision to be the weekend parent was not the act of a monster
who doesn't love her children, but a very rational, practical decision that was in the
children's best interests - even if other people's reactions have made me wobble a bit
sometimes.
And so to this weekend. It's taken me a good few weeks to get back on track after our
Easter away in France, but my partner has managed to talk me into a Mayday bank holiday
break in Pembrokeshire.
Of course I'll go because I live in hope that I can recapture some of that old family magic.
Assuming, of course, I can stay awake.
Charlotte Walker blogs as Purple Persuasion
Courtesy of the BBC’s website
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Searching for the future of bipolar diagnosis and
treatment in our genes
By Lee Eynon
The latest research into the causes of mental illness suggests
that as well as providing the blueprint for our bodies, our genes could also be playing a
significant role in how our minds work.
Breakthroughs in cancer research have already shown how important understanding the
genetics and biology behind illnesses can be for diagnosis, prevention and treatment.
People with susceptibilities to particular cancers can now be monitored, and preventative
action taken.
An example would be the recent well-publicised case of actress Angelina Jolie, who
underwent a precautionary double mastectomy after discovering she had the BRCA1
gene, which would otherwise have seriously increased her odds of developing breast
cancer.
A better understanding of genetics has also led to tailor-made therapies for cancer
patients, where genetic tests are used to determine which treatments are most likely to
work for a given individual.
Now, researchers are looking at the genes of people affected by mental illness, with the
aim of developing similar techniques to prevent and treat illnesses like bipolar disorder.
Of course, understanding cancer is not simple, but understanding mental illness is even
more challenging. The brain is the most complicated organ in the body – in fact, some
people say it is the most complicated thing in the universe. And, our mood and thinking are
the most complicated aspects of brain functioning.
Psychiatric genetics is a relatively young field of study, but for people with mental health
conditions it could prove to be life changing.
For the first time, mental health researchers are looking closely at the biological
processes and genetics behind disorders. This is a major change in thinking – previous
research was often limited to studying the symptoms of mental illness. This new way of
thinking provides researchers with the opportunity to understand the underlying causes of
these conditions.
This new biological perspective is already producing significant results that could have a
profound effect on the future of mental health medicine.
Earlier this year, a major international study compared the genetics of 33,000 people
diagnosed with a range of psychiatric disorders to those of 28,000 people without
disorders.
Their findings, published in the Lancet medical journal in February, suggested that people
with five mental illnesses - bipolar disorder, autism, schizophrenia, attention deficit– hyper
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hyperactivity disorder (ADHD) and major depressive disorder - all shared genetic
similarities. This suggests that people who exhibit these particular ‘genetic risk factors’ in
their DNA have a higher susceptibility to a range of mental illnesses.
These findings are making researchers start to think differently about the possible
relationships between psychiatric disorders that have often been thought of as completely
distinct. This may help explain why people often have symptoms of more than one disorder
or get given different diagnoses at different times in their lives.
These findings do not in any way mean that all five disorders are the same. But it does
show that some of the biology underlying the different disorders may be more similar than
had previously been assumed. And that can be very helpful in moving towards better
approaches to diagnosis and treatment that are more tailored to the workings of the brain.
It is important to stress that having these (or any other) risk factors does not guarantee
that a person will develop a mental illness, and it certainly does not mean that an individual
with a diagnosis of bipolar disorder will go on to develop symptoms of schizophrenia.
With regards to bipolar disorder in particular, the new research published in the Lancet
also highlighted the importance of the way that calcium levels are regulated in the brain,
which could be used in treatments and medications in the near future.
One of the leaders of this groundbreaking research is Professor Nick Craddock from
Cardiff University’s National Centre for Mental Health (NCMH) and the UK’s Bipolar
Disorder Research Network.
The professor was recently described by the Lancet as one of the world’s leading
authorities on psychiatric genetics, has acted as a script advisor for television soap East
enders on a storyline depicting bipolar disorder, and worked with Stephen Fry on a BBC
documentary on the illness.
“The results that we are seeing in our research have the potential to revolutionise the way
in which disorders like bipolar are diagnosed and treated,” explains Professor Craddock.
“If we can improve our understanding not only of the nature of mental illness, but also its
root causes, then we stand a far better chance of treating or even preventing the onset of
symptoms.”
But beating mental illness will be far from easy. Discovering these genetic risk factors is
just the beginning. Mental illness is caused by a combination of environmental and
biological factors, and the sheer complexity of the biology involved means that it will be
years before these discoveries lead to new treatments.
However, Professor Craddock is confident that they are coming: “It could take a decade or
two, but in the not-too-distant future, mental health professionals will have a whole new
arsenal of techniques in the battle against mental illness.
As we develop our understanding of genetics and brain function, blood tests and brain
scans could be used alongside to help with diagnosis of mental illness; meanwhile, as
we’re already seeing in cancer treatment, an individual’s genetics could be used to choose
the most effective treatments. ”
continued on next page
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continued from previous page
The key to improving mental health medicine in the future is research, and a great deal of
it. Not only because mental illness is complicated, but also because each patient is
different.
Professor Craddock and the team at the NCMH are building on
previous genetic research with the Bipolar Disorder Research
Network.
The new NCMH study aims to both collect genetic data and record the
experiences of over 6000 volunteers diagnosed with a range of
mental illnesses including bipolar disorder, schizophrenia, post-traumatic stress disorder,
dementia, autism and ADHD.
The NCMH will use this information to create a database that can be used for more studies
on how biological and environmental factors interact to cause mental illness. So far this
ambitious project has recruited over 1300 volunteers from across Wales, including almost
400 with bipolar disorder.
“Every person that takes part is helping us to better understand how mental illness works,
and could potentially help to improve the life of someone affected by it in the future” says
Professor Craddock.
The centre’s activities are not solely focused on genetics. The NCMH is also looking at
brain activity using Magnetic Resonance Imaging, more commonly known as MRI
scanning. This can be used to see how the brain changes in response to medication and
other therapies, or even as a way of treating mental illnesses.
An example of this would be the centre’s research into ‘neurofeedback’ techniques as a
treatment for depression. This study aims to determine whether people can learn to
control their brain function through looking at images of how it changes when they do a
task, such as imagining a positive event.
Research like this can be seen as bridging the gap between studying the symptoms of
disorders and the causes, providing researchers with the opportunity to examine the
relationship between the two.
But despite the promise of advanced technology and a growing body of research into the
biological causes of mental illnesses, Professor Craddock still believes that mental health
medicine should be guided by the needs of the individual patient:
“Diagnosis and treatment of mental health problems should always be centred on the
thoughts, feelings and experiences of the people affected.”
With this approach very much in mind, the NCMH team in collaboration with Dr Danny
Smith of Glasgow University have developed a range of psychoeducation packages for
people with bipolar disorder.
Beating Bipolar, for example, is an interactive web based programme that aims to improve
understanding of the condition (www.beatingbipolar.org). Its free to access, includes a
video of professionals and those with experience of bipolar disorder and discusses various
approaches that many have found to be beneficial.
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“Having a good understanding about bipolar disorder has been shown to be very important
in helping people stay well – we are delighted that Beating Bipolar has been so popular and
we can make it widely available so as many people can benefit as possible” says Dr Ian
Jones of NCMH.
Find out more about the research into Bipolar Disorder and other conditions at the
National Centre for Mental Health, visit www.ncmh.info, follow @walesMHN on Twitter, or
go to facebook.com/walesmentalhealth.
Find out more about the Bipolar Disorder Research Network at www.bdrn.org, and
register for Beating Bipolar at: www.beatingbipolar.org
Lee Eynon is Communications Officer for National Centre for Mental Health/Wales Mental
Health Network
Your Sweet Tooth May Be More Sensitive with Depression
Depression can affect mood, somatic experiences, and emotional
reactions. It can also affect cognitive abilities and behaviors. And a
recent study led by Petra Platte of the Department of Psychology at
the University of Wurzburg in Germany found that mild depression
can even affect taste, as well.
Existing research has suggested that emotional variances and stress can have a
significant impact on taste. However, Platte’s research is the first to examine induced
mood states compared to mild clinical depression and anxiety and to compare how each
emotional state differs with respect to taste sensitivity. For the study, Platte assessed 80
participants before exposing them to videos designed to induce sad, happy, and neutral
moods. After the video exposure, the participants were instructed to taste sour, sweet,
fatty, bitter and savoury things and rate them.
Platte found that the participants all rated the taste stimuli correctly, but those
with depression had higher sensitivity to sweet stimuli. Also, the taste ratings were more
intense for the depressed individuals after all three of the video exposures, suggesting that
regardless of mood induction, a unique taste response exists in people with depression.
Another interesting finding was that participants with depression did not alter their rating
of fatty foods after the mood induction, but were able to distinguish between high-fat and
low-fat foods prior to the video exposure. Anxiety also affected taste perception in that
prior to the mood condition, anxious participants were more sensitive to bitter and sweet
tastes than they were after the mood condition. But the video clips seemed to increase
sensitivity to citric acid for those with anxiety as they reported increases in sensitivity to
these flavours after the mood condition.
Platte believes that these findings are novel in that they demonstrate how even subclinical
levels of anxiety and depression can influence taste and for depression, can even lead to
deficits in fat sensitivity. Platte added, “This deficit may foster unconscious eating of fatty
foods in subclinical mildly depressed populations.”
http://www.goodtherapy.org/blog/sweet-tooth-may-be-more-sensitive-with-depression-0618131
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Blank Slate
Blank slate is intended as a space where staff and members alike contribute pictures, small anecdotes etc.
that don’t fit in anywhere else in the magazine. If you have something you’d like to contribute to On the Level
(maximum 1500 words), call or write to the office, or email to: [email protected] The deadline for
submissions for the next edition is 15th September.
September
CONTRIBUTORS
Alison Cairns, Alan Douglas, Tilda Boyle, Lesley
Houston, Fiona Watson, Dr Danny Smith, Chris
White, Lee Eynon, Sophie Dawson.
On The Level is printed by Cowan Print and
published by:
Bipolar Scotland
Studio 1015, Mile End Mill
Abbey Mill Business Centre
Paisley PA1 1TJ
T: 0141 560 2050
E: [email protected]
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Facebook—Bipolar Scotland
Twitter—@bipolarscotland
Company Number: 163306
Scottish Charity Number: SCO21705
Please Note:
The views and opinions expressed herein are not
necessarily those of Bipolar Scotland.
AND FINALLY. . . . . .
Free admission to our annual conference is one of the advantages of being a member of
Bipolar Scotland. Membership also offers people the chance to take part in our acclaimed
Self Management Training should any courses take place in your area. As soon as we
identify a location for the self management training, we write to all members in the area
offering them the chance to take part in this.
Some of you may find a renewal letter with this edition and we’d urge anyone who hasn’t
yet renewed their membership to do so as soon as possible. People who don’t renew will
have their details removed from our database and no further mailings will be sent out.
You can now renew your membership online using your credit card. Simply go to our
website www.bipolarscotland.org.uk and follow the step by step instructions for payment.
Alternatively, if you don’t have access to the internet, simply give Tilda a ring at the office
on the usual number and she can process this for you over the phone by taking your credit
card details.
So, if you want to keep receiving On the Level, renew your membership now!!!
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